Ch. 10 Cardiovascular and Vascular System

Question 1

What is the term for the divider between the heart chamber walls?

Answer 1

a. Septum

Response Feedback:
Rationale: The heart is divided into right and left sides by a septum which is a muscular wall.

Question 2

According to the ICD-10-CM Coding Guidelines which condition has a causal relationship with hypertension?

Answer 2

c.
Chronic Kidney Disease

Response Feedback:
Rationale: ICD-10-CM Coding Guideline I.C.9.a indicates that there is a presumed causal relationship between hypertension and chronic kidney disease.

Question 3

Patient presents to her physician 10 weeks following a true posterior wall myocardial infarction. The patient is still symptomatic and is diagnosed with ischemic heart disease. What is (are) the correct ICD-10-CM code(s) for this condition?

Answer 3

d.
Z51.89, I25.9

Response Feedback:
Rationale: Because it is past four weeks since the myocardial infarction and the patient is still symptomatic, ICD-10-CM guideline, I.C.9.e.1, indicates that the appropriate aftercare code is assigned rather than a code from category I21. Look in the ICD-10-CM Alphabetic Index for Aftercare directing you to Z51.89. Verify code selection in the Tabular List. The instructional note under category Z51 indicates to code also condition requiring care. Look in the Alphabetic Index for Disease/heart/ischemic (chronic or with a stated duration of over 4 weeks) directing you to I25.9. Verify in the Tabular List.

Question 4

What part of the cardiovascular system is responsible for the one-way flow of blood through the chambers of the heart?

Answer 4

c. Heart valves

Response Feedback:
Rationale: Heart valves are made of flaps (cusps/leaflets) opening and closing like one way swinging doors, preventing blood from flowing back.

Question 5

The conduction system contains pacemaker cells, nodes, the ____ and the ____.

Answer 5

c. Purkinje fibers and bundle of His

Response Feedback:
Rationale: The conduction system contains pacemaker cells, nodes, the bundle of His and the Purkinje fibers.

Question 6

A physician performs a four-vessel autogenous (one venous, three arterial) coronary bypass on a patient who had a previous CABG two years ago, utilizing the saphenous vein, radial artery and the left and right internal mammary arteries. Select the CPT® codes for this procedure.

Answer 6

a. 33535, 33517, 33530, 35600

Response Feedback:
Rationale: Because this is a combo graft, codes 33517-33523 must be coded for the venous portion of the graft. Also, this is a redo more than one month after the original surgery, so the add-on code 33530 is appropriate. Look in the CPT® Index for Coronary Artery Bypass Graft (CABG)/Arterial-Venous Bypass which directs you to 33517-33519, 33521-33523, 33531, and Arterial Bypass which directs you to 33533-33536. In this CPT® Index look for CABG is Harvest/Upper Extremity Artery which directs you to 35600. Look for the codes in the numeric section and you see all additional codes are add-on codes; therefore, no modifiers are required. To code for the reoperation look in the CPT® Index for Reoperation/Coronary Artery Bypass/Valve procedure which directs you to 33530.

Question 7

A PICC with a port is placed under fluoroscopic guidance for a 45 year-old patient for chemotherapy infusion by a physician. The procedure was performed in the hospital. Report the codes for the physician.

Answer 7

b.
36571, 77001-26

Response Feedback:
Rationale: Look in the CPT® Index for Central Venous Catheter Placement/Insertion/Peripheral/with Port and you are referred to 36570-36571. The age of patient is 45; therefore, report 36571. Fluoroscopic guidance for central venous access is reported with 77001 and can be found by looking in the CPT® Index for Fluoroscopy/Venous Access Device directing you to 36598, 77001. The correct code for fluoroscopy is 77001. Modifier 26 is necessary to show the professional service only.

Question 8

Due to infections from hemodialysis, the physician replaces a dual chamber implantable defibrillator system with a multi-lead system with an epicardial lead and transvenous dual chamber lead defibrillator system. The original dual leads are extracted transvenously. The generator pocket is relocated. What CPT® codes are reported?

