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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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 8 Heart/Pericardium (33010-33999) • Both ___________ percutaneous and open procedures • Extensive notes throughout • Frequent changes with medical advances (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 9 Heart/Pericardium (33010-33999) (…Cont’d) • Examples of Heart/Pericardium subheadings: – Pericardium – Cardiac Tumor – Pacemaker or Cardioverter__________ Defibrillator _________ Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 18 Electrophysiologic Operative Procedures (33250-33266) • Chest opened to full view—Incision – Cardiopulmonary ______________ (CP) bypass usually used Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 21 Coronary Artery Bypass Graft • CABG performed for coronary arteries severely clogged (atherosclerosis) (Cont’d…) Figure: 21.8A Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 32 Arteries and Veins (34001-37799) (…Cont’d) • Nonselective __________: Direct placement without further manipulation • Selective ________: Place and then manipulate into further order(s) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 33 Catheter Placement Example • Nonselective __________: 36000, Introduction of needle into vein • Selective _______: 36012, Placement of catheter into second order venous system Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 ____ Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 35 Brachiocephalic Vascular Family farthest • Report ______ extent of catheter placement in a vascular family Figure: 21.15 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 37 Embolectomy • Removal of embolus Figure: 21.16 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 38 Venous Reconstruction (34501-34530) • Types of repair: – Valve of femoral vein – Vena cava – Saphenopopliteal vein anastomosis Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 47 Vascular Injection Procedures (36000-36522) • Divided into: – Intravenous – Intra-Arterial—Intra-Aortic – Venous ______ (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 53 Therapeutic Services and Procedures (92920-92998) • Types of services: – Cardioversion – Infusions – Thrombolysis – Catheter placement (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 60 Cardiac Catheterization (93451-93572) • Used to identify valve disorders, abnormal blood flow bundled services in catheterization • Many _______ codes (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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. Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 64 Intracoronary Brachytherapy (…Cont’d) • Cardiologist: Places guidewire and catheter _______ • Radiation ________ oncologist: Places radioactive elements Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 74 Cardiovascular in Radiology Section (…Cont’d) • Radiology Section, Heart (75557-75574), and Aorta/Arteries (75600-75791) subsections (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 80 A Component Coding Example (…Cont’d) • Radiologist performs angiography (Supervision and interpretation) (75658), Radiology Section • Supply of contrast material (_____), 99070 Medicine Section Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 81 Conclusion CHAPTER 21 CARDIOVASCULAR SYSTEM Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 82