Cardiovascular System, Chapter 21

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Internal medicine physician specializing ini diagnosis and treatment of conditions of the heart?

Cardiologist

Cardiology is one of the largest subspecialties in medicine? True/False

True

When coding cardiology services, you will use codes from what 3 sections?

1)Surgery
2)Medicine
3)Radiology

The confusion in coding cardiology usually comes from not understanding components (parts) of coding cardiovascular services, the various locations of these codes in the CPT manual, and the terminology associated with cardiovascular services. True/False

True

Entering the body, breaking the skin to make a correction or examination?

invasive

Invasive cardiology procedures are also called___?

interventional procedures

Cardiovascular system surgery section codes (33010-37799)

heart and pericardium, endoscopy, arteries and veins, adjuvant techniques

Cardiovascular Medicine section codes (92950-93799)

therapeutic services and procedures, cardiography, implantable and wearable cardiac device, evaluations, echocardiography, cardiac catheterization, intracardiac electrophysiological procedures, peripheral arterial disease rehabilitation;noninvasive physiologic stuides and procedures, other procedures

Cardiovascular Radiology Section (75557-75791)

Diagnostic Radiology (heart, vascular procedures aorta and arteries), Diagnostic Ultrasound (Ultrasonic Guidance Procedures),Radiologic Guidance, Nuclear Medicine

To choose the correct cardiology code, first determine whether the procedure or service was invasive (interventional (percutaneous or open) or noninvasive. True /False

True

Electrophysiology (EP)

study of electrical system of the heart and includes the study of arrhythmias

electrogram

diagnostic procedure recording electrical activity within the heart by placing wire electrodes in the heart percutaneously

Medicine section (93600-93662) contains codes for invasive diagnostic and therapeutic procedures. true/false

True

Wolff-Parkinson-White syndrome

congental defect in which there is short circuit between atria and ventricles, results in rapid heartbeats. Condition due to muscle fiber that remains after heart developed that interrupts normal conduction.

Nuclear cardiology

diagnostic specialty using radiologic procedures to aid in the diagnosis of cardiologic conditions.

An x-ray examination that enables study of the patient's blood vessels and organs by injecting contrast media into the blood vessels and viewing the results on x-ray film.

angiography

Cardiovascular system subsection of the Surgery Section contains diagnostic and therapeutic procedures. They are dvided based on whether the procedure was performed on ____ or ______.

heart/pericardium or arteries/veins

What section would contain codes for procedures that involve the repair of the heart and coronary vessels?

Heart and pericardium subsection in Cardiovascular Surgery section

This section contains procedures that involve placement of pacemakers, repair of valve disorders, and graft/bypass procedures?

Heart and pericardium subsection in Cardiovascular Surgery section

The removal of a thrombus and a portion of the lining of an artery

thromboendarterectomy

Assigning a code for thromboendarterectomy depends on where procedure was performed. True/False

True

The location of the procedure - coronary or noncoronary- is the first step in selecting the correct cardiovascular surgical code. True/False

True

Codes in the Heart and Pericardium subheading of the Surgical section are for services provided to _____?

repair the heart

Numerous notes are located through the Surgical section for Heart and Pericardium that must be read prior thoroughly to coding. True/False

True

Procedure in which the surgeon withdraws fluid from the pericardial space by means of a needle inserted percutaneously

pericardiocentesis

Pericardiocentesis may be performed using radiologic (ultrasound) guidance. Is this coded separately from the Radiology section?

yes (for radiological supervision and interpretation use 76930)

Pericardiostomy tube

catheter is left in perdicardial sac/space leading to the outside of the body to allow for continued drainage

Cardiac tumor coded according to location. True/False

True (pericardial tumor removal from Pericardium category (33010-33050), tumor removal of heart coded from Cardiac tumor category (33120,33130))

A procedure in which areas of cardiac ischemia are exposed to laser beam to create holes in surface of the heart.

laser transmyocardial revascularization (coded alone or as add-on code to another open cardiac procedure)

cardiac ischemia

reversible muscle damage

Devices inserted into body to electrically shock the heart into regular rhythm.

pacemaker or pacing cardioverter-defbrillator

You need to know 3 things about service provided to correctly code the pacemaker. True/False

