1 / 83

CHAPTER 17

CHAPTER 17. CARDIOVASCULAR SYSTEM. Cardiovascular System (1 of 2). CV coding may require codes from: Radiology Medicine Surgery. Cardiovascular System (2 of 2). Radiology: Diagnostic studies Medicine: Nonsurgical and percutaneous Surgery: Open and percutaneous.

kura
Download Presentation

CHAPTER 17

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CHAPTER 17 CARDIOVASCULAR SYSTEM

  2. Cardiovascular System (1 of 2) • CV coding may require codes from: • Radiology • Medicine • Surgery

  3. Cardiovascular System (2 of 2) • Radiology: Diagnostic studies • Medicine: Nonsurgical and percutaneous • Surgery: Open and percutaneous

  4. Cardiology Coding Terminology (1 of 4) • 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

  5. Cardiology Coding Terminology (2 of 4) • Noninvasive: Procedures that do not break skin • Example: Electrocardiogram

  6. Cardiology Coding Terminology (3 of 4) • Electrophysiology(EPS): Study of electrical system of heart • Example: Study of irregular heartbeat (arrhythmia) Figure 17.30

  7. Cardiology Coding Terminology (4 of 4) • Nuclear Cardiology: Diagnostic and treatment specialty, uses radioactive substances for cardiac conditions • Example: MRI

  8. Cardiovascular in Surgery Section • Codes for procedures: • Heart/Pericardium (33010-33999) • Pacemakers, valve disorders • Arteries/Veins (34001-37799)

  9. Heart/Pericardium (33010-33999) (1 of 2) • Both percutaneous and open procedures • Extensive notes throughout • Frequent changes with medical advances

  10. Heart/Pericardium (33010-33999) (2 of 2) • Examples of Heart/Pericardium subheadings: • Pericardium • Cardiac Tumor • Pacemaker or Implantable Defibrillator

  11. Heart/Pericardium Categories • Pericardiocentesis: Percutaneous withdrawal of fluid from pericardial space • Excision of Cardiac Tumor: Open surgical procedure for removal of tumor on heart

  12. Pacemaker or Implantable Defibrillator (33202-33273) (1 of 6) • Devices that assist heart in electrical function Figure 17.7 A, Single pacemaker insertion. B, Dual chamber pacemaker. C, Biventricular pacemaker. (B from Lewis SL, Bucher L, Heitkemper MM, Harding MM: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, ed 10, St. Louis, 2017, Elsevier.)

  13. Pacemaker or Implantable Defibrillator (33202-33273) (2 of 6) Figure 17.5 • 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 From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby.

  14. Pacemaker or Implantable Defibrillator (33202-33273) (3 of 6) Figure 17.6 • 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.

  15. Pacemaker or Implantable Defibrillator (33202-33273) (4 of 6) • Approach: • Epicardial: Open procedure to place on heart • Transvenous: Through vein to place in heart

  16. Pacemaker or Implantable Defibrillator (33202-33273) (5 of 6) • Type of Service • Initial placement or replacement of all or part • Number of leads placed

  17. Pacemaker or Implantable Defibrillator (33202-33273) (6 of 6) • Patient record indicates revision or replacement • Usual follow-up period 90 days (global period) • Use -78 to indicate return to operating room within global period

  18. Electrophysiologic Operative Procedures (33250-33266) (1 of 2) • Surgeon repairs defect causing abnormal rhythm • Endoscopy Procedure • Without CP • Codes based on reason for procedure, approach, and if CP bypass used

  19. Electrophysiologic Operative Procedures (33250-33266) (2 of 2) • Chest opened to full view—Incision • Cardiopulmonary (CP) bypass usually used

  20. Patient-Activated Event Recorder (33285, 33286) • Also known as cardiac event recorder or loop recorder • Placed using a small parasternal incision • Divided based on devicebeing inserted or removed

  21. 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

  22. Coronary Artery Bypass Graft • CABG performed for coronary arteries severely clogged (atherosclerosis) Figure 17.8A

  23. Coronary Artery Bypass (1 of 2) Figure 17.9 • Determine what was used in repair: • Vein (33510-33516) • Artery (33533-33548) • Both artery and vein (33517-33523 and 33533-33536)

  24. Coronary Artery Bypass (2 of 2) • Number of bypass grafts performed and if vein and arterialgrafts are used • Example: Three venous grafts

  25. 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

  26. Arterial Grafting (33533-33548) (1 of 2) • 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) posterolateral

  27. Arterial Grafting (33533-33548) (2 of 2) • 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)

  28. Combined Arterial-Venous Grafting (1 of 2) • 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

  29. Combined Arterial-Venous Grafting (2 of 2) • Procuring saphenous vein included, if open retrieval • Endoscopic harvest is reported with 33508 • If reoperation report with 33530 • No modifier -51, add-on codes • Never used alone • Add-on codes always used with Arterial Grafting codes (33533-33548) • Arterial-Venous codes report only venous graft portion of procedure

  30. 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, 75956-75959 • Includes diagnostic imaging (pre- and intraoperative) • Stent-graft (endoprosthesis) reinforces weakened area

  31. Extracorporeal Membrane Oxygenation and Extracorporeal Life Support Services (33946-33989) • Cardiac and/or respiratory support to the heart and/or lungs • These systems provide cardiac and respiratory support for patients whose heart and lungs are diseased or damaged beyond function

  32. Arteries and Veins (34001-37799) (1 of 3) • 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

  33. Arteries and Veins (34001-37799) (2 of 3) Figure 17.14 • 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.

  34. Arteries and Veins (34001-37799) (3 of 3) • Nonselective: Direct placement without further manipulation • Selective: Place and then manipulate into further order(s)

  35. Catheter Placement Example • Nonselective: 36000, Introduction of needle into vein • Selective: 36012, Placement of catheter into second order venous system

  36. 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 catheterization of aorta

  37. Innominate/Brachiocephalic Vascular Family • Report farthestextent of catheter placement in a vascular family Figure 17.15

  38. 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

  39. Embolectomy • Removal of embolus Figure 17.16

  40. Venous Reconstruction (34501-34530) • Types of repair: • Valve of femoral vein • Vena cava • Saphenopopliteal vein anastomosis

  41. Aneurysm (1 of 2) • 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

  42. Aneurysm (2 of 2) • Repair by removal, bypass, or coil placement • Coil placement: Tiny, flexible, platinum coil pushed into aneurysm and forms “ball” to obstruct blood flow into aneurysm • Endovascular repair (34701-34848) from inside vessel • Direct (35001-35152) from outside vessel

  43. Endovascular Repair of Abdominal Aortic Aneurysm • 34701-34706 • Extensive notes preceding codes—“must reading” • 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

  44. Endovascular Repair of Iliac Aneurysm (34707-34708) • Extensive notes before codes • 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

  45. Repair Arteriovenous Fistula (35180-35190) • Abnormal passage • Divided based on fistula type: • Congenital • Acquired/traumatic • By site

  46. Angioplasty • Open or percutaneous by vessel • Transluminal angioplasty: Catheter passed into vessel and stretched • Code per vessel • Stent placement reported separately • Code imaging separately • Reported with codes 36902, 36905, 36907, and 37246-37249

  47. 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

  48. 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

  49. Vascular Injection Procedures (36000-36522) (1 of 2) • Divided into: • Intravenous • Intra-Arterial—Intra-Aortic • Venous

  50. Vascular Injection Procedures (36000-36522) (2 of 2) • Used for many procedures, includes: • Local anesthesia • Introduction of needle • Catheter • Injection of contrast material • Pre- and postoperative care • Example: Injection of an opaque substance for venography

More Related