1. Chapter 13
CPT Surgery III

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

3. Arterial Circulation
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4. Venous Circulation
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5. 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

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

7. 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)

8. 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

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

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

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

12. 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)

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

14. Artificial Pacemaker
Implanted under the skin
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15. Electrophysiologic Operative Procedures
Operative cardiac ablation
Modified maze procedure
Maze procedure

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

17. Coronary Artery Bypass Graft (CABG)
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(continued)

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

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

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

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

22. Balloon Angioplasty
Balloon angioplasty used to reopen blocked coronary artery
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23. Transluminal Angioplasty
Open transluminal angioplasty
Percutaneous transluminal angioplasty (PTA)

24. Percutaneous Transluminal Coronary Angioplasty (PTCA)
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25. Transluminal Atherectomy
Atherectomy devices inserted into vessel to remove plaque
Catheter with rotating blade
Laser catheter
Dissectional catheter

26. Atherectomy Catheter Rotating blade shaves and dislodges plaque
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27. Vascular Injection Procedures
Supplies reported with HCPCS level II codes if provided with vascular injection procedure
Catheters
Drugs
Contrast media

28. 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)

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

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

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

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

33. Lymphatic Circulation
Major lymph node locations
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34. Lymph Nodes Located in Back of head Neck (cervical region)
Armpits (axillary region)
Chest (supraclavicular region)
Abdomen (retroperitoneal region)
Groin (inguinal region)

35. Spleen
Spleen performs many important functions related to immune system
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(continued)

36. Spleen Excision Repair Laparoscopy Splenectomy
Ruptured spleen (splenorrhaphy)
Laparoscopy

37. 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)

38. 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

39. Bone Marrow Procedures
Harvesting
Aspiration
Biopsy
Transplantation
Preservation
Preparation
Purification

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

41. Lymph Circulation Interaction with blood vessels and cells
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