True (1. Where the electrode (lead) is placed: atrium, ventricle, or both ventricle and atrium; 2. Whether the procedure involves intial placement, replacement, upgrade or repair of all compnents or separate components of the pacemaker; 3. The approach used to place the pacemaker (epicardial or transvenous))

Single pacemaker has __ lead.

one (atrium or ventricle)

Dual pacemaker has two leads (one lead in right atrium and one in the right ventricle, and a biventricular pacemaker has ___leads

3 (one in right atrium, one in right ventricle, and one in left ventricle via coronary sinus vein)

There are two approaches used when inserting a pacemaker.

epicardial (opening the chest cavity and placing a lead on epicardial sac of heart) or transvenous (approach involves accessing a vein and inserting an electrode into the vein)

Fluoroscopy

x-rays (views internal structure)

Epicardial approach for inserting pacemaker are divided based on approach to heart___, ____, or ___.

thoracotomy, upper abdominal or endoscopic

Transverse approach for inserting pacemaker are divided based on ________.

area of heart (into which the pacemaker is inserted)

Cardioverter-defibrillator codes determined by:1. Revision or re placement of lead(s); 2. Replacement, repair, removal of components and 3._____

approach (used for insertion or repair)

A change of batteries in a pacemaker or pacing cardioverter-debrillator is a removal of old and reimplantation of a new generator. How are the removal and reimplantation reported

separately

In which Cardiovascular section is EP reported separately?

medicine section (with codes 93600-93660)

Professional portion of radiology service uses which modifier?

-26

What is the modifier for technical component of radiology service?

TC

If patient seen during 90-day follow-up period for implantation for unrelated problem, a new service can be billed. True/False

True (documentation in medical record must support statement that the service is unrelated to implantation)

What modifier is used for billing an unrelated problem in global period following pacemaker implantation?

-24 (unrelated E/M service)

What modifier is used for reposition or replacement of pacemaker during global period?

-78 (same physician)

patient-activated event recorder

(surgical implantation into subcutaneous tissue of the upper left quadrant) records electrical activity of the heart when patient presses a button

What is the patient-activated event record used for?

assist in diagnosing (hard-to-detect) heart rhythm problem

Cardiac event record or a loop record

patient-activated event recorder

coding of patient-activated event record divided on basis of whether device was _______

implanted or removed

The surgeon maps locations of electrodes of heart to locate source of arrhythmia. True/False

True

Cardiac valves

aortic, mitral, tricuspid,pulmonary

Procedures involving cardiac valves vary depending on whether was machine was used during the procedure?

cardiopulmonary bypass machine

What assumes patient's heart and lung functions during surgery?

Cardiopulmonary bypass

Cardiac valve procedures are located in CPT manual index under____

valve type or what was done (such as a repair or replacement)

coding aortic valve replacement

Aorta, Valve, Replacement

Coronary artery anomalies (33500-33507)

report services of repair of coronary artery (graft, ligation (tying off), and reconstruction)

Coronary artery repairs include endarterectomy and angioplasty. Will these be bundle or coded separately?

bundled

Use of cardiopulmonary bypass during coronary artery repair affects code choice. True/False

True

atherosclerosis

arteries clog with plaque

reversible ischemia

lack of blood to heart muscle (if bloodflow is increased the heart muscle may function near or at normal levels)

irreversible ischemia

when heart artery is clogged and heart muscle dies (myocardial infarction)

coronary artery bypass grafting is one way to increase flow of blood to heart muscle.

The diseased portion of artery is bypassed (by attaching a healthy vessel above and below the disease area and allowing health vessel to then become conduit of blood by bypassing the blockage)

percutaneous transluminal coronary angioplasty

PTCA

Procedure in which blockage in artery can be pushed to the sides when a balloon is expanded inside the artery

PTCA

CABG

coronary artery bypass graft

In coronary bypass grafts, an artery, a vein or both may be used. True/False

True

To code a CABG, know how my bypass grafts are performed.

True (code reflecting number of grafts assigned from category Venous Grafting only for Coronary Artery Bypass (33510-33516)

Which vein is most often harvest for CABG

saphenous vein

1. Two coronary bypass grafts using veins only.

CPT:

2. Coronary artery bypass using two arterial grafts

CPT:

3. Coronary artery bypass using 3 venous grafts in addition to the arterial grafts for conary arter disease, native artieres, due to arteriosclerotic coronary heart diease.

CPT:
ICD-9-CM code:

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