1. 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT The Cardiovascular System subsection: – Heart and Pericardium (33010–33999): Pericardium: 33010–33050, pericardiocentesis (surgical puncture into the pericardium) Pacemaker or Pacing Cardioverter-Defibrillator: 33202–33249, the coder must answer: – Was the device a pacemaker or a cardioverter-defibrillator? – Was it initial insertion, replacement, or repositioning? – Was the device permanent or temporary? – Was it single-chamber or dual-chamber, and where was lead placed (atrium or ventricle)? – Was the approach transvenous or epicardial? – Was the entire system (generator and leads) replaced, or was just the generator or leads replaced? – Was the pacemaker pocket revised? 12-24

2. 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.) The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Electrophysiologic Operative Procedures: 33250– 33266, referred to as EP procedures – Tissue ablation and reconstruction – Ablation works by scarring or destroying cardiac tissue that triggers abnormal heart rhythm – In some cases, can prevent abnormal electrical signals from traveling through the heart Heart (Including Valves) and Great Vessels: 33300– 33355, repair of cardiac wounds with or without cardiopulmonary bypass 12-25

3. The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Cardiac Valves: 33361–33478, the coder must answer: – Which valve(s) are involved: aortic, mitral, tricuspid, and/or pulmonary? – What procedure was performed: valvuloplasty, valvulotomy, or replacement? – Was procedure performed with or without cardiopulmonary bypass? Coronary Artery Bypass Grafting: 33510–33548, three types of coronary artery bypass grafts: – Venous grafting only for coronary artery, 33510–33516 – Combined arterial-venous grafting for coronary bypass, 33517–33530 – Arterial grafting for coronary bypass, 33533–33548 12-26 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

4. The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Septal Defect: 33641–33697, occurs when there is a hole in the septum between the upper chambers of the heart Heart/Lung Transplantation: 33930–33945, includes three major physician components: – Cadaver donor cardioectomy with or without pneumonectomy, 33930, 33940 (codes include harvesting and cold preservation of the allograft) – Backbench work, 33933, 33944 – Recipient heart with or without lung allotransplantation, 33935, 33945 12-27

5. 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.) The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Cardiac Assist: 33960–33993, when a failing heart needs to be partially or completely replaced by a mechanical circulatory device, this can be achieved by the use of a ventricular assist device (VAD) Aneurysm Repair: 33860–33877, 33880–33891, 34800–34834, 34900, 35001–35152, repair of a bulge or swelling in the wall of a vessel 12-28

6. The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490): Embolectomy/Thrombectomy: 34001–34203, codes within this range are determined by: – Artery/vein involved – Incision site: thoracic, arm, abdominal, or leg 12-29 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

7. The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490) (cont.): Vascular Injection Procedures: 36000–36598, based on whether the physician performed a selective or nonselective catheter placement: – Nonselective placement: Access vessel for the catheter is the femoral artery, and catheter does not advance further, OR access vessel is femoral artery, and catheter is advanced into aorta but no further – Selective placement: Catheter advances beyond aorta into right common carotid artery (second-order vessel) OR advances beyond aorta into right external iliac artery from left femoral artery access (contralateral placement from access) 12-30 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

8. The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490) (cont.): Central Venous Access Procedures: 36555–36598, central venous access device (CVAD) is a small, flexible tube placed in large veins for patients who require frequent access to their bloodstreams – Insertion: place catheter through newly established venous access – Repair: fix device without replacement of catheter or port/pump – Partial replacement: replace only catheter component – Complete replacement: replace entire device via same venous access site – Removal: remove entire device 12-31 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

9. The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490) (cont.): Hemodialysis Access: 36800–36870, most common method for hemodialysis access is creation of an arteriovenous (AV) fistula – Surgeon connects the artery to the vein – Connection between vessels causes blood to flow from artery directly to the vein – Eventually vein walls become thicker/stronger and are ideal placement site for dialysis needle 12-32 12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)