Deck 17: Cardiovascular System

Question 1

Within the cardiovascular system, what is compared to the branches of a tree?

A)veins
B)arteries
C)vascular families
D)coronary vessels

Answer 1

vascular families

Question 2

____ cardiology is entering the body to make a correction or for examination.

A)Invasive
B)Noninvasive
C)Electrophysiology
D)Nuclear

Answer 2

Invasive

Question 3

Pacemaker insertion codes are divided based on the surgical:

A)approach
B)type
C)necessity
D)complexity

Answer 3

approach

Question 4

____ is a procedure in which fluid is withdrawn from the space around the heart through a needle, and a catheter is left in to allow for continued drainage.

A)Pericardiocentesis
B)Pericardiotomy
C)Pericardiectomy
D)Pericardiostomy

Question 5

What does the abbreviation EP mean as it relates to cardiovascular services?

A)electropathophysiology
B)electric pathology
C)electrophysiology
D)elective procedure

Question 6

In which type of catheter placement is the catheter moved, manipulated, or guided into a part of the arterial system other than the vessel punctured?

A)localized
B)infused
C)infiltrated
D)selective

Question 7

What is the name of the electrodes that are placed into the atrium and/or ventricle of the heart when a pacemaker is inserted?

A)guidewires
B)catheters
C)leads
D)threads

Question 8

To correctly report coronary bypass grafts, you must know the anatomical site from which the vessel being grafted came.

Question 9

The epicardial approach involves accessing a vein and inserting a needle with a wire into the vein.

Question 10

What type of cardiology is a diagnostic specialty that uses radioactive elements to aid in the diagnosis of cardiology conditions?

A)nuclear
B)invasive
C)interventional
D)radiographics

Question 11

When coding a change of battery in a pacemaker, both the removal and the re-implantation are separately coded.

Question 12

If fluoroscopic guidance is used during the insertion of a pacemaker, it is bundled with the primary procedure and cannot be reported separately.

Question 13

The number of postoperative days usually assigned for the global period following implantation of a pacemaker is:

A)10
B)12
C)62
D)90

Question 14

An example of a noninvasive cardiology procedure/service is:

A)placement of a temporary pacemaker
B)placement of an intra-aortic balloon assist device
C)cardiovascular stress test
D)angioplasty

Question 15

Supervision and interpretation codes for angiography are located where in the CPT manual?

A)Cardiology subsection
B)Radiology section
C)Lab section
D)Medicine section

Question 16

The device that can be inserted into the body to electrically shock the heart into regular rhythm.

A)epicardial rhythm enhancer
B)implantable defibrillator
C)ventricle insertion
D)transverse marker

Question 17

The major division of the Cardiovascular subsection is by how a procedure involved a ____ vessel.

A)damaged or healthy
B)coronary or noncoronary
C)bypassed or native
D)selective or nonselective

Question 18

What are the three sections of the CPT manual that you use to code many cardiovascular services?

A)Medicine, Surgery, Anesthesia
B)Surgery, Radiology, Medicine
C)Anesthesia, Surgery, Radiology
D)Pathology, Radiology, Surgery

Question 19

The procedure in which the surgeon withdraws fluid from the pericardial space by means of a needle inserted percutaneously into the space is called:

A)centesis
B)laparotomy
C)pericardiotomy
D)pericardiocentesis

Question 20

PTCA is an acronym for Percutaneous Transluminal Coronary Angioplasty.

Question 21

Abdominal aortogram in an outpatient facility.
The right groin was prepped and draped in the usual fashion.Seldinger technique was used to enter the femoral artery.A 6-French sheath was placed.A pigtail catheter was introduced in the upper abdominal aorta, and an AP aortogram was done using the DSA cut film technique using 20 cc of Omnipaque.
Results: The abdominal aorta appears mildly irregular above and below the renal arteries, with no significant stenosis.Report physician services only.
CPT Codes: _______________________________________ (one Surgery code and then one Radiology code)

Question 22

A thromboendarterectomy of the carotid artery by neck incision, with a patch graft.
CPT Code: ____________________

