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17 Review
| Question | Answer |
|---|---|
| Name the 3 Main Coronary Arteries | Right Coronary Artery RC, Left Anterior Descending LD, Left Circumflex LC |
| What is the acronym commonly used for coronary artery bypass Graft? | CABG |
| Which CPT Appendix would be a helpful resource for selective vascular coding? | Appendix L |
| According to the CPT manual notes for bypass grafts, which of the following procurements is bundled in the bypass? | Saphenous Vein Graft |
| Indicator dilution studies when done with a cardiac catheterization are to be billed separately True or False? | False |
| Bundled into the cardiac catheterization codes are the positioning and repositioning of the cathetor/s True or False? | True |
| Modifier -51 can be added to all codes in the cardiac catheterization subheading True or False? | False; some codes are modifier -51 exempt |
| What are the two subheadings within the cardiovascular system subsection? | Heart and Pericardium and Arteries and Veings |
| The subspecialty of internal medicine that is concerned with diagnosis and treatment of the heart is? | Cardiology |
| In Ch 17 you learned about coding from which three sections of the CPT? | Radiology, Surgery, Medicine |
| Procedures that break the skin for correction or examination are known as? | Invasive Procedures |
| Procedures that do not break the skin are known as? | Non-Invasive Procedures |
| The study of the heart's electrical system is know as? | Cardiac Electrophysiology or EP ElectroPhysiology |
| The use of radioactive radiologic procedures to aid in the diagnosis of cardiologic conditions is termed (two words) Cardiology _______ _____________? | Nuclear Cardiology |
| A catheter that is inserted into an artery and manipulated to a further order is termed? | Selective catheter placement |
| A catheter that is inserted into an artery and not manipulated to a further order is termed? | Non-Selective Placement |
| Surgical Procedures in the heart and Pericardium Subheading contain procedures that are performed through both open surgical sites and ______ ____? | Percutaneous Approaches |
| This section of the CPT Manual contains codes for nonsurgical cardiovascular services | Medicine Section |
| This Procedure describes a Percutaneous Approach in which the physician inserts a catheter into a coronary vessel to destroy a blood clot by a drug? | Thrombolysis |
| Invasive cardiology procedures are also called ? | Interventional Procedures |
| The Medicine Section of the CPT manual contins the Cardiovascular subsection; these services are invasive/non-invasive or | Diagnostic Therapeutic |
| _______ is the term used when a radiologist is overseeing a technician who is performing a procedure | Supervision |
| Cardiac ___ may include the use of injectable dyes to show the body in a cross-sectional view | MRI |
| A catheter that is inserted into an artery and not manipulated to a further order is termed ______ _____? | Non-Selective Placement |
| Surgical procedures in the heart and Pericardium subheading contain procedures that are performed through both open surgical sites and ______ ______? | Percutaneous Approaches |
| This section of the CPT manual contains codes for non-surgical cardiovascular services? | The Medicine Section |
| This procedure describes a Percutaneous Approach in which the physician inserts a catheter into a coronary vessel to destroy a blood clot by a drug? | Thrombolysis |
| Invasive cardiology procedures are also called _____ procedures? | Interventional Procedures |
| The Medicine Section of the CPT manual contains the Cardiovascular subsection; these services are invasive/-non-invasive or ______ ______? | Diagnostic Therapeutic |
| _______ is the term used when a radiologist is overseeing a technician who is performing a procedure. | Supervision |
| Cardiac ____ may include the use of injectable dyes to show the body in a cross-sectional view | MRI |
| The study of the electrical system of the heart, including the study of arrhythmias | Electrophysiology |
| Radiographic recording of the heart or heart walls, or surrounding tissues | Echocardiography |
| Diagnostic specialty that uses radiopharmaceuticals to aid in the diagnosis of cardiologic conditions | Nuclear Cardiology |
| Membranous sac enclosing the heart and the ends of the great vessels | Pericardium |
| Performed by inserting a catheter percutaneously | Valvuloplasty |
