12.4 Guidelines and Format of the Cardiovascular Subsection of CPT The Cardiovascular System subsection: – Heart and Pericardium (33010–33999): Pericardium: 33010–33050, pericardiocentesis (surgical puncture into the pericardium) Pacemaker or Pacing Cardioverter-Defibrillator: 33202–33249, the coder must answer: – Was the device a pacemaker or a cardioverter-defibrillator? – Was it initial insertion, replacement, or repositioning? – Was the device permanent or temporary? – Was it single-chamber or dual-chamber, and where was lead placed (atrium or ventricle)? – Was the approach transvenous or epicardial? – Was the entire system (generator and leads) replaced, or was just the generator or leads replaced? – Was the pacemaker pocket revised? 12-24

12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.) The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Electrophysiologic Operative Procedures: 33250– 33266, referred to as EP procedures – Tissue ablation and reconstruction – Ablation works by scarring or destroying cardiac tissue that triggers abnormal heart rhythm – In some cases, can prevent abnormal electrical signals from traveling through the heart Heart (Including Valves) and Great Vessels: 33300– 33355, repair of cardiac wounds with or without cardiopulmonary bypass 12-25

The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Cardiac Valves: 33361–33478, the coder must answer: – Which valve(s) are involved: aortic, mitral, tricuspid, and/or pulmonary? – What procedure was performed: valvuloplasty, valvulotomy, or replacement? – Was procedure performed with or without cardiopulmonary bypass? Coronary Artery Bypass Grafting: 33510–33548, three types of coronary artery bypass grafts: – Venous grafting only for coronary artery, 33510–33516 – Combined arterial-venous grafting for coronary bypass, 33517–33530 – Arterial grafting for coronary bypass, 33533– Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Septal Defect: 33641–33697, occurs when there is a hole in the septum between the upper chambers of the heart Heart/Lung Transplantation: 33930–33945, includes three major physician components: – Cadaver donor cardioectomy with or without pneumonectomy, 33930, (codes include harvesting and cold preservation of the allograft) – Backbench work, 33933, – Recipient heart with or without lung allotransplantation, 33935,

12.4 Guidelines and Format of the Cardiovascular Subsection of CPT (cont.) The Cardiovascular System subsection (cont.): – Heart and Pericardium (33010–33999) (cont.): Cardiac Assist: 33960–33993, when a failing heart needs to be partially or completely replaced by a mechanical circulatory device, this can be achieved by the use of a ventricular assist device (VAD) Aneurysm Repair: 33860–33877, 33880–33891, 34800–34834, 34900, 35001–35152, repair of a bulge or swelling in the wall of a vessel 12-28

The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490): Embolectomy/Thrombectomy: 34001–34203, codes within this range are determined by: – Artery/vein involved – Incision site: thoracic, arm, abdominal, or leg Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490) (cont.): Vascular Injection Procedures: 36000–36598, based on whether the physician performed a selective or nonselective catheter placement: – Nonselective placement: Access vessel for the catheter is the femoral artery, and catheter does not advance further, OR access vessel is femoral artery, and catheter is advanced into aorta but no further – Selective placement: Catheter advances beyond aorta into right common carotid artery (second-order vessel) OR advances beyond aorta into right external iliac artery from left femoral artery access (contralateral placement from access) Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490) (cont.): Central Venous Access Procedures: 36555–36598, central venous access device (CVAD) is a small, flexible tube placed in large veins for patients who require frequent access to their bloodstreams – Insertion: place catheter through newly established venous access – Repair: fix device without replacement of catheter or port/pump – Partial replacement: replace only catheter component – Complete replacement: replace entire device via same venous access site – Removal: remove entire device Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)

The Cardiovascular System subsection (cont.): – Arteries and Veins (34001–34490) (cont.): Hemodialysis Access: 36800–36870, most common method for hemodialysis access is creation of an arteriovenous (AV) fistula – Surgeon connects the artery to the vein – Connection between vessels causes blood to flow from artery directly to the vein – Eventually vein walls become thicker/stronger and are ideal placement site for dialysis needle Guidelines and Format of the Cardiovascular Subsection of CPT (cont.)