Question 23

Placement of a dual-chamber pacemaker.
Using a standard technique, the left infraclavicular subcutaneous pacemaker pocket was created with sharp and blunt dissection.The 2 j-tipped guidewires were advanced through a left subclavian vein using standard left subclavian venotomy under fluoroscopic guidance.The peel-away sheaths and introducers were advanced over the guidewires, and the guidewires were removed.The pacemaker leads were advanced under fluoroscopic guidance into the right ventricular apex and right atrial appendage.The pacemaker leads were seen to function adequately in vivo and were sutured in place with 0 silk.The leads were connected to the pulse generator, which was delivered into the wound in the usual fashion; 2-0 Vicryl suture was used to close the deep tissue layer and a 4-0 running subcuticular suture was used to close the skin.There were no complications of the procedure.Code the pacemaker placement only.
CPT Code: ____________________

Question 24

Arrhythmia ablation is a treatment for:

A)bradycardia/tachycardia
B)atrial fibrillation
C)complete heart block
D)all of the above

Question 25

Code 36000 (Introduction of needle or intracatheter, vein) is an example of:

A)selective catheterization
B)nonselective catheterization
C)injection procedure
D)none of the above

Question 26

Old pacemaker at the end of life.Replacement of pulse generator.
After local anesthetic had been infiltrated, an incision was made over the right upper chest where the pacemaker had been implanted.The old pulse generator was removed.The new pulse generator, a Guidant Discovery DR model #1275, serial #abcdefg was implanted.
The atrium sensing was 2 mV, threshold 1.4 V, impedance 500 MHz.In the ventricle our sensing was 7 mV, threshold 1.4 V, and impedance 5600 MHz.There was no VA conduction.
The new pulse generator was attached to the old leads.Left and DDD are lower rate 75, upper rate 120 beats per minute."AV delay" 150 ms and mode switching is on.The wound was closed in layers.
CPT Code: ____________________

Question 27

A(n) ____ is a mass of undissolved matter that is present in blood and is transported by the blood.

A)thrombus
B)aneurysm
C)false aneurysm
D)embolus

Question 28

If catheterization is performed on the coronary arteries, in which section would you find the codes?

A)Surgery
B)Radiology
C)Medicine
D)All of the above

Question 29

A coronary artery bypass using a saphenous vein graft.
CPT Code: ____________________

Question 30

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)preinjection and postinjection care related to procedure

Question 31

A Holter monitor is similar to an electrocardiogram in that:

A)leads are attached to the patient
B)the reading is sped up by computers
C)it records readings for 24 hours
D)all of the above

Question 32

If the clinic physician performs the catheterization procedure at the hospital, which modifier would you append to the catheterization code?

A)-51
B)-26
C)-TC
D)no modifier needed

Question 33

The pulse generator of a pacemaker is also referred to as:

A)the lead
B)the electrode
C)the battery
D)cardioverter

Question 34

Which of the following modifiers does NOT identify a coronary artery?

A)-RC
B)-LC
C)-LD
D)-MC

Question 35

If a clinic owns its own x-ray equipment, what modifier would be used when coding for the supervision and interpretation of a cardiac catheterization?

A)-26
B)-TC
C)-51
D)no modifier

Question 36

Cardiovascular stress test codes are used for:

A)exercise-induced studies
B)pharmacologically-induced studies
C)both a and b
D)neither a nor b

Question 37

A percutaneous transluminal balloon angioplasty of the right renal artery from a right femoral artery access.
CPT Code: ____________________

Question 38

The implantation of a patient-activated cardiac event recorder.
CPT Code: ____________________

Question 39

A five-vessel coronary artery bypass using two arteries and three vein grafts.
CPT Codes: _______________________________________ (two codes)

Question 40

Ambulatory blood pressure monitoring is:

A)a basic blood pressure check taken in an outpatient (ambulatory) clinic
B)electronic measurement of a patient's blood pressure
C)a procedure that is performed in the physician clinic by hooking a patient to a device that measures their blood pressure over several hours
D)a procedure that is done over a 24-hour period by means of a portable device worn by the patient