| The term that describes the procedure in which the surgeon withdraws fluid from the pericardial space by means of a needle inserted into the space is | Periocardiocentesis |
| Codes for excision of cardiac tumors are divided based on whether the tumor is located ___ or ___ | internally/intracavitary or Externally/on the heart muscle epicardium |
| What are the names of two devices that are inserted into the body to electrically shock the heart into regular rhythm? | The inplantable defibrillater and the pacemaker |
| The 2 approaches to insert devices that electrically shock the heart into regular rhythm are ____ and ______ | Transvenous and Epicardial approaches |
| If the patient is returned to the operating room for repositioning or replacement of the pacemaker or implantable defibrillator during the global period modifier ___ would be appended to the code | modifier -78 unplanned return to OR by same physician |
| If a physician implanted a pacemaker and 10 days later the patient returns to the se surgeon for removal of sutures, would you charge for the service and why or why not | No, Service is bundled into 90 day surgical package for a pacemaker insertion |
| If a patient is seen for a rash on the heel of the foot by the same physician whoimplanted a pacemaker 20 days earlier, would you bill for the office service for the rash? | Yes the rash is an unrelated condition |
| When you bill for E?M Services unrelated to a pacemaker implantation during the allowable followup days, what modifier would you use on the code to alert the third party payer | Modifier -24 Unrelated E and M by sam physician during post op Period |
| What are the 4 Cardiac valves | Tricuspid, Pulmonary, Mitral, and Aortic Valves |
| What is the name of the device that can be surgically implanted into the subcutaneous tissue in the upper left quadrant to record heart rhythms when the patient depresses a button? | Patient-Activated Event Recorder |
| What arteries feed the heart | Left and Right coronary Arteries |
| When a heart artery is clogged and the heart muscle performs at a low level as a result of a lack of blood the condition is called | Reversible Ischemia |
| When a heart artery is clogged and the heart muscle dies, the condition is called | Irreversible Ischemia |
| A Mass of undissloved matter in the blood that is transported by the blood current is a/n | Embolus |
| Local Anesthesia, Catheter Introduction, and injection of ___ ____ are procedures that are included in a vascular injection | Contrast Material |
| Pericardium | Membranous sac enclosing the heart and ends of the great vessels |
| Cardiopulmonary | Refers to the Heart and Lungs |
| Bypass | To go around |
| Pacemaker | Electrical device that controls the beating of the heart by electrical impulses |
| Single-chamber device | Electrode of the pacemaker is placed only in the atruim or only in the ventricle, but not in both places |
| Dual Chamber Device | Electrodes of the pacemaker are placed in both the right atrium and the right ventricle of the heart |
| Electrode | Lead attached to a generator that carries the electrical current from the generator to the atria or ventricles |
| Ventricle | Chamber in the lower part of the heart |
| Atrium | Chamber in the upper part of the heart |
| Implantable defibrillator | Surgically placed device that directs an electrical current shock to the heart to restore rhythm |
| Artery | Vessel that carries oxygenated blood from the heart to the body tissues |
| Vein | Vessel that carries deoxygenated blood to the heart from the body tissues |
| Aneurysm | A sac of clotted blood or fluid formed in the circulatory system ie vein or artery |
| Embolism | Blockage of a blood vessel by a blood clot or other matter that has moved from another area of the body through the circulatory system. |
| Thrombosis | Blood Clot |
| Endarterectomy | Incision into an artery to remove the inner lining to remove disease or blockage |
| Angioplasty | Surgical or percutaneous procedure on a vessel to dilate the vessel open, used in treatment of atherosclerotic disease |
| Injection | Forcing a fluid into a vessel or cavity |
| Catheter | Tube placed into the body to put fluid in or take fluid out |
| Arteriovenous Fistula | Direct communication (passage) between an artery and vein |
| Anomaly | Abnormality |
| Ischemia | Deficient blood supply caused by obstruction of the circulatory system |
| Cardiopulmonary bypass | Blood bypasses the heart through a heart-lung machine during open heart surgery |
