MEDICAL CODING AND BILLING
CARDIOVASCULAR
CHAPTER 16
OVERVIEW
Cardiovascular system uses three sections of the CPT book -pg 471 SBS TB)
 Surgery (33010 – 37799) – for the cardiovascular surgeries
o Heart and Pericardium
o Endoscopy
o Arteries and veins
o Adjuvant Techniques
 Medicine (92950 – 93799) – nonsurgical cardiovascular services
o Therapeutic Services
o Cardiography
o Echocardiography
o Cardiac Catheterization
o Intracardiac Electrophysiological Procedures
o Peripheral Arterial Diseases Rehabilitation
o Other Vascular Studies
o Other Procedures
 Radiology (75557 – 75791) – for diagnostic or radiological visualization codes
o Heart
o Aorta and Arteries
o Diagnostic Ultrasound (various)
o Radiologic Guidance (77001 – 77032)
o Nuclear Medicine (78414 – 78499)
30,000’S
Major invasive procedures requiring the surgeon to open a patient up
 Invasive –
o entering the body (ex. Removal of a clot from a vessel)
o or breaking the skin to make a correction or for examination
 Invasive Cardiology procedures are also called Interventional Procedures
where the doctor’s need to do something / cut into the patient to correct /
examine the patient.
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MEDICAL CODING AND BILLING
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CHAPTER 16 (cont)
OVERVIEW
Note: To choose the correct cardiology code, first determine whether the procedure or
service was invasive (interventional, open, percutaneous) or noninvasive. (pg 472 SBS
TB).
Ex. What CPT and ICD-9-Cm codes report a percutaneous insertion of a dual (=2)
chamber pacemaker by means of the subclavian vein.
In human anatomy, the subclavian veins are two large veins, one on
either side of the body. Its diameter is approximately that of a man's small
finger. It is divided into right and left subclavian vein.
The diagnosis was sick sinus syndrome, tachy-brady.
A. 33249 (Insertion or repositioning of electrode lead(s) for single or dual chamber
pacing cardioverter-defribillator and insertion of pulse generator – eliminate
because pulse generator was not inserted), 427.0 (Paroxysmal supraventricular
tachycardia), 427.81 (sick sinus syndrome)
B. 33217 (Insertion of 2 transvenous electrodes, permanent pacemaker or
cardioverter-defibrilator), 427.81 ((sick sinus syndrome)
C. 33208 (Insertion or replacement of permanent pacemaker with transvenous
electrode(s) atrial and ventricular – eliminate because artery and vein), 427.81
D. 33240 (Insertion of single or dual chamber pacing cardioverter-defibillator pulse
generator- eliminate because pulse generator not inserted), 426.12 (Mobitz
(type) II atrioventricular block – eliminate because artery and vein), 427.0
Electrophysiology - (93600-93662) – study of the electrical system of the heart and
includes the study of arrhythmias. (invasive diagnostic procedure, located in the
Medicine section pg, 472 SBS TB and pg 468 CPT book – read instructions
Pg 480 SBS TB also
 Includes the insertion and repositioning of electrode catheters, recording of
electrograms before and during pacing or programmed stimulation of multiple
locations in the heart, analysis of recorded information, and report of the
procedure.
 When providing the surgical procedures, see 33202-33249, 33250-33266
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MEDICAL CODING AND BILLING
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CHAPTER 16 (cont)
Angiography – pg 472-473 SBS TB
 Nuclear cardiology – uses radioactive radiologic procedures to aid in the
diagnosis of cardiologic conditions
 Ex. A nuclear cardiologist may inject a radioactive dye into the bloodstream to
improve the detail of the study. (use the Heart section – 75557-75574, Aorta and
Arteries 75600-75791, Veins and Lymphatics 75801-75893) and the code from
the Medicine section for the injection (admin/injection codes are in the 90,000
section of CPT.
Cardiovascular Coding in the Surgery Section (33010 – 37799) – pg 473-474 SBS
TB
Contains the diagnostic and therapeutic procedure codes
 Further divided on the basis of whether the procedure was performed on the:
o Heart/pericardium (33010 – 33999) – pg 163 – 178 CPT
 Procedures involve the repair of the heart, pericardium and /or
coronary vessels such as:
 Pacemakers
 Repair of valve disorders
 Graft/bypass
 Procedures are performed both percutaneously and thru open
surgical sites.
 Pericardiocentesis (33010, 33011) –withdrawal of fluid from the
pericardial space by means of aspiration (pg 475 SBS TB)
 33020 – 33050 – open surgical procedures for the removal of
clots, foreign bodies, tumors, cysts, a portion of the pericardium,
or to create a window to allow pericardial fluid to drain into the
pleural space
 Cardiac Tumor (33120, 33130) – only 2 tumor removal codes in
this section
 Transmyocardial Revascularization – 33140, +33141 if needed
 Pacemaker or Pacing Cardioverter-defibrillator (33202-33249)
 See pg 476 - 478 SBS TB for coding information and
read guidelines in the CPT book
Note: Do exercises on pg 479 SBS TB and work backwards to see how they got the
answers.
