Download chapter 21 cardiovascular system

CHAPTER 21
CARDIOVASCULAR SYSTEM
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 1
Cardiovascular System
• CV coding may require codes from:
• Radiology
• Medicine
• Surgery
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 2
Cardiovascular System
(…Cont’d)
• Radiology: Diagnostic
_________ studies
• Medicine: Nonsurgical
__________ and percutaneous
Open and percutaneous
• Surgery: _____
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 3
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…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 4
Cardiology Coding
Terminology
(…Cont’d)
• __________:
Noninvasive Procedures that do not
break skin
– Example: Electrocardiogram
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 5
Cardiology Coding
Terminology
(…Cont’d)
• Electrophysiology
______________
(EPS): Study of
electrical system
of heart
― Example: Study of
irregular heartbeat
(_________)
arrhythmia
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 6
Cardiology Coding
Terminology
(…Cont’d)
• ______
Nuclear Cardiology: Diagnostic and
treatment specialty, uses radioactive
substances for cardiac conditions
• Example: MRI
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 7
Cardiovascular in Surgery Section
• Codes for procedures:
– Heart/Pericardium (___________)
33010-33999
• Pacemakers, valve disorders
– Arteries/Veins (___________)
34001-37799
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Slide 8
Heart/Pericardium
(33010-33999)
• Both ___________
percutaneous and open procedures
• Extensive notes throughout
• Frequent changes with medical advances
(Cont’d…)
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Slide 9
Heart/Pericardium
(33010-33999)
(…Cont’d)
• Examples of Heart/Pericardium
subheadings:
– Pericardium
– Cardiac Tumor
– Pacemaker or Cardioverter__________ Defibrillator
_________
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Slide 10
Heart/Pericardium Categories
Pericardiocentesis Percutaneous withdrawal
• _______________:
of fluid from pericardial space
• Excision of Cardiac Tumor: Open surgical
procedure for removal of tumor on heart
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 11
Pacemaker or Pacing CardioverterDefibrillator (33202-33249)
electrical
• Devices that assist heart in ________
function
Figure: 21.7 A, Single pacemaker insertion. B, Dual chamber pacemaker. C, Biventricular pacemaker. (B from Lewis
SL, Dirksen SR, Heitkemper MM, Bucher L, Camera IM: Medical-Surgical Nursing: Assessment and Management
of Clinical Problems, ed 8, St. Louis, 2011, Mosby.)
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 12
Pacemaker or Pacing CardioverterDefibrillator (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
Figure: 21.5
From Forbes CD, Jackson WF: Color Atlas
and Text of Clinical Medicine, ed 3, 2003,
Mosby.
(Cont’d…)
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Slide 13
Pacemaker or Pacing CardioverterDefibrillator (33202-33249)
(…Cont’d)
Figure: 21.6
• Placed:
– Atrium (_____
single chamber
(uses 1 lead)
– Ventricle (_____
single chamber)
– Both (___
dual chamber (uses 2
leads)
– Biventricular
__________, both
ventricles and right
atrium (__
3 leads)
From Miller RD, editor: Miller's Anesthesia, ed 7,
Philadelphia, 2010, Churchill Livingstone.
(Cont’d…)
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Slide 14
Pacemaker or Pacing CardioverterDefibrillator (33202-33249)
(…Cont’d)
• Approach:
Epicardial Open procedure to place on heart
– ________:
– Transvenous
__________: Through vein to place
in heart
(Cont’d…)
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Slide 15
Pacemaker or Pacing CardioverterDefibrillator (33202-33249)
(…Cont’d)
• Type of Service
– Initial placement or replacement
of all or part
leads placed
– Number of _____
(Cont’d…)
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Slide 16
Pacemaker or Pacing CardioverterDefibrillator (33202-33249)
(…Cont’d)
• Patient record indicates revision or
replacement
• Usual follow-up period 90 days
(_____
global period)
-78 to indicate return to operating
• Use ___
room within global period
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Slide 17
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
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Slide 18
Electrophysiologic Operative
Procedures (33250-33266)
• Chest opened to full view—Incision
– Cardiopulmonary
______________ (CP) bypass usually used
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Slide 19
Patient-Activated Event Recorder
(33282, 33284)
• Also known as cardiac event recorder or
loop recorder
____
• Internal surgical implantation required
device being implanted
• Divided based on ______
or removed
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Slide 20
Cardiac Valves (33361-33478)
• Divided on valve and CP bypass:
– Aortic, mitral, tricuspid, pulmonary
• Transcatheter Aortic Valve Replacement
(TAVR)/Implant (TAVI)
– 33361-33369
– Via artery: Percutaneous, open, or transaortic
– Codes divided based on the approach
– 33367-33369 add-on codes reported in
addition to more primary procedure
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Slide 21
Coronary Artery Bypass Graft
• CABG performed
for coronary arteries
severely clogged
(atherosclerosis)
(Cont’d…)
Figure: 21.8A
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Slide 22
Coronary Artery Bypass
(…Cont’d)
Figure: 21.9
• Determine what was
used in repair:
– Vein (_____-33516)
33510
– Artery (33533-_____)
33548
– Both artery and vein
(_____-33523
and
33517
33533-_____)
33536
From Monahan FD, Neighbors M: Medical-Surgical
Nursing: Foundations for Clinical Practice, ed 2,
Philadelphia, 1998, Saunders.
