Cardiovascular Systems
Chapter 10
1
CPT® copyright 2010 American Medical Association. All
rights reserved.
Fee schedules, relative value units, conversion factors
and/or related components are not assigned by the AMA,
are not part of CPT®, and the AMA is not recommending
their use. The AMA does not directly or indirectly practice
medicine or dispense medical services. The AMA assumes
no liability for data contained or not contained herein.
CPT® is a registered trademark of the American Medical
Association.
2
Objectives
• Master anatomical concepts necessary to understand the
cardiovascular system
• Define key terms, and recognize common eponyms and
acronyms
• Explain the most common pathologies that effect this system
• Understand cardiovascular procedures and surgeries, and
where in CPT® to locate the relevant codes
• Introduce ICD-9-CM and HCPCS Level II codes and coding
guidelines as they apply to this system
• Supply examples and review material to improve your
application of the above concepts
3/23/2016
3
Circulatory System
• Cardiovascular System
– Heart
– Blood Vessels
• Arteries
• Veins
• Lymphatic System
3/23/2016
4
Anatomy
• Arteries
– Carry oxygenated blood
– Take blood away from heart to the body
• Veins
– Carry deoxygenated blood
– Bring blood back to the heart from the
capillary beds
• Capillaries
– Connect arteries and veins
3/23/2016
6
Anatomy
• Lymphatic System
– Lymph – fluid collected
– Lymph nodes – small collections of lymphatic
tissue through which lymph fluid is filtered
– Lymphocytes – cells of the immune system
3/23/2016
7
Electrical Conduction in the Heart
– Conduction begins in sinoatrial node of
right atrium
• Nature’s pacemaker
• Firing causes contraction of muscle
– Moves to atrioventricular node
• Then to Bundle of His along septum
• Then to Purkinje fibers along the surface of
ventricles
Circulations
• Pulmonary Circulation
– Pushes deoxygenated blood into the lungs
– Carbon dioxide removed and oxygen added
– Blood flows to the left atrium
• Systemic Circulation
– Blood flows from left atrium into the left
ventricle
– Pumped to the body to deliver oxygen and
remove carbon dioxide
3/23/2016
9
Heart
• 4 Chambers
– Two atria
– Two ventricles
• Three layers
– Myocardium
– Epicardium
– Pericardium
3/23/2016
10
Heart Valves
• Atrioventricular valves
– Tricuspid
– Bicuspid
• Semilunar valves
– Pulmonary
– Aortic
3/23/2016
11
ICD-9-CM Coding
• Chapter 01 – Infectious and parasitic
diseases
• Chapter 02 – Neoplasms
• Chapter 07 – Diseases of the Circulatory
System
• Chapter 14 – Congenital Anomalies
• Chapter 16 – Signs, Symptoms and IllDeffined Conditions
3/23/2016
12
Diseases of the Circulatory System
• Acute rheumatic fever (390-392)
– Symptoms include fever, joint pain, lesions of
the heart, blood vessels and joint connective
tissue, abdominal pain, skin changes, and
chorea
• Chronic rheumatic heart disease (393398)
– Persistant inflammation of heart lining due to
rheumatic heart disease.
