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Step by Step Chapter 21 Class Quiz

Laparoscopic splenectomy.

Code: 38120

Abdominal aortogram.
The right groin was prepped and draped in the usual fashion. Seldinger technique was used to enter the femoral artery. A 6-French sheath was placed. A pigtail catheter was introduced in the upper abdominal aorta, and an AP aortogram was done using the DSA cut film technique using 20 cc of Omnipaque.
Results: The abdominal aorta appears mildly irregular above and below the renal arteries, with no significant stenosis.
(Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)

CPT Codes: (Surgery Code)36200, (Radiology Code) 75625-26

The physician repairs a large laceration of the diaphragm that occurred during a car accident from the seat belt the patient was wearing through a transabdominal approach.

Code: 39501

Mr. O'Brien presents to his cardiologist's office complaining of chest pain. Dr. McCoy, the cardiologist, decides to obtain a cardiovascular stress test. Because Dr. McCoy's office does not have the proper equipment to perform this test, he sends Mr. O'Brien to the hospital for the test. Dr. McCoy accompanies Mr. O'Brien and supervises the stress test as well as provides his interpretation and written report. Report Dr. McCoy's service.
(Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)

CPT Codes: 93016, 93018

Right and left heart catheterization, selective coronary angiography, and left ventriculogram.
The patient was prepped and draped in the usual sterile fashion and sedation was administered for a total of fentanyl, 25 mcg IV, and Versed, 0.5 mg IV. One percent lidocaine was infused in the right groin and a 7-French sheath was inserted in the right femoral artery. A 7-French Swan-Ganz catheter was advanced through the right heart chambers and into the pulmonary artery. After pulmonary capillary wedge pressure and pulmonary artery pressures were obtained, thermodilution cardiac outputs were measured. The Swan-Ganz catheter was then pulled back to the right heart chambers prior to removal. Selective coronary angiography was then performed. A 6-French JL4 catheter was used for selective angiography of the left coronary artery and right coronary artery. A 6-French pigtail catheter was used for RAO left ventriculogram using a hand injection. Following the procedure, the sheaths were removed and hemostasis was achieved using VasoSeal. The patient tolerated the procedure well without complications.

RIGHT HEART CATHETERIZATION: The right heart pressures were as follows: The mean pulmonary capillary wedge pressure was 10 mm Hg. The pulmonary artery pressures were 37/17 with a mean of 20 mm Hg. The right ventricular pressure was 34/2 and the mean right atrial pressure was 5 mm Hg. The mean cardiac output was 4.2 L per minute.
LEFT HEART CATHETERIZATION: The left main coronary artery appeared calcified. There was no obstructive disease observed. The left anterior descending artery was also calcified in its ostial and proximal portions. There was mild luminal irregularity noted in the proximal and mid portions of the vessel. Two moderate size diagonal branches were observed without high-grade disease. The mid LAD contained a 40%-50% narrowing. The remaining distal vessel appeared free of disease. The circumflex vessel was a large vessel. There was a 60% focal lesion in the proximal portion of this artery. There was some ectasia noted also in the proximal portion of the vessel. A large obtuse marginal branch was observed which appeared free of high-grade disease. The right coronary artery was 100% occluded in its proximal portion. The distal vessel filled via left-to-right collaterals from the LAD and circumflex system.
VENTRICULOGRAM: The left ventriculogram showed good LV systolic function with an ejection fraction of 60%. No wall motion abnormalities were noted. The left ventricular end diastolic pressure was 7-8 mm Hg.
1. Mild-to-moderate LAD and circumflex disease
2. Occluded proximal right coronary artery, presumably chronic
3. Good LV systolic function.
4. Normal right heart pressures

(Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)

Right and left heart catheterization CPT code: 93526-26
Injection procedure CPT code: 93543, 93545
Imaging supervision CPT code: 93555-26, 93556-26

Direct repair of aneurysm associated with occlusion of the vertebral artery.

CPT Code: 35005

Harvest of one segment of vein from upper arm for coronary artery bypass procedure. Code vein harvest only.

CPT Code: 35500

PTCA of left anterior descending coronary artery.
A 6-French JL4 guiding catheter was used, and a 014 extra-support wire was passed through the LAD obstruction and "entered" the distal vessel. This was first dilated with a 3-mm 20 CrossSail balloon, subsequently with a 3.5 10 cutting balloon (arteriectasis). With the cutting balloon, there were four inflations at 6-7 atmospheres and up to 1-minute inflation times.
The balloon was withdrawn, and angiography showed the vessel to be wide open with mild irregularities and less than 15% narrowing remaining. There was no distal embolism. There was no dissection noted. There was normal TIMI flow. The case was then terminated at this point and balloons, catheters, and wires were removed, and the patient was sent to her room in good condition.