Question 41

An in-person electronic analysis of a dual chamber pacemaker system with reprogramming.
CPT Code: ____________________

Question 42

Mr.O'Brien presents to his cardiologist's office complaining of chest pain.Dr.McCoy, the cardiologist, decides to obtain a cardiovascular stress test.Because Dr.McCoy's office does not have the proper equipment to perform this test, he sends Mr.O'Brien to the hospital for the test.Dr.McCoy accompanies Mr.O'Brien and supervises the stress test as well as provides his interpretation and written report.Report Dr.McCoy's service.
CPT Codes: ____________________ (two codes)

Question 43

Location: Inpatient Hospital
CARDIOLOGY PROCEDURES
PROCEDURE PERFORMED: Cardioversion.
PROCEDURE: The patient was sedated.Under cardiac monitoring and pulse oximetry monitoring, the patient received 360 joules of synchronous energy with successful cardioversion to sinus rhythm.
IMPRESSION: Successful cardioversion from atrial fibrillation to sinus rhythm.The patient will be started on sotalol and be monitored overnight.
CPT Code: ____________________

Question 44

Reoperation by neck incision 60 days after initial procedure of thromboendarterectomy of carotid artery with a patch graft.
CPT Codes: ____________________ (two codes)

Question 45

Harvest of one segment of vein from upper arm for coronary artery bypass procedure.Report vein harvest add-on code only.
CPT Code: ____________________

Question 46

Selective catheterization of both renal arteries.
The right femoral artery was entered by Seldinger technique, and a 6-French sheath was placed.No heparin was used.The patient had a BP of over 200 systolic.After placement of the 6-French sheath, a pigtail catheter was introduced and an aortogram was done in the AP projection using 20 cc of dye.Next a 5-French Cobra catheter was introduced, and both the left renal artery and the right renal artery were selectively opacified.The patient was sent to her room in good condition without complications after renal angiograms had been done, the sheath had been removed, and hemostasis had been secured.
Results: Right renal artery-there is a single right renal artery with a minimal irregularity along the wall, but no evidence of significant fibromuscular dysplasia or stenosis is noted.The distal nephrogram appears unremarkable.
Left renal artery-there are two renal arteries, the upper pole renal artery rising in the normal location and the lower pole renal artery considerably lower.Both these vessels appear relatively unremarkable with no stenosis or fibromuscular dysplasia seen either.
CPT Code: (Surgery Code) ____________________

Question 47

Direct repair of aneurysm associated with occlusion of the vertebral artery.
CPT Code: ____________________

Question 48

What is the code for a tunneled centrally inserted central venous catheter, without pump or port, in a 72-year-old patient?
CPT Code: ____________________

Question 49

Limited bilateral study, noninvasive physiologic study of arteries of the arm.
CPT Code: ____________________

Question 50

Placement of a temporary pacemaker.
The right subclavian area was prepped and draped in the usual fashion.Local anesthetic was infiltrated.The subclavian vein was entered via Seldinger technique with a Cook needle.A guidewire was passed to the right heart.A 6-French dilator sheath was placed.The dilator and wire were then removed.The sheath was sutured into place.A 5-French bipolar pacemaker wire was placed near the apex of the right ventricle.
Temporary pacing was instituted.Threshold was less than 0.5 mV.Pacer settings were 60 per minute demand and 5 MA.Patient returned to her room in good condition.
CPT Code: ____________________

Question 51

A patient presents to the physician's office to have blood drawn for various lab tests.The venous blood is drawn by the medical assistant and sent to the lab with an order from the physician.Code only the drawing of the blood.
CPT Code: ____________________

Question 52

Pulmonary endarterectomy with embolectomy requiring cardiopulmonary bypass.
CPT Code: ____________________

Question 53

Patient has a diagnosis of end-stage renal disease and requires an arteriovenous fistula (shunt) using Gore-Tex graft for hemodialysis.Nondirect.
CPT Code: ____________________

