Chapter 13 CPT Surgery III

Cardiovascular System Subsection Heart and pericardium Arteries and veins Arranged anatomically Arranged according to procedure performed

Arterial Circulation Delmar/Cengage Learning

Venous Circulation Delmar/Cengage Learning

Cardiovascular Notes Instruction for selective vascular catheterization Report separately when performed as part of cardiovascular procedure Parenthetical notes located above “heart and pericardium” heading Located throughout cardiovascular subsection

Cardiopulmonary Bypass Review operative report to determine whether to assign cardiopulmonary bypass code for procedure performed e.g., code 33305 versus code 33300

Selective Vascular Catheterization Insertion and manipulation/guidance of catheter into branches of arterial system to perform diagnostic or therapeutic procedures Usually performed under fluoroscopic guidance Crucial to have knowledge of how blood flows throughout circulatory system (continued)

Selective Vascular Catheterization Separate codes not reported for administration of local anesthesia, introduction of needle or catheter, or injection of contrast material Codes not reported for nonselective vascular catheterization

Heart and Pericardium 33010-33999 Key terms Pericardium Pericardiocentesis Tube pericardiostomy Pericardiectomy

Coding Tip Report code from 32658-32661 when surgical thoracoscopy performed to: Remove clot or foreign body Create pericardial window Carry out total pericardiectomy Excise pericardial cyst, tumor, or mass

Pacemaker/Pacing Cardioverter-Defibrillator Regulates patient’s heartbeat to prevent arrhythmias Two types Single chamber Dual chamber

Pacemakers Determine Type of pacemaker device (single or dual) Surgical approach for electrode placement Epicardial Endocardial (transvenous) Whether insertion is initial, repair, replacement, or upgrade procedure (continued)

Pacemakers Determine Whether insertion involves entire pacemaker system or just a component Whether fluoroscopic guidance was used

Artificial Pacemaker Implanted under the skin Delmar/Cengage Learning

Electrophysiologic Operative Procedures Operative cardiac ablation Modified maze procedure Maze procedure

Cardiac Valves Valvular heart disease Valvular atresia Valvular prolapse Valvular regurgitation Valvular stenosis

Coronary Artery Bypass Graft (CABG) Delmar/Cengage Learning (continued)

CABG Code according to type of graft Venous Combined arterial-venous

Congenital Heart Defects Septal defects Heart murmur Tetralogy of Fallot Transposition of great vessels Truncus arteriosus

Heart/Lung Transplantation Three components Cadaver donor cardiectomy with or without pneumonectomy Backbench work Recipient heart with or without lung allotransplantation

Embolectomy and Thrombectomy Surgical removal of blood clot that circulates throughout bloodstream Thrombectomy Surgical removal of fixed blood clot

Balloon Angioplasty Balloon angioplasty used to reopen blocked coronary artery Delmar/Cengage Learning

Transluminal Angioplasty Open transluminal angioplasty Percutaneous transluminal angioplasty (PTA)

Percutaneous Transluminal Coronary Angioplasty (PTCA) Delmar/Cengage Learning

Transluminal Atherectomy Atherectomy devices inserted into vessel to remove plaque Catheter with rotating blade Laser catheter Dissectional catheter

Atherectomy Catheter Rotating blade shaves and dislodges plaque Delmar/Cengage Learning

Vascular Injection Procedures Supplies reported with HCPCS level II codes if provided with vascular injection procedure Catheters Drugs Contrast media

Coding Tips Codes for cardiac catheterization assigned from Medicine section of CPT When multiple vessels accessed during catheterization in different vascular families, report code for highest level of selectivity in each vascular family (continued)

Coding Tips Do not report separate code for when catheter is removed from vessel

Therapeutic Apheresis Procedure codes based on blood components White blood cells Red blood cells Platelets Plasmapheresis Extracorporeal immunoadsorption and plasma reinfusion Extracorporeal selective adsorption

Central Venous Access Procedures Determine Patient’s age Whether catheter was tunneled Whether procedure was done via cutdown or peripherally

Hemic and Lymphatic Systems Headings include the following Spleen General Lymph nodes and lymphatic channels

Lymphatic Circulation Major lymph node locations Delmar/Cengage Learning

Lymph Nodes Located in Back of head Neck (cervical region) Armpits (axillary region) Chest (supraclavicular region) Abdomen (retroperitoneal region) Groin (inguinal region)

Spleen Spleen performs many important functions related to immune system Delmar/Cengage Learning (continued)

Spleen Excision Repair Laparoscopy Splenectomy Ruptured spleen (splenorrhaphy) Laparoscopy

General Bone marrow services/procedures Red marrow Yellow marrow Produces red blood cells, white blood cells, and platelets Yellow marrow Replaces red marrow with fatty tissue that does not produce blood cells (continued)

General Stem cell services/procedures Hemopoietic Stromal Pertains to the formation of red blood cells, white blood cells, and platelets Stromal Produces fat, cartilage, and bone Can differentiate into many kinds of tissue

Bone Marrow Procedures Harvesting Aspiration Biopsy Transplantation Preservation Preparation Purification

Lymph Nodes and Lymphatic Channels Incision Excision Limited lymphadenectomy for staging Laparoscopy Radical lymphadenectomy Introduction

Lymph Circulation Interaction with blood vessels and cells Delmar/Cengage Learning