(Cont’d…)
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Slide 23
Coronary Artery Bypass
(…Cont’d)
• Number of bypass grafts performed and if
vein and arterial
____
______ grafts are used
– Example: Three venous grafts
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 24
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
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Slide 25
Arterial Grafting (33533-33548)
• 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…)
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Slide 26
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
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Slide 27
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 (33533-33548)
– The -51 modifier not used with these codes
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 28
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
Arterial Grafting codes
• Add-on codes always used with ______
(33533-33548)
• Arterial-Venous codes report only ______
venous graft portion of
procedure
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Slide 29
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,
_____-75959
75956
• Includes diagnostic imaging (pre- and intraoperative)
• _________
Stent-graft (endoprosthesis) reinforces weakened
area
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Slide 30
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…)
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Slide 31
Arteries and Veins
(34001-37799)
Figure: 21.14
(…Cont’d)
• Catheters placed into
vessels for monitoring,
removal, repair
• Using nonselective or
selective catheter
placement
From Roberts JR, Hedges JR, editors: Clinical
Procedures in Emergency Medicine, ed 4,
Philadelphia, 2004, Saunders.
(Cont’d…)
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Slide 32
Arteries and Veins
(34001-37799)
(…Cont’d)
• Nonselective
__________: Direct placement without
further manipulation
• Selective
________: Place and then manipulate into
further order(s)
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Slide 33
Catheter Placement Example
• Nonselective
__________: 36000, Introduction of
needle into vein
• Selective
_______: 36012, Placement of catheter
into second order venous system
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Slide 34
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
aorta
catheterization of ____
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Slide 35
Brachiocephalic Vascular Family
farthest
• Report ______
extent of catheter
placement in a
vascular family
Figure: 21.15
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Slide 36
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
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Slide 37
Embolectomy
• Removal of embolus
Figure: 21.16
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Slide 38
Venous Reconstruction
(34501-34530)
• Types of repair:
– Valve of femoral vein
– Vena cava
– Saphenopopliteal vein anastomosis
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Slide 39
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…)
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Slide 40
Aneurysm
(…Cont’d)
coil
• Repair by removal, bypass, or ___
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
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Slide 41
Endovascular Repair of
Abdominal Aortic Aneurysm
• 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
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Slide 42
Endovascular Repair of Iliac
Aneurysm (34900)
• Extensive notes before codes
guidance (75954)
• Uses fluoroscopic ________
• 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
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 43
Repair Arteriovenous Fistula
(35180-35190)
• Abnormal passage
• Divided based on fistula type:
– Congenital
Traumatic
– Acquired/_________
– By site
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Slide 44
Angioplasty (35450-35476)
• Open or percutaneous by vessel
angioplasty Catheter
• Transluminal
____________________:
passed into vessel and stretched
– Code per vessel
– Stent placement reported separately
– Code imaging separately
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 45
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
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 46
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
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Slide 47
Vascular Injection Procedures
(36000-36522)
• Divided into:
– Intravenous
– Intra-Arterial—Intra-Aortic
– Venous
______
(Cont’d…)
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Slide 48
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
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 49
Transcatheter Procedures
(37184-37217)
Arterial mechanical thrombectomy (37184-_____)
37186
• Removal arterial thrombus by mechanical device
transcatheter
• Used to report a variety of ___________
procedures
Venous mechanical thrombectomy (_____,
37187 37188)
• Removal of venous thrombus by means of a
mechanical device
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 50
Cardiovascular in Medicine
Section
• Services can be:
noninvasive
– Invasive or __________
therapeutic
– Diagnostic or _________
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 51
Cardiovascular in Medicine
Section
(…Cont’d)
• Subheadings:
– CoronaryTherapeutic Services and Procedures
– Cardiography
– Cardiovascular Monitoring Services
– Implantable and Wearable Cardiac Device
Evaluations
– Echocardiography
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 52
CV in Medicine Section
(…Cont’d)
• Cardiac Catheterization
Intracardiac Electrophysiologic (EP)
• _________________________
Procedures/Studies
Arterial Disease (PAD)
• Peripheral
_____________________
Rehabilitation
• Noninvasive Physiologic Studies and
Procedures
• Other Procedures
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Slide 53
Therapeutic Services and Procedures
(92920-92998)
• Types of services:
– Cardioversion
– Infusions
– Thrombolysis
– Catheter placement
(Cont’d…)
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Slide 54
Therapeutic Services
(92920-92998)
(…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 additional vessels)
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Slide 55
Cardiography and Cardiovascular
Monitoring Services (93000-93278)
• Types of service:
– Stress tests
Figure: 21.22
Figure: 21.24
– _____
Holter monitor
From Young AP, Proctor DB:
Kinn's The Medical Assistant,
ed 10, St. Louis, 2007,
Saunders.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
From Forbes CD, Jackson WF:
Color Atlas and Text of Clinical
Medicine, ed 3, 2003, Mosby.