ICD-9-CM: Hypertension
• Hypertensive Disease
– 401 Essential hypertension
– 402 Hypertensive heart disease
– 403 Hypertensive chronic kidney disease
– 404 Hypertensive heart and chronic kidney
disease
ICD-9-CM: Ischemic Heart Disease
• 410 Acute myocardial infarction
• 411 Other acute and subacute forms of
ischemic heart disease
• 412 Old myocardial infarction
• 413 Angina pectoris
• 414 Other forms of chronic ischemic heart
disease
ICD-9-CM: Aneurysm
• 414.1 Aneurysm and dissection of heart
– 414.10 Aneurysm of heart (wall)
– 414.11 Aneurysm of coronary vessels
– 414.12 Dissection of coronary artery
– 414.19 Other aneurysm of heart
ICD-9-CM: Heart Disease
•
•
•
•
•
•
•
•
•
•
•
415 – 417 Diseases of pulmonary circulation
420 Acute pericarditis
421 Acute and subacute endocarditis
422 Acute myocarditis
423 Other diseases of pericardium
424 Other diseases of endocardium
425 Cardiomyopathy
426 Conduction disorders
427 Cardiac dysrhythmias
428 Heart Failure
429 Ill-defined descriptions and complications of heart
disease
ICD-9-CM: Congenital Anomalies
• 745 Bulbus cordis anomalies and anomalies of cardiac
septal closure
• 746 Other congenital anomalies of heart
• 747 Other congenital anomalies of circulatory system
Signs & Symptoms
• 785 Symptoms involving cardiovascular system
–
–
–
–
–
–
–
–
785.0 Tachycardia, unspecified
785.1 Palpitations
785.2 Undiagnosed cardiac murmurs
785.3 Other abnormal heart sounds
785.4 Gangrene
785.5X Shock without mention of trauma
785.6 Enlargement of lymph nodes
785.9 Other symptoms involving cardiovascular system
• 786.5X Chest pain
– 786.50 Chest pain, unspecified
– 786.51 Precordial pain
– 786.59 Other
Terms
•
•
•
•
Apex – bottom point of the heart
Retrograde – against the current
Antegrade – with the current
Cardioversion – shock treatment to the
heart
• CPR – Cardiopulmonary resuscitation
• Tachycardia – rapid beating of the heart
• Pacing – refers to electrical activity of the
heart
3/23/2016
20
CPT Coding
• Surgical Section – 33010-37799
• Radiology Section
– Heart – 75557-75574
– Vascular – 75600 – 75989
– Diagnostic Ultrasound (various CPTs)
– Radiologic Guidance – 77001 – 77032
– Nuclear Medicine – 78414 – 78499
• Medicine Section
– Cardiovascular – 92950 – 93799
– Noninvasive Vascular Diagnostic Studies –
93875-93990
Pericardium
• Pericardiocentesis (33010 – 33011)
– Diagnostic test
– Cardiac tamponade
– Radiological supervision and interpretation
(76930)
• Pericardial window (33025)
Pacemakers/Defibrillators (33202- 33249)
• Pacemaker System
• Pacing cardioverter-defibrillator system
• Codes
– Insertion or replacement (33210-33213)
– Implanted pacemakers (33212-33214)
– Biventricular (2 ventricles) (33224-33226)
Electrophysiologic Operative
Procedures
• Incision
– 33250 – 33261
• Endoscopy
– 33265 - 33266
Wounds of the Heart and Great
Vessels
• 33300-33335 – repair of great vessels
• Great vessels:
– Superior vena cava
– Inferior vena cava
– Pulmonary artery
– Four pulmonary veins
– Aorta
3/23/2016
25
Cardiac Valve Procedures
• Aortic Valve (33400 – 33417)
• Mitral Valve (33420 – 33430)
• Tricuspid Valve (33460 – 33468)
• Pulmonary Valve (33470 – 33478)
CABG
• Coronary Artery Bypass Graft
– Venous (33510-33516)
– Arterial-Venous (33517-33523)
– Reoperation (+33530)
– Arterial (33533-33536)
– Arterial Graft (33548)
Cardiac Anomalies (33600-33853)
• Single Ventricle and Other Complex Cardiac
Anomalies (33600 – 33622)
• Septal Defect (33641 – 33697)
• Sinus of Valsalva (33702 – 33722)
• Venous Anomalies (33724 – 33732)
• Shunting Procedures (33735 – 33768)
• Transposition of the Great Vessels (33770 –
33783)
• Truncus Arteriosus (33786 – 33788)
• Aortic Anomalies (33800 – 33853)
Heart/Lung Transplantation
• 33930-33945
• Distinct Components of Physician Work
– Cadaver donor cardiectomy with or without
pneumonectomy
– Backbench work
– Recipient heart with or without lung
allotransplantation
3/23/2016
29
Aneurysms
•
•
•
•
•
•
•
•
•
•
Abdominal Aorta
Axillary artery
Basilar Artery
Brachial Artery
Carotid Artery
Celiac Artery
Femoral Artery
Hepatic Artery
Iliac Artery
Innominate Artery
•
•
•
•
•
•
•
•
•
•
Intracranial Artery
Mesenteric Artery
Popliteal Artery
Radial Artery
Renal Artery
Splenic Artery
Subclavian Artery
Thoracoabdominal Aortal
Ulnar Artery
Vertebral Artery
Thromboendarterectomy/Angioplasty
• Clots
– Removed endoscopically
• Plaque
– Removed endoscopically
– Balloon angioplasty
– Stents
Bypass Grafts
• Non-coronary vessels
– Vein (35500-35572)
– In-situ vein (35583-35671)
• Vein is left in native location
– Other than vein (35681-35683)
• Code by type/location
3/23/2016
32
Vascular Injection Procedures
• Treatment of aneurysm
• Injection for venography and visualization
• Diagnostic
3/23/2016
33
Central Venous Access (36555-36598)
• Placed for frequent access to bloodstream
• Tip of catheter must terminate in the:
–
–
–
–
Subclavian
Brachiocephalic
Iliac
Inferior or superior vena cava
• Code by
–
–
–
–
Procedure (insertion, repair, replacement, removal, etc.)