Answer 8

33244, 33202-51, 33264-51, 33223-59

Response Feedback:
Rationale: When a new system is placed after removal of an old system, report the codes for removal of the components and insertion of the new system. This is a transvenous system. The removal of the dual chamber implantable defibrillator electrodes is reported with 33244. Look in the CPT® Index for Cardiac Assist Devices/Implantable Defibrillators/Transvenous Implantable Pacing Defibrillator (ICD)/Removal/Electrodes referring you to 33244. The insertion of the epicardial electrode is reported with 33202. In the CPT® Index look for Cardiac Assist Device/Implantable Defibrillators/Transvenous Implantable Pacing Defibrillator (ICD)/ Insertion/Electrode referring you to 33202-33203, 33216-33217,33224-33225. The dual defibrillator generator was replaced with a multi-lead defibrillator generator 33264. Look in the CPT ® Index for Cardiac Assist Devices/ Transvenous Implantable Pacing Defibrillator (ICD)/ Replacement, Pulse Generator referring you to 33262-33264. Code 33264 describes the removal and replacement of an implantable defibrillator pulse generator. Two leads were replaced. Look in the CPT® Index for Cardiac Assist Devices/Implantable Defibrillators/ Transvenous Implantable Pacing Defibrillator (ICD)/ Insertion/Electrode referring you to 33202, 33203, 33216, 33217, 33224, 33225. Code 33217 describes the insertion of two transvenous electrodes for an implantable defibrillator; however, the notes under 33264 tell you not to report 33217. Code 33217 is bundled with 33264. The notes for this section of CPT® tell you to use 33223 for the relocation of the skin pocket for clinical situations such as infection. Modifier 51 is needed on 33202 and 33264. Modifier 59 is needed on 33223 to show that it is separate from 33244.

Question 9

In the cath lab, from a right femoral artery access, the following procedures are performed: Catheter placed in the left renal, accessory renal superior to the left renal and one main right renal artery. Radiologic supervision and imaging is performed in all locations. What CPT® code(s) is/are reported?

Answer 9

a. 36252

Response Feedback:
Rationale: Look in the CPT® Index for Angiography/Renal Artery and you are directed to 36251-36254. This is a bilateral procedure, with an accessory left renal artery. Code 36252 includes bilateral and accessory renal angiography, and radiologic supervision and imaging.

Question 10

What information is required to accurately code PVD with diabetes in ICD-10-CM?

Answer 10

d. Whether the patient has gangrene.
Response Feedback:
Rationale: PVD is the abbreviation for Peripheral Vascular Disease. ICD-10-CM indexes PVD with diabetes with one code. For proper code selection the provider must document if the patient has gangrene or not. Look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/with/peripheral angiopathy which directs the coder to E11.51.

Question 11

A patient in the ED was found to have a ruptured abdominal aortic aneurysm. He was taken to emergency surgery; a physician performed a direct repair. The physician documented that the aneurysm involved the common iliac. Select the proper CPT® code for this procedure.

Answer 11

b.
35103

Response Feedback:
Rationale: You must read the question carefully because this is a ruptured aortic aneurysm involving the common iliac not a ruptured aneurysm of the common iliac. Look in the CPT® Index for Aneurysm Repair/Abdominal Aorta which directs you to multiple codes. On review of the code ranges, code 35103 is correct. Code 35102 is a repair of an aneurysm not ruptured.

Question 12

Which statement is TRUE regarding codes for hypertension and heart disease in ICD-10-CM?

Answer 12

b.
Hypertension and heart disease have an assumed causal relationship.

Response Feedback:
Rationale: ICD-10-CM Coding Guidelines I.C.9.a states a causal relationship is presumed between hypertension and heart involvement. Only if the documentation specifically states they are unrelated, are they to be coded separately. ICD-10-CM guideline I.C.9.a.1 indicates two codes are required to report hypertension and heart failure.

Question 13

Aortography and bilateral extremity angiography were performed. The physician placed the catheter in the aorta at the level of the renal arteries and injected contrast for the aortography and repositioned the catheter just above the bifurcation for angiography of the lower extremities. Which CPT® codes are reported?