Question 54

Coronary artery bypass using two arterial grafts.
CPT Code: ____________________

Question 55

PTCA of left anterior descending coronary artery.
A 6-French JL4 guiding catheter was used, and a 014 extra-support wire was passed through the LAD obstruction and "entered" the distal vessel.This was first dilated with a 3-mm 20 CrossSail balloon, subsequently with a 3.5 10 cutting balloon (arteriectasis).With the cutting balloon, there were four inflations at 6-7 atmospheres and up to 1-minute inflation times.
The balloon was withdrawn, and angiography showed the vessel to be wide open with mild irregularities and less than 15% narrowing remaining.There was no distal embolism.There was no dissection noted.There was normal TIMI flow.The case was then terminated at this point and balloons, catheters, and wires were removed, and the patient was sent to her room in good condition.
CPT Code: ____________________

Question 56

Echocardiogram, transthoracic-complete study with color-flow Doppler and echocardiography.
CPT Code: ____________________

Question 57

Duplex scan of aorta, complete study.
CPT Code: ____________________

Question 58

Ambulatory blood pressure monitoring of 24 hours, using magnetic tape, including the recording, analysis, interpretation, and report.
CPT Code: ____________________

Question 59

Cardioversion.
Reason for procedure: Atrial fibrillation.
Elective, external 175 J of synchronous cardioversion was undertaken very easily, with complete resolution of atrial fibrillation to normal sinus rhythm.
CPT Code: ____________________

Question 60

Venous bypass graft for occlusive disease, femoral-popliteal.
CPT Code: ____________________

Question 61

Right and left heart catheterization, selective coronary angiography, and left ventriculogram.
The patient was prepped and draped in the usual sterile fashion and sedation was administered for a total of fentanyl, 25 mcg IV, and Versed, 0.5 mg IV.One percent lidocaine was infused in the right groin and a 7-French sheath was inserted in the right femoral artery.A 7-French Swan-Ganz catheter was advanced through the right heart chambers and into the pulmonary artery.After pulmonary capillary wedge pressure and pulmonary artery pressures were obtained, thermodilution cardiac outputs were measured.The Swan-Ganz catheter was then pulled back to the right heart chambers prior to removal.Selective coronary angiography was then performed.A 6-French JL4 catheter was used for selective angiography of the left coronary artery and right coronary artery.A 6-French pigtail catheter was used for RAO left ventriculogram using a hand injection.Following the procedure, the sheaths were removed and hemostasis was achieved using VasoSeal.The patient tolerated the procedure well without complications.
RIGHT HEART CATHETERIZATION: The right heart pressures were as follows: The mean pulmonary capillary wedge pressure was 10 mm Hg.The pulmonary artery pressures were 37/17 with a mean of 20 mm Hg.The right ventricular pressure was 34/2 and the mean right atrial pressure was 5 mm Hg.The mean cardiac output was 4.2 L per minute.
LEFT HEART CATHETERIZATION: The left main coronary artery appeared calcified.There was no obstructive disease observed.The left anterior descending artery was also calcified in its ostial and proximal portions.There was mild luminal irregularity noted in the proximal and mid portions of the vessel.Two moderate size diagonal branches were observed without high-grade disease.The mid LAD contained a 40%-50% narrowing.The remaining distal vessel appeared free of disease.The circumflex vessel was a large vessel.There was a 60% focal lesion in the proximal portion of this artery.There was some ectasia noted also in the proximal portion of the vessel.A large obtuse marginal branch was observed which appeared free of high-grade disease.The right coronary artery was 100% occluded in its proximal portion.The distal vessel filled via left-to-right collaterals from the LAD and circumflex system.
VENTRICULOGRAM: The left ventriculogram showed good LV systolic function with an ejection fraction of 60%.No wall motion abnormalities were noted.The left ventricular end diastolic pressure was 7-8 mm Hg.

(Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)
Right and left heart catheterization CPT code: ____________________

Question 62

OPERATIVE REPORT
PERMANENT PACEMAKER INSERTION
PROCEDURE PERFORMED: Permanent pacemaker insertion.
INDICATION: Symptomatic bradycardia.
DESCRIPTION OF THE PROCEDURE: Informed consent was obtained.The patient was pre-medicated with intravenous Versed and Nubain.The left infraclavicular area was prepped and draped in the usual manner.The area was then anesthetized with 1% Lidocaine.The left subclavian vein was entered with an 18-gauge thin-walled needle.A guidewire was advanced through the needle.The needle was removed.A 1.5-inch incision was made down to the pectoralis fascia.Using blunt and sharp dissection a pocket was created.A 9-French sheath introducer set was advanced over the guidewire and the introducer was removed.A Medtronic ventricular lead was advanced to the right ventricle.In the final position, the measured R wave was 7.9 mV.The captured threshold was 0.7 volt and the lead impedance was 860 ohms.A 7-French sheath introducer set was advanced over the wire and the wire and the introducer were removed.A Medtronic atrial lead was advanced to the right atrium and in the final position the measured P wave was 6.2 mV.The captured threshold was 0.4 volt and the lead impedance was 639 ohms.
Both leads were anchored in place using 0 silk that was sutured around the anchor and its lead.Both leads were then connected to a Medtronic pulse generator brand name Kappa DR, model #KDR901.The pulse generator and the leads were positioned inside the pocket after it was flushed with Neomycin.The subcutaneous tissue was closed with 3-0 Vicryl and the skin was closed with 4-0 Vicryl.The patient tolerated the procedure well and there were no complications.The device was programmed to DDDR, lower rate of 60, upper rate of 130.
CPT Code: ____________________

Question 63

Left heart catheterization with coronary angiography and left ventriculogram.
The right groin was prepped and draped in the usual fashion.Seldinger technique was used and a 6-French sheath was placed in the right femoral artery.A local anesthetic was used and sublingual nitroglycerin was given; no heparin was used.The left and right coronary arteries were selectively opacified in the LAO and RAO projections using manual injections of Optiray.A ventriculogram was done in the RAO projection with the use of a 6-French pigtail catheter.The catheters were then withdrawn, the sheath was removed and VasoSeal applied, and the patient was sent to her room in good condition without complications.
PRESSURES: Aorta 117/63, LV 110/2-6
RIGHT CORONARY ARTERY: This is a dominant vessel.There is a long segment of severe subtotal disease extending from the proximal portion to almost the mid third.The rest of this vessel also appears to be diffusely diseased.The posterior descending branch is identified and this is 80% narrowed at its ostium.There is another 90% lesion in the distal 1/3 of this vessel.The AV branch is diminutive.
LEFT CORONARY ARTERY: Left main trunk is calcified and has a 60%-70% distal narrowing.Left anterior descending is severely diseased from its origin, and gives off a diagonal and septal perforator and then the LAD is totally occluded.The circumflex calcification is seen in the main trunk where moderate plaque is seen compromising the lumen about 50%-60%.The circumflex then divides into two branches; the first is the lateral branch and then a second lateral branch.The first lateral branch is severely narrowed in its proximal portion to 90%, and then has another long segment of about 75% narrowing.This does appear to be a diffusely diseased vessel.The second lateral branch also has a long segment of 90% disease distally.The terminal AV branch of the circumflex is completely occluded.
LEFT VENTRICLE: End systolic and end diastolic volumes are increased.There is diffuse impairment of contractility indicating diffuse multiwall ischemia.Overall contractility is mild-to-moderately impaired with an ejection fraction of the post PVC beat being around 40% or so.No major wall segment abnormalities are noted.The mitral and aortic valves are normal.The descending aorta is slightly dilated.

(Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)
Left heart catheterization CPT code: ____________________

Question 64

Cardiopulmonary resuscitation.
CPT Code: ____________________

Question 65

Insertion of a single lead implantable defibrillator pulse generator.
CPT Code: ____________________

Question 66

____________________ is a procedure in which the surgeon withdraws fluid from the pericardial space by means of a needle.