1. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 21 CARDIOVASCULAR SYSTEM

2. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Cardiovascular System CV coding may require codes from: Radiology Medicine Surgery (Cont’d…)

3. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Cardiovascular System (…Cont’d) Radiology: Diagnostic studies Medicine: Nonsurgical and percutaneous Surgery: Open and percutaneous

4. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Cardiology Coding Terminology Invasive: Enters body –Example: Opening chest for removal, tumor on heart or percutaneous placement of catheter in artery Both Medicine and Surgery sections contain invasive procedures (Cont’d…)

5. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 Cardiology Coding Terminology (…Cont’d) Noninvasive: Procedures that do not break skin –Example: Electrocardiogram (Cont’d…)

6. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Cardiology Coding Terminology (…Cont’d) Electrophysiology (EPS): Study of electrical system of heart ―Example: Study of irregular heartbeat (arrhythmia) (Cont’d…)

7. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Cardiology Coding Terminology (…Cont’d) Nuclear Cardiology: Diagnostic and treatment specialty, uses radioactive substances for cardiac conditions Example: MRI

8. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 Cardiovascular in Surgery Section Codes for procedures: –Heart/Pericardium (33010-33999) Pacemakers, valve disorders –Arteries/Veins (34001-37799)

9. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 Heart/Pericardium (33010-33999) Both percutaneous and open procedures Extensive notes throughout Frequent changes with medical advances (Cont’d…)

10. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Heart/Pericardium (33010-33999) (…Cont’d) Examples of Heart/Pericardium subheadings: –Pericardium –Cardiac Tumor –Pacemaker or Cardioverter-Defibrillator

11. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Heart/Pericardium Categories Pericardiocentesis: Percutaneous withdrawal of fluid from pericardial space Excision of Cardiac Tumor: Open surgical procedure for removal of tumor on heart

12. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Pacemaker or Pacing Cardioverter- Defibrillator (33202-33249) Figure: 21.7 A, Single pacemaker insertion. B, Dual chamber pacemaker. C, Biventricular pacemaker. (B from Christensen BL, Kockrow ED: Adult Health Nursing, ed 5, St. Louis, 2006, Mosby.) Devices that assist heart in electrical function (Cont’d…)

13. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Pacemaker or Pacing Cardioverter- Defibrillator (33202-33249) (…Cont’d) Divided by where electrodes (leads) placed, approach, and type of service Pacemaker electrically stimulates myocardium of one or more chambers to contract when heart fails to do so Device can be temporary or permanent (Cont’d…) From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby. Figure: 21.5

14. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Pacemaker or Pacing Cardioverter- Defibrillator (33202-33249) (…Cont’d) Placed: –Atrium (single chamber (uses 1 lead) –Ventricle (single chamber) –Both (dual chamber (uses 2 leads) –Biventricular, both ventricles and right atrium (3 leads) (Cont’d…) From Miller RD, editor: Miller's Anesthesia, ed 6, Philadelphia, 2005, Churchill Livingstone. Figure: 21.6

15. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Pacemaker or Pacing Cardioverter- Defibrillator (33202-33249) (…Cont’d) Approach: –Epicardial: Open procedure to place on heart –Transvenous: Through vein to place in heart (Cont’d…)

16. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 Pacemaker or Pacing Cardioverter- Defibrillator (33202-33249) (…Cont’d) Type of Service –Initial placement or replacement of all or part –Number of leads placed (Cont’d…)

17. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Pacemaker or Pacing Cardioverter- Defibrillator (33202-33249) (…Cont’d) Patient record indicates revision or replacement Usual follow-up period 90 days (global period) Use -78 to indicate return to operating room within global period

18. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Electrophysiologic Operative Procedures (33250-33266) Surgeon repairs defect causing abnormal rhythm Endoscopy Procedure –Without CP Codes based on reason for procedure, approach, and if CP bypass used

19. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 Electrophysiologic Operative Procedures (33250-33266) Chest opened to full view—Incision –Cardiopulmonary (CP) bypass usually used

20. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 Patient-Activated Event Recorder (33282, 33284) Also known as cardiac event recorder or loop recorder Internal surgical implantation required Divided based on device being implanted or removed

21. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 21 Cardiac Valves (33400-33496) Divided on valve and CP bypass: –Aortic –Mitral –Tricuspid –Pulmonary Code descriptions all similar

22. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 22 Coronary Artery Bypass Graft CABG performed for coronary arteries severely clogged (atherosclerosis) (Cont’d…) Figure: 21.8A

23. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 23 Coronary Artery Bypass (…Cont’d) Determine what was used in repair: –Vein (33510-33516) –Artery (33533-33536) –Both artery and vein (33517-33523 and 33533-33536) (Cont’d…) From Monahan FD, Neighbors M: Medical-Surgical Nursing: Foundations for Clinical Practice, ed 2, Philadelphia, 1998, Saunders. Figure: 21.9

24. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 24 Coronary Artery Bypass (…Cont’d) Number of bypass grafts performed and if vein and arterial grafts are used –Example: Three venous grafts

25. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 25 Venous Grafting Only for Coronary Artery Bypass Graft Codes 33510-33516 –Divided based on number of grafts being placed Procurement of saphenous vein included in procedure (not coded separately) when retrieved through open incision Code + 33508 reported separately –Endoscopic, surgical, video-assisted harvest of vein(s) –Add-on code, do not append -51

26. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 26 Arterial Grafting (33533-33536) Divided based on number of grafts Right coronary artery (RCA) has two branches –Right marginal –Right posterior descending (PDA) Left main coronary artery (LMCA) has seven branches 1) Left anterior descending, 2) diagonal, 3) septal, 4) circumflex (LCX), 5) obtuse marginal (OM), 6) posterior descending, 7) posteriolateral (Cont’d…)

27. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 27 Arterial Grafting (…Cont’d) Several codes (33542-33548) for myocardial resection, repair of a ventricular septal defect, and ventricular restoration procedures Obtaining artery for grafting included in codes, except: –Procuring an upper extremity artery (i.e., radial artery), coded separately (35600)

28. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 28 Combined Arterial-Venous Grafting Codes 33517-33523 –Divided based on number of grafts Report combined arterial-venous procedures with two codes: –1) appropriate combined arterial-venous graft code, and –2) appropriate arterial graft code (33533-33536). –The -51 modifier not used with these codes (Cont’d…)

29. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 29 Combined Arterial-Venous Grafting (…Cont’d) Procuring saphenous vein included, if open retrieval Endoscopic harvest is reported with 33508 If reoperation report with 33530 –No -51, add-on codes Never used alone Add-on codes always used with Arterial Grafting codes (33533-33536) Arterial-Venous codes report only venous graft portion of procedure

30. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 30 Endovascular Repair of Descending Thoracic Aorta (33880-33891) Placement prostheses for repair of descending thoracic aorta Synthetic aortic prostheses placed via catheter Less invasive than chest or abdominal incision Report fluoroscopic guidance separately, 75956-75959 Includes diagnostic imaging (pre- and intraoperative) Stent-graft (endoprosthesis) reinforces weakened area

31. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 31 Arteries and Veins Subheading (34001-37799) Only for noncoronary vessels Divided based on whether artery or vein used –Example: Different codes for embolectomy, depending on artery or vein Codes describe excision of acquired thrombus or congenital thrombus of an artery or vein Thrombus, aggregation of blood factors frequently causing vascular obstruction at the point of formation (Cont’d…)

32. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 32 Arteries and Veins (34001-37799) (…Cont’d) Catheters placed into vessels for monitoring, removal, repair Using nonselective or selective catheter placement (Cont’d…) From Roberts JR, Hedges JR, editors: Clinical Procedures in Emergency Medicine, ed 4, Philadelphia, 2004, Saunders. Figure: 21.14

33. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 33 Arteries and Veins (34001-37799) (…Cont’d) Nonselective: Direct placement without further manipulation Selective: Place and then manipulate into further order(s)

34. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 34 Catheter Placement Example Nonselective: 36000, Introduction of needle into vein Selective: 36012, Placement of catheter into second order venous system

35. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 35 Vascular Families Are Like a Tree Main branch—first order (tree trunk) Second order branch (tree limb) Third order branch (tree branch) Appendix L, CPT, Vascular Families –Lists first, second, third, and beyond third order branches –Assumption that starting point is catheterization of aorta

36. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 36 Brachiocephalic Vascular Family Report farthest extent of catheter placement in a vascular family Figure: 21.15

37. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 37 Embolectomy and Thrombectomy (34001-34490) Embolus: Dislodged thrombus Thrombus: Mass of material in vessel, in place of formation Balloon removal: Threaded into vessel, inflated under mass, pulled out with mass

38. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 38 Embolectomy Removal of embolus Figure: 21.16

39. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 39 Venous Reconstruction (34501-34530) Types of repair: –Valve of femoral vein –Vena cava –Saphenopopliteal vein anastomosis

40. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 40 Aneurysm Aneurysm: ballooned or weakened area of vessel To select the correct code, check the operative report for: –Type of prosthesis –Location of aneurysm –Any additional services to facilitate placement of endograft –Whether open artery access was performed, and if so, was conduit created –Whether open repair was required (Cont’d…)

41. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 41 Aneurysm (…Cont’d) Repair by removal, bypass, or coil placement Coil placement: Tiny, flexible, platinum coil pushed into aneurysm and forms “ball” to obstruct blood flow into aneurysm Endovascular repair (34800-34900) from inside vessel Direct (35001-35152) from outside vessel

42. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 42 34800-34834 Extensive notes preceding codes—“must reading” Uses fluoroscopic guidance, report Radiology 75952 or 75953 Includes access, catheter manipulation, balloon angioplasty, stent placement, site closure Other procedures performed at same time are coded separately Verify bundled codes in CCI edits Endovascular Repair of Abdominal Aortic Aneurysm

43. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 43 Endovascular Repair of Iliac Aneurysm (34900) Extensive notes before codes Uses fluoroscopic guidance (75954) Includes positioning, deployment of stent or balloon angioplasty Report separately –Open femoral or iliac artery exposure –Introduction of guidewires or catheters –Extensive artery repair or replacement

44. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 44 Repair Arteriovenous Fistula (35180-35190) Abnormal passage Divided based on fistula type: –Congenital –Acquired/Traumatic –By site

45. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 45 Angioplasty (35450-35476) Open or percutaneous by vessel Transluminal angioplasty: Catheter passed into vessel and stretched –Code per vessel –Stent placement reported separately –Code imaging separately

46. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 46 Noncoronary Bypass Grafts (35500-35671) Divided by: –Vein –In-Situ Veins (veins repaired in their original place) –Other than Vein Coded according to the beginning and ending vessels of the graft and vein used for the graft

47. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 47 Bypass Graft, Vein Code by type of graft and vessels being used to bypass –Example: 35506, Bypass graft, with vein; carotid-subclavian or subclavian-carotid –Graft attached to carotid and to subclavian, bypassing a defect of subclavian

48. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 48 Vascular Injection Procedures (36000-36522) Divided into: –Intravenous –Intra-Arterial—Intra-Aortic –Venous (Cont’d…)

49. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 49 Vascular Injection Procedures (36000-36522) (…Cont’d) Used for many procedures, includes: –Local anesthesia –Introduction of needle –Catheter –Injection of contrast material –Pre- and post-operative care Example: Injection of an opaque substance for venography

50. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 50 Transcatheter Procedures (37184-37216) Arterial mechanical thrombectomy (37184-37186) Removal arterial thrombus by mechanical device Used to report a variety of transcatheter procedures Venous mechanical thrombectomy (37187, 37188) Removal of venous thrombus by means of a mechanical device

51. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 51 Cardiovascular in Medicine Section Services can be: –Invasive or noninvasive –Diagnostic or therapeutic (Cont’d…)

52. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 52 Cardiovascular in Medicine Section (…Cont’d) Subheadings: –Therapeutic Services and Procedures –Cardiography –Implantable and Wearable Cardiac Device Evaluations –Echocardiography (Cont’d…)

53. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 53 CV in Medicine Section (…Cont’d) Cardiac Catheterization Intracardiac Electrophysiologic (EP) Procedures/Studies Peripheral Arterial Disease (PAD) Rehabilitation Noninvasive Physiologic Studies and Procedures Other Procedures

54. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 54 Therapeutic Services (92950-92998) Types of services: –Cardioversion –Infusions –Thrombolysis –Catheter placement (Cont’d…)

55. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 55 Therapeutic Services (92950-92998) (…Cont’d) Many groups of codes are divided by: –Method (e.g., balloon, blade) –Location (e.g., aortic or mitral valve) –Number (e.g., single or multiple vessels)

56. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 56 Cardiography (93000-93278) Types of service: –Stress tests –Holter monitor From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby. Figure: 21.22Figure: 21.24

57. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 57 Cardiography (93000-93278) Electrocardiogram Separate codes for global procedure and components (professional and technical) –See 93000, 93005, 93010

58. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 58 Holter Report Used to identify cardiac arrhythmias Figure: 21.26

59. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 59 Implantable and Wearable Cardiac Device Evaluations (93279-93299) New codes in 2009 Category notes include definitions and instructions Extensive notes

60. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 60 Echocardiography (93303-93352) Noninvasive diagnostic procedure: Ultrasound detects presence of cardiac or vascular disease Figure: 21.27

61. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 61 Cardiac Catheterization (93451-93568) Used to identify valve disorders, abnormal blood flow Many bundled services in catheterization codes (Cont’d…)

62. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 62 Cardiac Catheterization (93451-93568) (…Cont’d) Example: –Introduction –Positioning/Repositioning of catheter –Pressure readings inside heart or vessels –Blood samples –Rest/Exercise studies –Final evaluation and report Many codes -51 exempt

63. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 63 Three Components of Coding Cardiac Catheterization Placement of catheter Injection Imaging supervision, interpretation, and report All 3 components are included in most catheterization codes Some cardiac catheterization codes require an imaging/injection code 93530-93533, cath for congenital anomalies require 93563 or 93564 (imaging/injection) From LaFleur Brooks M: Exploring Medical Language: A Student- Directed Approach, ed 7, St. Louis, 2009, Mosby.

64. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 64 Intracoronary Brachytherapy (92974) New Procedure uses radioactive substances to destroy restenosis of coronary vessel Patients have had stent placed in coronary vessel Stent “restenosis” (reformation of plaque) (Cont’d…) From Zipes DP, editor: Braunwald's Heart Disease, ed 7, Philadelphia, 2005, Saunders Brachytherapy delivery system for coronary artery stent restenosis From Zipes DP, editor: Braunwald's Heart Disease, ed 7, Philadelphia, 2005, Saunders Figure: 21.29

65. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 65 Intracoronary Brachytherapy (…Cont’d) Cardiologist: Places guidewire and catheter Radiation oncologist: Places radioactive elements

66. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 66 Intracardiac Electrophysiologic Procedures/Studies (93600-93662) Services to diagnose and treat conditions of electrical system of heart Tests involve placement of special catheters into heart and cardiac vessels for purpose of pacing and recording intracardiac activity

67. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 67 EP System of Heart Electrical conduction system (Cont’d…) Figure: 21.30

68. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 68 EP System of Heart (…Cont’d) Electrical recording codes divided based on location of recording device Example: Bundle of His or right ventricle (Cont’d…)

69. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 69 EP System of Heart (…Cont’d) Pacing: Temporary pacing to stabilize beating of heart –Example: Intraventricular or intra-arterial pacing

70. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 70 Peripheral Arterial Disease (PAD) Rehabilitation (93668) Rehabilitation sessions: 45-60 minutes Use of motorized treadmill/track to build patient’s CV endurance Supervised by exercise physiologist or nurse

71. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 71 Noninvasive Physiologic Studies and Procedures (93701-93790) Category contains codes for services such as: –Plethysmography: Recordings of changes in size of body part when blood passes through it (Cont’d…)

72. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 72 Noninvasive Physiologic Studies and Procedures (93701-93790) (…Cont’d) Electronic Analysis: Checks electronic function of devices, such as pacemakers (Cont’d…)

73. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 73 Noninvasive Physiologic Studies and Procedures (93701-93790) (…Cont’d) Ambulatory Blood Pressure Monitoring: Outpatient basis over 24-hour period Thermograms: Visual recordings of temperature of body From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby.

74. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 74 Cardiovascular in Radiology Section Divided complete procedures into two components: Technical and Professional (Cont’d…)

75. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 75 Cardiovascular in Radiology Section (…Cont’d) Radiology Section, Heart (75557-75574), and Aorta/Arteries (75600-75791) subsections (Cont’d…)

76. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 76 Cardiovascular in Radiology Section (…Cont’d) Example: Angiography –Technical component angiography—remains in Radiology Section –Professional component injection—moved to Surgery Section (Cont’d…)

77. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 77 Cardiovascular in Radiology Section (…Cont’d) Complete angiography requires radiology code and surgery code Reflects common practice of cardiologist performing injection and radiologist reporting angiography results

78. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 78 Contrast Material Often radiologic procedures use contrast material to improve image Many codes have contrast material bundled into service –“With contrast” or “with or without contrast” Only injected contrast qualifies (Cont’d…)

79. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 79 Contrast Material (…Cont’d) Contrast not included in description, used in procedure; code both contrast material and injection separately Physician performs injection procedure in hospital outpatient department; use -26 for professional component only

80. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 80 A Component Coding Example Two physicians (cardiologist and radiologist from same facility) perform angiography of third order brachiocephalic artery with contrast Cardiologist placing catheter (36217)— Surgery Section (Cont’d…)

81. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 81 A Component Coding Example (…Cont’d) Radiologist performs angiography (Supervision and interpretation) (75658), Radiology Section Supply of contrast material (99070), Medicine Section

82. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 82 Conclusion CHAPTER 21 CARDIOVASCULAR SYSTEM