CPT Code: 92982

Ambulatory blood pressure monitoring of 24 hours, using magnetic tape, including the recording, analysis, interpretation, and report.

CPT Code: 93784

Biopsy of a lymph node by fine needle aspiration without image guidance.

Code: 10021

Bone marrow biopsy by needle aspiration.

CPT Code: 38221

Left heart catheterization with coronary angiography and left ventriculogram.
The right groin was prepped and draped in the usual fashion. Seldinger technique was used and a 6-French sheath was placed in the right femoral artery. A local anesthetic was used and sublingual nitroglycerin was given, no heparin was used. The left and right coronary arteries were selectively opacified in the LAO and RAO projections using manual injections of Optiray. A ventriculogram was done in the RAO projection with the use of a 6-French pigtail catheter. The catheters were then withdrawn, the sheath was removed and VasoSeal applied, and the patient was sent to her room in good condition without complications.
PRESSURES: Aorta 117/63, LV 110/2-6
RIGHT CORONARY ARTERY: This is a dominant vessel. There is a long segment of severe subtotal disease extending from the proximal portion to almost the mid third. The rest of this vessel also appears to be diffusely diseased. The posterior descending branch is identified and this is 80% narrowed at its ostium. There is another 90% lesion in the distal 1/3 of this vessel. The AV branch is diminutive.
LEFT CORONARY ARTERY: Left main trunk is calcified and has a 60%-70% distal narrowing. Left anterior descending is severely diseased from its origin, and gives off a diagonal and septal perforator and then the LAD is totally occluded. The circumflex calcification is seen in the main trunk where moderate plaque is seen compromising the lumen about 50%-60%. The circumflex then divides into two branches; the first is the lateral branch and then a second lateral branch. The first lateral branch is severely narrowed in its proximal portion to 90%, and then has another long segment of about 75% narrowing. This does appear to be a diffusely diseased vessel. The second lateral branch also has a long segment of 90% disease distally. The terminal AV branch of the circumflex is completely occluded.
LEFT VENTRICLE: End systolic and end diastolic volumes are increased. There is diffuse impairment of contractility indicating diffuse multiwall ischemia. Overall contractility is mild-to-moderately impaired with an ejection fraction of the post PVC beat being around 40% or so. No major wall segment abnormalities are noted. The mitral and aortic valves are normal. The descending aorta is slightly dilated.
1. Coronary atherosclerosis
2. Mild-to-moderate impairment of LV Function.

(Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)

Left heart catheterization CPT code:
Injection procedure CPT codes:
Imaging supervision CPT codes:

What is the code for a tunneled centrally inserted central venous catheter, without pump or port, in a 72-year-old patient?

CPT Code: 36558

Suprahyoid lymphadenectomy.

CPT Code: 38700

Placement of a dual-chamber pacemaker.
Using a standard technique, the left infraclavicular subcutaneous pacemaker pocket was created with sharp and blunt dissection. The 2 j-tipped guidewires were advanced through a left subclavian vein using standard left subclavian venotomy under fluoroscopic guidance. The peel-away sheaths and introducers were advanced over the guidewires, and the guidewires were removed. The pacemaker leads were advanced under fluoroscopic and electrophysiologic guidance into the right ventricular apex and right atrial appendage. The pacemaker leads were seen to function adequately in vivo and were sutured in place with 0 silk. The leads were connected to the pulse generator, which was delivered into the wound in the usual fashion; 2-0 Vicryl suture was used to close the deep tissue layer and a 4-0 running subcuticular suture was used to close the skin. There were no complications of the procedure.

CPT Code: 33208

A thromboendarterectomy of the carotid artery by neck incision, with a patch graft.

CPT Code: 35301

The implantation of a patient-activated cardiac event recorder.

CPT Code: 33282

An in-person electronic analysis of a dual chamber pacemaker system with reprogramming.

CPT Code: 93280

Duplex scan of aorta, complete study.

CPT Code: 93978

A patient presents to the physician's office to have blood drawn for various lab tests. The venous blood is drawn by the medical assistant and sent to the lab with an order from the physician. Code only the drawing of the blood.

CPT Code: 36415

A percutaneous transluminal balloon angioplasty of the right renal artery from a right femoral artery access. (Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)

CPT Codes: (Surgery Code)35471, (Radiology Code) 36245, 75966-26

Single-level, noninvasive physiologic study of arteries of the arm, bilateral.

CPT Code: 93922

Patient has a diagnosis of end-stage renal disease and requires an arteriovenous fistula (shunt) using Gore-Tex graft for hemodialysis. Nondirect.

CPT Code: 36830

Echocardiogram, transthoracic—complete study with color-flow Doppler and echocardiography.

CPT Code: 93306

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