Tunneled or not
With pump or port
Patient age
• See CVAP table in CPT®
3/23/2016
34
CPT®
• Hemodialysis (36800-36822)
• Portal Decompression (37410-37183)
– Treat hypertension/occlusion of portal vein
– TIPS (37182, 37183) diverts blood from the portal vein to
the hepatic vein
• Transcatheter Procedures
– Removal of clot
•
•
•
•
3/23/2016
Arterial (37184-37186)
Venous (37187-37188)
Other (37195-37216)
Foreign body retrieval, stent placement, etc.
35
Endovascular Revascularization (3722037235)
• Treat occlusive disease in lower extremities
• Three territories
– Illiac
– Femoral/Popliteal
– Tibial/Peroneal
• Codes arranged in a hierarchy for each territory
–
–
–
–
stent placement with atherectomy (highest)
stent placement
atherectomy
angioplasty (lowest)
–
3/23/2016
36
Bundled to Endovascular Revascularization
(37220-37235)
–
–
–
–
–
conscious sedation
vascular access
catheter placement
traversing the lesion
imaging related to the intervention (previously billed as the
supervision and interpretation code for the specific
intervention)
– use of an embolic protection device (EPD)
– imaging for closure device placement
– closure of the access site
37
Medicine Section
•
•
•
•
•
•
•
•
•
•
Therapeutic services and procedures
Cardiography
Cardiovascular monitoring services
Implantable wearable cardiac device evaluations
Echocardiography
Cardiac Catheterizations
Intracardiac Electrophysiological Procedures/Studies
Peripheral Arterial Disease Rehabilitation
Noninvasive physiologic studies and procedures
Other procedures
3/23/2016
38
CPR
• Cardiopulmonary resuscitation
– Includes defibrillation
– Includes treatment to the pulmonary system
– Non considered a component of critical care
services
• Cardioversion
– Electrical shock delivered to the heart to
convert an abnormal heart rhythm back to a
normal rhythm
3/23/2016
39
Cardiovascular Therapeutic
Services and Procedures
• Thrombolysis – Dissolving of a blockage
by a thrombus clot in a vessel
• Coronary stent – wire metal mesh tube
placed inside an artery to hold the vessel
open
• Angioplasty – dilate and open a blocked
artery
3/23/2016
40
Monitoring Heart Activity
• Cardiography (93040 – 93042)
– Codes for professional component, technical
component and global
• Implantable and Wearable Cardiac Device
Evaluations (93279-93299)
• Cardiac Stress Tests
– Activity or pharmaceutical
3/23/2016
41
Echocardiography
(93303-93352)
• Diagnostic ultrasound of the heart
• M-mode recording – used to measure
chamber dimensions and to establish the
timing of events
• Doppler echocardiography – records the
direction and velocity of blood flow
• Color-flow mapping – allows images of the
blood to be displayed
3/23/2016
42
Cardiac Catheterizations
(93451-93581)
• Most common access point – femoral
artery
• Right or left heart catheterization?
3/23/2016
43
Cardiac Anomalies
• Septal Defect – holes in the walls of the
pump separating the atria and ventricles
• Repair of Septal Defect
– 93580-93581
– Transcatheter Closure
3/23/2016
44
Intracardiac Electrophysiological
Procedures/Studies
• 93600-93662
• Percutaneous
• Indications - Cardiac arrythmias causing:
• Palpitations – irregular heart beats
• Syncope – loss of consciousness
• Cardiac arrest
3/23/2016
45
Peripheral Arterial Disease
(PAD)
• Rehabilitation is reported per session
• Narrowing or blockage of the arteries in
the legs
• Symptoms:
– Cramping
– Aching
– Numbness
3/23/2016
46
Modifiers
•
•
•
•
•
•
•
•
26 – Professional Component
TC – Technical Component
LC – Left Circumflex, Coronary Artery
LD – Left Anterior Descending Coronary Artery
RC –Right Coronary Artery
80 – Assistant Surgeon
51 – Multiple Procedures
52 – Reduced Services
3/23/2016
47
The End
3/23/2016
48