Answer 13

a. 36200, 75625-26, 75716-26

Response Feedback:
Rationale: Because the catheter was repositioned, and separate studies were performed, both the aortography and the extremity angiography are reported. Look in the CPT® Index for Catheterization/Aorta which directs you to 36160-36200. In the CPT® Index see Aorta/Aortography and you are referred to 75600-75630. To locate angiography of the lower extremities, look for Angiography/Leg Artery referring you to 73706, 75635, 75710-75716. Modifier 26 reports the professional service.

Question 14

PREOPERATIVE DIAGNOSIS: Heart Block
POSTOPERATIVE DIAGNOSIS: Heart Block
ANESTHESIA: Local anesthesia
NAME OF PROCEDURE: Reimplantation of dual chamber pacemaker
DESCRIPTION: The chest was prepped with Betadine and draped in the usual sterile fashion. Local anesthesia was obtained by infiltration of 1% Xylocaine. A subfascial incision was made about 2.5 cm below the clavicle, and the old pulse generator was removed. Using the Seldinger technique, the subclavian vein was cannulated and through this, the old atrial lead was removed, and a new atrial lead (serial # 6662458) was placed in the right atrium and to the atrial septum. Thresholds were obtained as follows: The P-wave was 1.4 millivolts, atrial threshold was 1.6 millivolts with a resultant current of 3.5 mA and resistance of 467 ohms.
Using a second subclavian stick in the Seldinger technique, the old ventricular lead was removed and a new ventricular lead (serial # 52236984) was inserted and placed into the right ventricular apex. The thresholds were obtained and were as follows: R-wave was 23.5 millivolts. The patient was pacing at 100% at 0.5 volts, with resultant current of 0.8 mA and resistance of 480 ohms. When we were satisfied with the thresholds, the leads were connected to the pacemaker generator (serial # 22561587), which was inserted into the previously created pocket.
The wound was thoroughly irrigated with antibiotic solution and hemostasis was obtained. The incision was closed in layered fashion with 2-0 Dexon. A compressive dressing was applied, and the patient tolerated the procedure very well. He was taken to the recovery room in satisfactory condition.
What CPT® codes are reported?

Answer 14

a.
33235, 33208-51, 33233-51

Response Feedback:
Rationale: Look for Cardiac Assist Devices/Pacemaker System/Removal. Code 33235 reports removal of the electrodes of a dual pacemaker lead system. Next, look for Cardiac Assist Devices/Pacemaker System/Insertion/System. Code 33208 reports replacement of permanent pacemaker generator with transvenous electrodes to the right atrium and right ventricle. Code 33233 reports the removal of a pacemaker generator and is indexed - Cardiac Assist Devices/Pacemaker System/Removal. Modifier 51 reports multiple procedures performed during the same session.

Question 15

Preoperative Diagnosis: Coronary artery disease associated with congestive heart failure. In addition, the patient has diabetes and massive obesity.
Postoperative Diagnosis: Same
Anesthesia: General endotracheal
Incision: Median sternotomy

Indications: The patient had presented with severe congestive heart failure associated with her severe diabetes. She had significant coronary artery disease, consisting of a chronically occluded right coronary artery but a very important large obtuse marginal artery coming off as the main circumflex system.

She also has a left anterior descending artery which has moderate disease and this supplies quite a bit of collateral to her right system. The decision was therefore made to perform a coronary artery bypass grafting procedure particularly because she is so symptomatic. The patient was brought to the operating room.

Description of Procedure: The patient was brought to the operating room and placed in supine position. Myself, the operating surgeon was scrubbed throughout the entire operation. After the patient was prepared, median sternotomy incision was carried out and conduits were taken from the left arm as well as the right thigh. The patient weighs almost three hundred pounds and with her obesity there was some concern as to taking down the left internal mammary artery. Because the radial artery appeared to be a good conduit, she should have an arterial graft to the left anterior descending artery territory. She was cannulated after the aorta and atrium were exposed and after full heparinization.

Attention was turned to the coronary arteries. The first obtuse marginal artery was a very large target and the vein graft to this target indeed produced an excellent amount of flow. Proximal anastomosis was then carried out to the foot of the aorta. The left anterior descending artery does not have severe disease but is also a very good target, and the radial artery was anastomosed to this target, and the proximal anastomosis was then carried out to the root of the aorta.

