Peripheral and Cardiology Coder 2018 Cardiovascular Services and Procedures Prepared and Published By: MedLearn Publishing A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN 55101 1-800-252-1578 www.medlearnmedia.com
Introduction...1 Moderate (Conscious) Sedation...9 Cardiac Catheterization Right Heart Catheterization... 13 Right Heart Catheterization with Coronary Angiography... 15 Right Heart Catheterization with Coronary and Bypass Graft Angiography (including SVG and IMA)... 16 Left Heart Catheterization... 17 Left Heart Catheterization With or Without Left Ventriculogram... 17 Left Heart Catheterization With or Without Left Ventriculography and Coronary Angiography... 18 Left Heart Catheterization With or Without Left Ventriculography, Coronary Angiography and Bypass Graft Angiography (Including SVG and/or IMA)... 19 Right and Left Heart Catheterization... 19 Right and Left Heart Catheterization With or Without Left Ventriculography... 20 Right and Left Heart Catheterization With or Without Left Ventriculography and Coronary Angiography... 20 Right and Left Heart Catheterization With or Without Left Ventriculography, Coronary Angiography and Bypass (Including SVG and/or IMA) Angiography... 21 Congenital Heart Catheterization... 22 Coronary and/or Bypass Graft Angiography (including SVG and/or IMA) Performed Without Concomitant Left Heart Catheterization Procedure... 23 Coronary and Bypass Graft (including SVG and/or IMA) Angiography Without Concomitant Left Heart Catheterization... 23 Injection Procedures for Congenital Cardiac Catheterization... 24 Coronary Angiography When Performed With Congenital Cardiac Catheterization... 24 Bypass Graft Angiography (Including SVG, IMA and radial) With Congenital Cardiac Catheterization... 24 Left Ventricular or Left Atrial Angiography Performed with Congenital Cardiac Catheterization... 24 Injection Procedures for Cardiac Catheterization... 25 Right Ventricular or Right Atrial Angiography Performed with Cardiac Catheterization... 25 Supravalvular Aortography (Aortic Root Injection) Performed with Cardiac Catheterization... 25 iii
Pulmonary Angiography Performed with Cardiac Catheterization... 25 Swan-Ganz Placement... 26 Left Heart Catheterization by Transseptal or Transapical Puncture... 26 Pharmacologic Agent Administration... 28 Physiologic Exercise Study...30 Intravascular Doppler Flow Reserve Measurement... 31 Renal Artery Angiography (Non-Selective) During Cardiac Catheterization... 32 Iliac and/or Femoral Artery Angiography (Non-Selective) During Cardiac Catheterization... 32 Vascular Closure Devices... 33 Low Osmolar Contrast Media/Non-Ionic Contrast... 33 Ambulatory Blood Pressure Monitoring... 35 Cardiopulmonary Resuscitation... 35 Cardiac Catheterization Procedures and Codes... 36 Coronary Interventions: Stenting, Angioplasty and Atherectomy of Major Coronary Arteries, Coronary Artery Branches and Bypass Grafts Coronary Interventions... 37 Percutaneous Transluminal Coronary Angioplasty... 42 Percutaneous Transluminal Coronary Atherectomy... 42 Intracoronary Stent Placement (Bare Metal or Drug-Eluting)... 43 Combination (Multiple Interventions) Codes... 45 Interventions Within Bypass Graft or Through Graft... 46 Interventions for Acute Total/Subtotal Occlusion During Myocardial Infarction (MI)... 47 Interventions for Chronic Total Occlusion (CTO)... 50 Modifier Assignment... 51 Coding Examples...51 Valvuloplasty... 57 Pulmonary Artery Angioplasty... 57 T-Wave Alternans... 57 Aortic Valves... 58 Cardiopulmonary Bypass Support... 59 Intra-Aortic Balloon Assist/Intra-Aortic Balloon Pump (IABP)... 60 Transcatheter Mitral Valve Repair... 61 Coronary Thrombectomy and Intravascular Brachytherapy... 63 Endoluminal Imaging of Intracoronary Vessel or Graft... 64 Repair of Septal Defect... 65 iv
Repair of Structural Heart Defect (Transcatheter Closure of Paravalvular Leak)... 67 Intravascular Catheter-Based Coronary Vessel or Graft Spectroscopy... 68 Percutaneous Transcatheter Closure of the Left Atrial Appendage... 70 Wireless Pressure Sensor Implantation... 70 Coronary Interventional Procedures and Codes... 70 Noninvasive Vascular Diagnostic Studies... 71 General Guidelines... 71 Required Documentation for Duplex Studies... 72 Extremity Arterial Studies (Including Digits)... 72 Extremity Venous Studies (Including Digits)... 78 Cardiovascular Stress Tests/Exercise Stress Tests... 79 Cardiovascular Illustrations and Guidelines...81 Frequently Asked Questions Related to Cardiac Catheterization Coding...93 Selective Catheter Coding (Non-Cardiac Procedures) Component Coding... 99 Vascular Family... 100 Catheter Placements... 102 Transcatheter Therapy Rules... 107 Angiographic Radiology of the Head, Neck and Chest... 110 Coding Tips... 115 Interventional Radiology of the Head, Neck and Chest... 117 Coding Tips... 121 Angiographic Radiology of the Abdomen... 133 Coding Tips... 133 Renal Angiography... 134 Coding Tips... 136 Interventional Radiology of the Abdomen... 138 Coding Tips... 138 Angiographic Radiology of the Upper Extremities... 142 Coding Tips... 144 Interventional Radiology of the Upper Extremities... 145 Coding Tips... 146 Angiographic Radiology of the Lower Extremities... 149 Coding Tips... 153 v
Interventional Radiology of the Lower Extremities... 155 Coding Tips Angioplasty, Stenting, Atherectomy... 161 Coding Tips Thrombectomy and Thrombolysis... 167 Case Studies...181 Appendix A 2018 Medicare Payment Rates... 217 MPFS Status Codes... 247 Hospital OPPS Status Indicators... 248 Appendix B Modifiers... 251 CPT Modifiers... 251 HCPCS Level II Modifiers... 262 Sample Charge-Capture Tools Diagnostic Angiography Procedures... 263 Interventional Radiology Procedures... 264 References...267 vi