AAPC - American Academy of Professional Coders Cardiovascular System Coding Questions and Answers

Question 1

A patient undergoes a pre-scheduled coronary artery bypass grafting (CABG) procedure. The surgeon uses the left internal mammary artery to bypass the left anterior descending artery and also harvests and uses a saphenous vein to bypass the right coronary artery. How should this procedure be coded?

Accepted Answer

33533 for the arterial graft and +33517 for the venous graft.

Answer

CPT coding for a combined arterial-venous bypass graft requires two codes. The first code is from the arterial graft series (33533-33536) to identify the arterial graft. The second code is an add-on code from the combined arterial-venous graft series (+33517-+33523) to report the number of venous grafts. In this scenario, 33533 represents one arterial graft, and +33517 is the add-on code for one venous graft used in combination with an arterial graft.

Question 2

A patient with symptomatic bradycardia undergoes a procedure for the insertion of a new permanent dual-chamber pacemaker system, which includes the pulse generator and transvenous electrodes in both the right atrium and right ventricle. Which CPT® code should be reported for this entire procedure?

Accepted Answer

33208

Answer

CPT® code 33208 describes the insertion of a new or replacement permanent pacemaker with transvenous electrodes in both the atrium and ventricle (a dual-chamber system). This is a comprehensive code that includes the pulse generator and the placement of both leads. The other codes represent components of the procedure or a different device (33249 is for an implantable defibrillator system).

Question 3

During a cardiac catheterization procedure, a physician performs a left heart catheterization, left ventriculography, and selective coronary angiography. Which CPT® code correctly bundles all of these services?

Accepted Answer

93458

Answer

CPT® code 93458 represents a combined left heart catheterization with coronary angiography, which includes left ventriculography when performed. This single code should be used instead of reporting the individual components separately, as CPT guidelines state to use the most comprehensive code that describes all the procedures performed.

Question 4

A patient undergoes a percutaneous coronary intervention (PCI). The cardiologist performs a successful balloon angioplasty in the left anterior descending (LAD) artery and then places a drug-eluting stent in the right coronary artery (RCA) during the same session. Which of the following is the correct coding?

Accepted Answer

92928-RC, 92920-LD

Answer

When different types of PCI are performed on separate major coronary arteries, each intervention is reported with a base code. Code 92928 is for stent placement in a single major coronary artery, and 92920 is for balloon angioplasty in a single major coronary artery. The appropriate coronary artery modifiers (-RC for right coronary, -LD for left anterior descending) are appended to specify the location of each intervention. Add-on codes are used for interventions in branches of the *same* major artery, which is not the case here.

Question 5

Which of the following services is bundled into the primary CPT codes for cardiac ablation (e.g., 93653, 93656) and should NOT be reported separately when performed during the same session?

Accepted Answer

A comprehensive electrophysiology (EP) study

Answer

According to CPT guidelines, comprehensive electrophysiology (EP) studies (e.g., 93619, 93620) are considered an integral part of the primary cardiac ablation procedures (93653, 93654, 93656) and are not separately reportable. Services like 3D mapping or ablation of a distinct, separate arrhythmia may be reported with add-on codes under specific circumstances.

AAPC - American Academy of Professional Coders Practice Test

AAPC - American Academy of Professional Coders Practice Test

AAPC - American Academy of Professional Coders Cardiovascular System Coding Questions and Answers