Surgery

Medicine

Radiology

entering the body

breaking the skin

to make a correction or from examination

includes percutaneous procedures

not breaking the skin

usually performed for diagnostic purposes

• Electrophysiology
• the study of the electrical system of the heart
• includes the study of arrhythmias

• a diagnostic specialty 
• uses radioactive radiologic procedures to aid in the dx of cardiologic conditions.

• HCPCS Level II codes will often also be reported
• "A" codes report radiopharmaceuticals
• "G" codes report the procedures and procedures combined with the supplies, radiopharmaceuticals and drugs
• "J" codes report the drugs
• "Q" codes report contrast agents.

contains codes for procedures that involve the

• repair of the heart and coronoary vessels, such as placement of pacemakers
• repair of valve disorders
• graft/bypass procedures.

location of the procedure

coronary vs noncoronary

The Surgery section, Cardiovascular System subsection,

Heart and Pericardium Subheading

(33010-33999)

• Pericardiocentesis codes 33010 and 33011

• are divided based on initial or subsequent service

During pericardiocentesis 33010, 33011

insertion can be performed using radiologic (ultrasound) guidance - use of which would be reported with

a separate code from the Radiology section.

a note follows the pericardiocentesis codes that states: (for radiological supervision and interpretation, use 76930), that is ultrasonic guidance for pericardiocentesis, imaging supervision, and interpretation.

Pericardium category

(33010-33050)

1. where the electrode is placed (atrium, ventrical or both ventricle and atrium
2. Whether the procedure involves initial placemennt, replacement, upgrade or repair of all components or separate components of the pacemaker
3. The approach used to place the pacemaker (epicardial or transvenous)

Fluoroscopic portion is reported separately with a radiology code (71090) because it is not bundled into the pacemaker codes.

Transvenous codes are further divided based on the area of the heart into which the pacemaker is inserted.

1. Revision or replacement of lead(s)
2. Replacement, repair, removal of components
3. Approach used for insertion or repair

not included in the surgery code reported for the insertion.

The EP is reported separately using the Medicine section codes 93600-93660

not included.

if radiology supervision and interpretation are provided, you would report the service using the Radiology code 71090, Insertion of pacemaker, fluoroscopy, radiography, radiological supervision, and interpretation, remembering to use the modifier -26 on a radiology service when only the professional portion of the ervice was provided and -TC when only the technical portion was provided.

Most of the codes for the EP tests are in the Medicine section.

endarterectomy and angioplasty.

Do not unbundle

procedures  often require use of cardiopulmonary bypass to allow the surgeon to repair the defect while the heart is without blood flow 

Reporting

Coronary Artery Bypass Grafting

you must know whether an artery, vein or both are being used as the bypass graft.

know how many bypass grafts are being performed.

modifier -51 would not be assigned with the code for the venous grafts because codes 33517-33523 are add-pn codes.

vasculor family

first order

vascular family

second order

vascular family

third order

exercise-induced studies

pharmacologically-induced studies

Which item is not considered to be bundled in with a vascular injection?

a. local anesthesia

b. contrast media

c. introduction of needle or catheter

d. pre-injection and post-injection care related to the procedure.