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MEDICAL CODING AND BILLING
CARDIOVASCULAR
CHAPTER 16 (cont)
Patient-Activated Event Recorder (Loop Recorder) – pg 480 SBS TB
 33282 & 33284 – surgical implantation into the subcutaneous tissue in the
upper left quadrant (where your heart is) with leads running to the outside of
the body. Records the heart’s rhythms. Patient presses the buttons and
records the electrical activity of the heart.
Cardiac Valves – 33400 – 33496 – pg 481 SBS TB
 Subcategories of aortic, mitral, tricuspid, and pulmonary valves
Do exercises on pg 481 and work backwards.
Coronary Artery Anomalies – 33500 – 33507
 Used to report the services of repair of the coronary artery by various
methods
Coronary Artery Bypass – pg 482 SBS TB
 Reversible ischemia
 Irreversible ischemia
 Coronary artery bypass grafting
 Percutaneous transluminal coronary angioplasty (PTCA)
Note: Check to see if the coronary bypass is for the artery (33533-33536), vein (3351033516) or both (33517-33523) and what type of bypass graft (33533-33536) is being
used, plus how many bypass grafts are being performed. 9pg 482 – 484 SBS TB)
Note: Do exercise on pf 484 SBS TB and work backwards
Arteries/veins – (34001 – 37799) – pg 178 – 202 CPT, pg 486 – 494 SBS TB
 Same type of procedures for coronary arteries but for noncoronary (nonheart)
vessels
Coding Clue: The location of the procedure – coronary or noncoronary – is the first
step in selecting the correct cardiovascular surgical code,
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MEDICAL CODING AND BILLING
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CHAPTER 16 (cont)
Vascular Families
 Nonselective catheter placement – catheter or needle is placed directly into
an artery or vein or is placed only into the aortia from any approach
 Selective catheter placement means the catheter must be moved,
manipulated, or guided into a part of the arterial system other than the aorta
or the vessel punctured (that is, into the branches), generally under
fluoroscopic guidance
 First order – main artery in a vascular family
 Second order – branch off the main artery
 Third order – next branch off the second order, and so on
Note: Code to the farthest extent of the vascular family using an initial code; then code
any additional services of the second order, third order, or beyond by using an add-on
code
Embolectomy/Thrombectomy – pg 488 SBS TB
 Embolus – mass of undissolved matter that is present in blood and is transported
by the blood
 Thrombus – blood clot that occludes, or shuts off, a vessel
 When a thrombus is dislodged, it becomes and embolus
 Divided based on the artery or vein in which the clot or thrombus is located, etc.
Cardiovascular Repairs – pg 489 SBS TB
 Vein repairs
 Aneurysm repair
 Pseudoaneurysm (false aneurysm)
 Fistula repair (35180-35190)
 Angioscopy
 Transluminal angioplasty (35450-35476)
 Transluminal atherectomy (35480-35495)
Bypass Grafts, Veins – pg 490-491 SBS TB
 CABG (coronary artery bypass grafting)
 Grafts can be vessels harvested from other areas of the body or they may be
made of artificial materials
Vascular Access – ex. Dialysis treatments – pg 491 SBS TB
Vascular Injection Procedures – 36000 – 36522
 See pg 491 for bundling information
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MEDICAL CODING AND BILLING
CARDIOVASCULAR
CHAPTER 16 (cont)
Pg 493 – 494 SBS TB – draw into CPT book onto page 575 CPT book. On page
576 – vascular families. (used for interventional radiology)
Cardiovascular Coding in the Medicine Section – 92950 – 93799, pg 495 SBS TB
 Invasive vs Non-Invasive Procedure - an incision into or a puncture of the skin
vs procedure that doesn’t break the skin
o Division of the codes is based on method, location, number of vessels
 Diagnosis and treatment
 Various types of test
 Monitoring of a patient’s condition
 Percutaneous procedures
 Same day procedures
o Thrombolysis – 92975
o Intravasular Ultrasound – 92978, 92979
o Intracoronary Stent Placement – 92980, 92981
o Uses radiographic guidance
o Valvuloplasty – 92960 – 92990
HCPCS to ID the specific coronary arteries that are treated - pg 497 SBS TB
 RC – right coronary
 LC – left circumflex
 LD – left anterior descending
Sections 92950-93799 – only considered invasive because there is an incision into or a
puncture of the skin. Does not fall into the 30,000 section because it’s not major
surgery and the doctor does not cut a patient open.