Sternal closure was then done using wires. The subcutaneous layers were closed using Vicryl suture. The skin was approximated using staples.
What CPT® coding is reported?

Answer 15

b.
33533, 33517, 35600

Response Feedback:
Rationale: One arterial graft and one vein graft was performed. Look in the CPT® Index for Coronary Artery Bypass Graft (CABG)/Arterial-Venous Bypass for range 33517-33519. Next, look for Arterial Bypass which directs you to 33533-33536. This was a combination arterial-venous graft with one vein graft (33517) and one an arterial graft (33533). The upper extremity radial artery graft procurement (35600) is separately reportable. Codes 33517 and 35600 are add-on codes and are modifier 51 exempt.

Question 16

In the cardiac suite, an electrophysiologist performs an EP study. With programmed electrical stimulation, the heart is stimulated to induce arrhythmia. Observed is right atrial and ventricular pacing, recording of the bundle of His, right atrial and ventricular recording and left atrial and ventricular pacing and recording from the left atrium. What CPT® coding is reported?

Answer 16

a.
93620, 93621, 93622

Response Feedback:
Rationale: The studies performed make up a comprehensive study (93620) which includes: evaluation with right atrial pacing and recording, right ventricular pacing and recording, and His bundle recording with induction of or attempted induction of arrhythmia. Left atrial pacing and recording (93621) and left ventricular pacing and recording (93622) are add-on codes. Look in the CPT® Index for Electrophysiology Procedure which directs you to 93600-93660.

Question 17

INDICATIONS FOR CORONARY INTERVENTION: Acute inferior myocardial infarction. Documented mildly occlusive plaque with much clot in the right coronary artery.
PROCEDURE: Insertion of temporary pacemaker in the right femoral vein. Primary stenting of the right coronary artery with a 4.5 x 16 mm Express stent. Angio-Seal to the vessels of the right common femoral artery post procedure, and also Angio-Seal of the right common femoral vein.
TECHNIQUE: Judkins percutaneous approach from the right groin with Perclose at the arterial puncture site post procedure.
CATHETERS: 4 French Angio-Jet catheter device, insertion of a 5 French temporary pacing wire, a 4.5 x 16 mm Express stent.
PRESSURES: Aortic Pressure: 107/78

RESULTS:
Coronary stenting procedure of the right coronary artery: The right coronary artery was primarily stented with a 4.5 x 16 mm Express stent. It was expanded to 12 atmospheres. There was no residual stenosis.

IMPRESSION: Successful Angio-Jet and stenting of the distal right coronary artery with no residual stenosis. Angio-Seal to the right femoral vein post procedure.

PROCEDURE: Through the femoral artery sheath, the EBU was advanced to the right coronary. Following this a PT graphic intermediate wire was used to cross the lesion. Following this angioplasty of the lesion was performed, utilizing a 2.5 x 20 millimeter CrossSail balloon at multiple sites to ten atmospheres. Following this there was a fair result; however, there was a significant stenosis and significant calcification at the area, and the decision was made to pursue trying to stent the lesion. Multiple stents were attempted, including a 2.5 x 9 millimeter zipper MX and a 2.5 x 13 millimeter Guidant stent. This was abandoned, and in switching out to a balloon for further ballooning, the patient became hypertensive and with difficulty in terms of her respiratory status. Angiography revealed an occlusion of the mid left anterior descending and thrombus throughout the proximal left anterior descending extending into the left main. Recheck of ACT showed the ACT to be at eight seconds. This likely represented subtherapeutic range for her anticoagulation. A check of her medications revealed that instead of Angiomax, the patient had been given ReoPro without antithrombotic agent. She was therefore given IV heparin up to 12,000 units, and her ReoPro was continued. The lesion was then rewired, and an AngioJet was used to try to suction out this area of thrombus.
Unfortunately, the AngioJet was unable to cross the mid left anterior descending lesion and therefore was somewhat limited in its use for a more distal thrombus, although it did suction out the proximal left anterior descending thrombus. At this point, the patient was emergently intubated, and multiple pressors were started, including dopamine, Levophed, vasopressin, and epinephrine. Following this, a laser was attempted to cross the lesion an excimer laser X80 Spectranetics 0.9 Vitesse; however, this laser was unable to cross the lesion. Therefore, a long balloon, a 2.0 x 40 millimeter CrossSail balloon, was used to cross the lesion and inflate multiple segments of the mid left anterior descending up to a maximum inflation pressure of ten atmospheres. This improved flow though by no means restored it back to normal. Therefore, following this, longer balloon inflations were performed utilizing a 2.0 x 20 millimeter CrossSail balloon up to fourteen atmospheres for one and a half minutes. This did not improve significantly the flow distally, and therefore the decision was made to try to stent the mid segment with a 2.5 x 9 millimeter zipper MX stent to a maximum inflation pressure of fourteen atmospheres. This resolved the issue in terms of the mid left anterior descending lesion; however, beyond the stent there continued to be residual stenosis, and multiple balloons were used to balloon this up to a 2.5 x 20 millimeter balloon up to fourteen atmospheres. The final result in the left anterior descending revealed a lesion in the mid-left anterior descending that was approximately 40 percent, there was TIMI III flow throughout the proximal and mid left anterior descending. However, at the level of the apex, there was TIMI 0 flow. Throughout the angioplasty, the patient had episodes of bradycardia, and a temporary pacemaker was placed, and this was removed at the end of the procedure.

