Cardiovascular Systems

Chapter 10

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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

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Circulatory System

• Cardiovascular System– Heart– Blood Vessels

• Arteries• Veins

• Lymphatic System

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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

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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

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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 dioxide04/21/23 9

Heart

• 4 Chambers– Two atria– Two ventricles

• Three layers– Myocardium– Epicardium– Pericardium

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Heart Valves

• Atrioventricular valves– Tricuspid– Bicuspid

• Semilunar valves– Pulmonary – Aortic

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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 Ill-Deffined Conditions

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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 (393-398)– 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

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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

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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

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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

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Vascular Injection Procedures

• Treatment of aneurysm

• Injection for venography and visualization

• Diagnostic

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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®

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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

• Arterial (37184-37186)• Venous (37187-37188)• Other (37195-37216)• Foreign body retrieval, stent placement, etc.

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Endovascular Revascularization (37220-37235)

• 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)

–

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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

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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

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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

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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

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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

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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

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Cardiac Catheterizations(93451-93581)

• Most common access point – femoral artery

• Right or left heart catheterization?

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Cardiac Anomalies

• Septal Defect – holes in the walls of the pump separating the atria and ventricles

• Repair of Septal Defect– 93580-93581– Transcatheter Closure

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Intracardiac Electrophysiological Procedures/Studies

• 93600-93662

• Percutaneous

• Indications - Cardiac arrythmias causing:• Palpitations – irregular heart beats• Syncope – loss of consciousness• Cardiac arrest

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Peripheral Arterial Disease (PAD)

• Rehabilitation is reported per session

• Narrowing or blockage of the arteries in the legs

• Symptoms:– Cramping– Aching– Numbness

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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

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The End

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