Cardiography – 93000 – 93278
Ex. Stress tests – 93015 – 93018
Are drug or exercised induced
ECG – bundled into the stress test
Holter Monitor – 12 lead ECG – 93000 – 93010
Other ECG’s – 93040 – 93278
Telephonic transmission – 93012, 93014
SAECG – Signal averaged electro cardiography – 93278 (more
sophisticated version of the ECG)
Echocardiography – 93303 – 93350
Systole – heart is contracting
Diastole – heart at rest
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MEDICAL CODING AND BILLING
CARDIOVASCULAR
CHAPTER 16 (cont)
 Cardiac Catheratization – 93501 – 93572
o Uses a guide wire and catheter
o An bill for additional injection procedure codes – 93540 or 93544
o Cardiologist supervises, interprets, and reports on the x-ray imaging – 93555
and 93556
 3 components of cardiac cathertization
 Placement – 93501 – 93533
 Injection – 93539 – 93545
 Imaging supervision, interpretation and report on the injection
procedure – 93555, 93556
Indicator dilution studies – can only be billed when complete cardiac catheterization was
not done – 93561 – 93572
Intracoronary Brachytherapy – 92974 – add-on code, use with codes in 70000 section
SA Node – Sinoatrial node aka hearts pacemaker
AV node – atrioventricular node, where the pulses from the SA node passes through, in
turn passes the impulses to the bundle of HIS, then on to the Purkinje fibers to stimulate
the ventricles of the heart.
Pacing – regulation of the heart
 Recording is done by and ECG – 93600 – 96303
Single recording – 93602 and 96303
Single paring – 93610 - 93612
 The pacing services – 93610 – 93612
More complex procedures – 93619 – 93622
Mapping – if the doctor cracks you open – 93631 and use codes from 33250 – 33261
If mapping not done intraoperatively – 96309 or 96315
Ablation – destroy certain tissue that is bad – 96351 and 96352
Peripheral Arterial Disease Rehab – 93668, rehabilitation exercises for the heart
Non-invasive Physiologic Studies and Procedures – 93701 – 93790
 Depends on type of pacemaker used
Plethysmography – 93720 – 93772
Electronic Analysis – 93279 – 93299
Ambulatory Blood Pressure Monitoring – 93784 – 93790
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MEDICAL CODING AND BILLING
CARDIOVASCULAR
CHAPTER 16 (cont)
Virtual Surgery Game – Heart Operation Game
http://www.bhf.org.uk/cbhf/games/heart_op/
Cardiovascular Coding in the Radiology Section -70,000’S, pg 509
 Uses radioactive elements
 Professional and technical components (TC and 26 modifiers)
 Supervision
 Interpretation
 Global Service
Report both the technical and professional components of the following service: This
68-year-old male is seen in Radiation Oncology Department for prostate cancer. The
oncologist performs a complex clinical treatment planning, dosimetry calculation,
complex isodose plan; treatment devices include blocks, special shields, wedges, and
treatment management. The patient had 5 days of radiation treatments for 2 weeks, a
total of 10 days of treatment.
A.
B.
C.
D.
77263, 77300, 77315, 77334, 185
77300, 77315, 77334, 77427 x 2, 185
77263, 77300, 77315, 77334, 77427 x 2, 185
77263, 77427 x 2, 185
Watch the verbage – pg 510 SBS TB
 With contrast
 Without contrast
 With or without contrast
 Without and with contrast
Ex. CT of abdomen and pelvis: Technique: CT of the abdomen and pelvis was
performed without oral or IV contrast material per physician request. No previous CT
scans for comparison.
Findings: No ascites. Moderate-sized pleural effusion on the right.
A.
B.
C.
D.
74160-26, 789.59
74150-269, 511.9
74150, 511.9
74160, 789.59
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MEDICAL CODING AND BILLING
CARDIOVASCULAR
CHAPTER 16 (cont)
Ex. This 69-year-old female is in for a magnetic resonance examination of the brain
because of new seizure activity. After imagining without contrast, contrast was
administered, and further sequences were performed. Examination results indicated
no apparent neoplasm or vascular malformation.
A.
B.
C.
D.
70543-26, 780.31
70543-26, 780.39
70553-26, 780.39
70553, 345.90
Heart subsection – 75557 – 75574, pg 511 SBS TB
 These use MRI – MRI is a radioactive type of test that show’s the body in a
cross-sectional view. May use injectable dyes to aid in imaging.
 Types of test:
o MRA
o CT Scan
Aorta and Arteries - 75600 – 75791, pg 511 SBS TB
 NOTE: can code the contrast IF the description does not refer to the inclusion of
contrast material
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Remember: Coding is not brain surgery
It’s harder. Get certified
A person can actually learn brain surgery
A person never learns coding – the rules change every day
There are about 5000 brain surgeons in the US with a medium income of $600,000.
We have been unable to locate any coders in the US who make $600,000. There’s
always hope.
For a brain surgeon, it’s the eyes that usually go first. For the coder, the brain can
pretty much go any day of the week, followed, in quick succession, by everything else.
On a bad day, a brain surgeon may sit back and wish they were coding claims instead
of being elbow deep in someone’s noggin.
On a bad day, which can occur at any time, a coder may sit back and consider visiting a
brain surgeon. Hey, you’ve tried everything else. Maybe they’ve figured out that
transplant thing by now.
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