IMPRESSION: Successful stent to the mid left anterior descending, complicated by thrombotic event in the left anterior descending system. Final result was a successful stent to the mid left anterior descending with residual TIMI 0 flow in the distal left anterior descending. We returned to the right coronary artery and successfully employed a 4.5 x 16 mm Express sent. At the end of the case, an intra-aortic balloon pump was placed in the left femoral artery sheath, and the patient was sent to the Coronary Care Unit on multiple pressors including epinephrine, vasopressin, Levophed and dopamine.
What CPT® coding is reported?

Answer 17

c.
92928-RC, 92928-LD, 33967, 92973

Response Feedback:
Rationale: Only one base code is reported per major coronary artery. In this case angioplasty and stent placement was performed in the right coronary artery (92928-RC) and in the left anterior descending (92928-LD). Look in the CPT® Index for Coronary Artery/Angioplasty/with Stent Placement directing you to 92928-92929. A thrombectomy was performed by AngioJet in the LD reported with 92973. Look in the CPT Index for Coronary Artery/Thrombectomy which directs you to 92973. A temporary pacemaker was inserted through the femoral vein; however, it is bundled with the cardiac catheterization. At the end of the procedure, an intra-aortic balloon pump was inserted, 33967. Look in the CPT® Index for Insertion/Balloon/Intra-Aortic which directs you to 33967, 33973.

Question 18

In the hospital setting a patient undergoes transcatheter placement of an extracranial vertebral artery stent in the right vertebral artery. Which CPT® code is reported by the physician providing only the radiologic supervision and interpretation?

Answer 18

b.
0075T-26

Response Feedback:
Rationale: This is a Category III code. Look in the CPT® Index for Artery/Stent Placement/Extracranial Vertebral. Code 0075T is the correct code. When you check 0075T you will see supervision and interpretation is included; therefore, modifier 26 reports the professional service.

Question 19

Preoperative Diagnosis: Aortic valve stenosis with coronary artery disease associated with congestive heart failure
Postoperative Diagnosis: Same
Anesthesia: General endotracheal
Incision: Median sternotomy
Description of Procedure: The patient was brought to the operating room and placed in supine position. After the patient was prepared, median sternotomy incision was carried out and conduits were taken from the left arm as well as the right thigh. She was cannulated after the aorta and atrium were exposed and after full heparinization.

She went on cardiopulmonary bypass, and the aortic cross-clamp was applied. Cardioplegia was delivered through the coronary sinuses in a retrograde manner. The patient was cooled to 32 degrees. Iced slush was applied to the heart. The aortic valve was then exposed through the aortic root by transverse incision. The valve leaflets were removed, and the 23 St. Jude mechanical valve was secured into position by circumferential pledgeted sutures. At this point, aortotomy was closed.