| Fistula | Abnormal opening from one area to another area within the body or to outside of the body |
| Shunt | Surgical or percutaneous procedure on a vessel to dilate the vessel open, used in treatment of atherosclerotic disease |
| The First Order | Is the main artery in a vascular family |
| Second Order | Is the branch off the main artery |
| Third Order | Is the next branch off the second order, and so on. |
| A Vascular Family can have more than one | second-order, third-order, and so on, Code to the farthest extent of the placement within the into one vascular family. ie if cathetor was manipulated from first to second to third order report only the third order. |
| Non-selective catheter placement means | the catheter or needle is placed directly into an artery or veing and not manipulated farther along or is place only into the aorta from any approach and not advance any farther. |
| Selective catheter placement means | the catheter must be moved, manipulated, or guided into a part of the venous or arterial system, passed into a branch of the aorta or access vessel, and then advanced farther through the vessel to enter any of the vascular families, into the branches |
| Selective and Non-selective catheter or needle placement both typically use real-time | fluoroscopic guidance |
| Selective Placement involoves moving a catheter from | the main artery /vein (like the Aorta or Vena Cava) into a specific branch vessel, requiring precise fluoroscopic steering and rotational manipulation to navigate to the target vessel often classified by order. 1st, 2nd, 3rd order |
| Non-Selective Placement of catheter or needle the catheter | remains in the initial vessel entered or in the aorta/vena cava, often using pigtail catheters for high-flow injections, and uses fluoroscopy to ensure proper placement for general mapping |
| Flouroscopy is usually included in selective or non-selective | procedures unless the CPT specifically indicates it is not /imaging guidance is not included or if it is a distinct separate and documented diagnostic imaging study performed. |
| Appendix L of the CPT manual is a listing of the | Vascular families based on the starting poin of the Aorta |
| Code to the farthest extent of the vascular family using an initial code; Pthen code any additional services of the secon order, third order, or beyound by using | An Add-on Code |
| Percutaneous Transluminal Coronary Angioplasty PTCA is a porcedure where | A blockage can be pushed to the sides of the coronary arterial walls by a procedure in which a balloon is expanded inside the artery. This procedure is PTCA |
| CABAG Coronary Artery Bypass Grafting is | one way to increase the flow of blood The diseased portion of the artery is bypassed by attaching a healthy vessel above and below the diseased area and allowing the healthy vessel to then become the conduit of the blood bypassing the blockage. |
| Modifier -51 would not be assigned with the code for the venous grafts because 33517-33523/they are add on codes. This means that the venous code is never | reported alone but always follows anarterial code. |
| Vein Repairs | are performed by locating the defective vessel, clamping the vessel off and bypassing or grafting the defect. |
| Aneurysm Repair codes are divided according tyo the type of aneurysm and the vessel the aneurysm is located in . The aneurysm is formed by the dilation of the wall of an arter is is filled with fluid or clotted blood. During Repair | the aneurysm is located, and clamps are placed above and below it The section containing the aneurysm is then removed or bypassed |
| The Aneurysm codes often refer to a pseudoaneurysm (false aneurysm which is an Aneurysm in which the vessel is | injured and the aneurysm is being contained by the tissue that surrounds the vessel |
| Endovascular aneurysm repair EVAR is a technology that involves | placing a stent, graft, a fabric tube, inside the affected area of the blood vessel accesed through an artery |
| Pacing | is the regulaton of the heart rate. Pacing is recorded with 93610 and 93612 |
| Recording | is a record of the electrical activity of the heart taken by means of an ECG. Recording Services are reported with 93600-93603 |
| Bundle of His Recording is | a reading taken inside the heart intracardia at the tip of the bundle of His. The bundle of His is also known as the atrioventricular bundle or AV bundle and is the bundle of cardiac muscle fibers that conducts electrical impulses that regulate heart beat |