Slide 56
Cardiography and Cardiovascular
Monitoring Services (93000-93278)
• Electrocardiogram
• Separate codes for global procedure and
components (professional and technical)
– See 93000, 93005, 93010
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Slide 57
Holter Report
• Used to identify
cardiac __________
arrhythmias
Figure: 21.26
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 58
Implantable and Wearable Cardiac
Device Evaluations (93279-93299)
• New codes in 2009
• Category notes include definitions and
instructions
• Extensive notes
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 59
Echocardiography
(93303-93352)
Figure: 21.27
• Noninvasive diagnostic procedure: Ultrasound detects
presence of cardiac or vascular disease
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Slide 60
Cardiac Catheterization
(93451-93572)
• Used to identify valve disorders, abnormal
blood flow
bundled services in catheterization
• Many _______
codes
(Cont’d…)
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Slide 61
Cardiac Catheterization
(93451-93572)
(…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
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Slide 62
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 StudentDirected Approach, ed 7,
St. Louis, 2009, Mosby.
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Slide 63
Intracoronary Brachytherapy
(92974)
• New Procedure uses
radioactive substances
to destroy restenosis
of coronary vessel
• Patients have had ____
stent placed
in coronary vessel
From Zipes DP, editor: Braunwald's
Heart Disease, ed 7, Philadelphia,
2005, Saunders
restenosis
• Stent “________”
(reformation of plaque)
(Cont’d…)
Figure: 21.29
Brachytherapy delivery system for
coronary artery stent restenosis
From Zipes DP, editor:
Braunwald's Heart Disease, ed 7,
Philadelphia, 2005, Saunders
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Slide 64
Intracoronary Brachytherapy
(…Cont’d)
• Cardiologist: Places guidewire and
catheter
_______
• Radiation
________ oncologist: Places radioactive
elements
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Slide 65
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
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Slide 66
EP System of Heart
• Electrical conduction system
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Figure: 21.30
Slide 67
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…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 68
EP System of Heart
(…Cont’d)
• Pacing: Temporary pacing to stabilize
beating of heart
– Example: Intraventricular or intra-arterial
pacing
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 69
Peripheral Arterial Disease (PAD)
Rehabilitation (93668)
• Rehabilitation sessions: 45
__-60 minutes
• Use of motorized treadmill/track to build
patient’s CV endurance
physiologist
• Supervised by exercise __________
nurse
or _____
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 70
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…)
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Slide 71
Noninvasive Physiologic Studies and
Procedures (93701-93790)
(…Cont’d)
• Electronic Analysis: Checks electronic
function of devices, such as pacemakers
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 72
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
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
From Forbes CD, Jackson WF: Color Atlas and
Text of Clinical Medicine, ed 3, 2003, Mosby.
Slide 73
Cardiovascular
in Radiology Section
• Divided complete procedures into
two components: Technical
________ and
Professional
__________
(Cont’d…)
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Slide 74
Cardiovascular
in Radiology Section
(…Cont’d)
• Radiology Section, Heart (75557-75574),
and Aorta/Arteries (75600-75791)
subsections
(Cont’d…)
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Slide 75
Cardiovascular
in Radiology Section
(…Cont’d)
• Example: Angiography
– Technical
________ component angiography—remains
in Radiology Section
– Professional
__________ component injection—moved to
Surgery Section
(Cont’d…)
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Slide 76
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
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Slide 77
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…)
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Slide 78
Contrast Material
(…Cont’d)
• Contrast not included in description, used
in procedure; code both contrast material
injection separately
and _______
• Physician performs injection procedure in
hospital outpatient department; use
___ for professional component only
-26
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Slide 79
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…)
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Slide 80
A Component Coding
Example
(…Cont’d)
• Radiologist performs angiography
(Supervision and interpretation) (75658),
Radiology Section
• Supply of contrast material (_____),
99070
Medicine Section
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Slide 81
Conclusion
CHAPTER 21
CARDIOVASCULAR SYSTEM
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 82