| Mapping | Locating the origin of the arrhythmia and defining the pathway . The surgeon then destroys the source of arrhythmia |
| Bradycardia | heart rhythm |
| Tachycardia | Fast Heart rhythm |
| Radiofrequency -Ablation- one of two ways | energy to burn away the abnormal areas of the heart. Then the heart can beat normal again. |
| Open Heart Surgery-Ablation two of two ways | surgeon the maze procedure makes small cuts in the heart to direct healthy electrical rhythms |
| cryoablation | a very cold subtance is used to freeze the cells that are creating problems |
| Endocardial resection | the surgeon removes a section of the thin layer of the heart where the abnoraml rhythms originate |
| Ablaation can be performed by using a catheter with a tip that emits elcectric current when the tip is place on tissue and activated the tissue is destroyed Sometimes physicians destroy certain sites along the | conduction pathway as a treatment for slow or fast heart rhythms. |
| Ablation procedures are reported according to whether they were at | at the AV Node, 93650 a separate 93655 or an additional Treatment 93657 |
| Ambulatory blood pressure monitoring is | an outpatient procedure that is conducted over a 24 hour period by means of a portable device worn by the patient. There is a code for the total procedure including recording, scanning, analysis, and interpretaion report also individual compent codes |
| Technical Component is | the equipment and the technician who actually provides the service. |
| Professional Component is | the interpretation of the results and the writing of a report about the results. |
| Global Service | the total service |
| Global Radiology code with no modifier is used when | both the professional component and the technical component were provide by the same entity when that entity provides the total service both professional and technical then use the gobal code |
| The clinic that owns their own equipment and employs a technician who takes the x-rays would report | -TC |
| The xrays sent out to a radiologist to interpret the x-ray would report | -26 Professional Component |
| Contrast Material | Commonly used with radiology procedures to enhance the image. |
| Oral or Rectal contrast material is | not reported separately. It is considered part of the procedure |
| Contrast Material that can be reported separately: | Intravenous, intra-arterial, or intrathecal-fluid filled space between the layers of tissue covering the brain and spinal cord- can be reported separately as long as the code doesn't say its included. |
| Two physicians, cardiologist and a radiologist from the same facility, perform s an angiography of the brachiocephalic artery -first order- using contrast material. Access was the rt femoral artery coding is as follows: | Cardiolgois placing the catheter-36215, Surgery Section, Radiologist performing the angiography: 75710, Rad Section, Supply of the contrast material: 99070 Medicine Section, or HCPCS Level II code such as A4641, Radiopharmaceutical, diagnostic |
| Two physicians a cardiologist and a radiologist from different facilities, perform an angiography of the brachiocephalic artery first order using contrast material. The codeing for the cardiologist is as follow | Cardiologist placing the catheter: 36215 Aurgery section for the Radiologist performing the angiography: 75710 Rad section, Supply of the contrast material: 99070, Medicine Section, or a HCPCS Level II code such as A4641 Radiopharmaceutical, diagnostic |
| If the radiologist is at the same facility as the equipment, you report 75710 angiography. If the angiography was performed at the hospital and the radiologist from a clinic read the angiography the radiologist would report | 75710-26 and the hospital would report 75710-TC |
| RC --HCPCS Specific coronary Artery modifier | Right Coronary |
| RC --HCPCS Specific coronary Artery modifier | Left Circumflex |
| RC --HCPCS Specific coronary Artery modifier | Left Anterior Descending |
| RC --HCPCS Specific coronary Artery modifier | Left Main Coronary Artery |
| Endoluminal Imaging | |
| Intracoronary Stent placement | performed using a catheter to reinforce a coronary vessel that has collapsed or is block stent placement is usually with radiographyic guidance which is included . codes are divided based on whether more than1 coronary vessel was cleared of obstrucgtion |
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