Attention was turned to the coronary arteries. The first obtuse marginal artery was a very large target and the vein graft to this target indeed produced an excellent amount of flow. Proximal anastomosis was then carried out to the foot of the aorta. The radial artery was anastomosed to the left anterior descending artery target in an end-to-side manner. The proximal anastomosis was then carried out to the root of the aorta.

The patient came off cardiopulmonary bypass after aortic cross-clamp was released. She was adequately warmed. Protamine was given without adverse effect. Sternal closure was then done using wires. The subcutaneous layers were closed using Vicryl suture. The skin was approximated using staples. What CPT® codes are reported?

Answer 19

d.
33405, 33533-51, 33517, 35600

Response Feedback:
Rationale: A mechanical valve was placed (33405). Look in the CPT® Index for Replacement/Aortic Valve and you are directed to code 33405. A one artery, one venous CABG was performed (33533, 33517). Look in the CPT® Index for Coronary Artery Bypass Graft (CABG)/Arterial-Venous Bypass which directs you to codes 33517-33519, and also look for Arterial Bypass which directs you to codes 33533-33536. The left radial artery is an upper extremity artery and separately reportable (35600), as noted in the guidelines preceding categories Combined Arterial Venous Grafting for Coronary Artery Bypass and preceding Arterial Grafting for Coronary Artery Bypass. Modifier 51 is appended to 33533, because it is an additional procedure performed during the same session. The other codes are add-on codes; therefore, modifier 51 exempt.

Question 20

The cardiologist advances a 6 French catheter into the left renal artery via a right common femoral puncture. It is selectively catheterized and angiographic films are taken. The catheter was then removed and a diagnostic guiding type, RDC catheter was used and the left renal artery was selectively engaged. A 0.014 Supracore wire was used and the lesion was crossed. A 6.0 X 18 mm balloon expandable Racer stent was introduced. This was expanded around 8 atmospheres of pressure which is nominal. Angiography revealed excellent results with no residual stenosis. What CPT® codes are reported?

Answer 20

c.
36245-LT, 37236

Response Feedback:
Rationale: The left renal artery is a first order vessel as noted in Appendix L of the CPT® codebook (36245-LT). To locate the selective catheterization, look in the CPT® Index for Artery/Abdomen/Catheterization referring you 36245-36248. 36245 is the correct code for the selective catheterization. Angiography of the left renal vessel was performed; however, there is no mention in the report of the results of the angiography. This is not a diagnostic angiography, rather it is angiography for mapping (checking out known stenosis). The stent was deployed (37236) in the left renal artery; this code also includes the radiologic supervision and interpretation. In the CPT® Index look for Angioplasty/with Intravascular Stent Placement referring you to 37215-37218, 37236-37239 or you can look for Artery/Stent Placement/Carotid. Follow-up renal angiography is bundled with the stent procedure.

Question 21

The skin over the left groin was prepped and draped in a sterile fashion and anesthetized with 1% Xylocaine. Through a right femoral artery access, a 5 French pigtail catheter was placed in the abdominal aorta and a run-off was performed following injection of 80cc of contrast. Oblique DSA images of the iliac circulation were performed following two injections, each 15cc.

Findings: Abdominal aorta: no signs of renal artery stenosis. There is mild atheromatous change involving the lower abdominal aorta. There are two eccentric plaques arising from the distal aorta just above the iliac bifurcation. There are high-grade stenoses involving both proximal iliacs, the right far more pronounced than the left.

The right superficial femoral, profunda femoral, popliteal arteries are normal. The trifurcation vessels are unremarkable.

On the left, there is an eccentric plaque in the common femoral artery just below the catheter entrance site. This creates approximately 40-50% stenosis at this site. The remainder of the proximal femoral artery is normal. The trifurcation vessels and popliteal artery are normal. What CPT® codes are reported?

Answer 21

d.
36200, 75630-26

Response Feedback:
Rationale: The nonselective catheter placement in the aorta is reported with 36200. Look in the CPT® Index for Aorta/Catheterization/Catheter. Contrast was injected from one catheter placement site, and there is a report for the aorta and the extremities, making this an abdominal aortogram with bilateral iliofemoral lower extremity angiography which directs you to 75630. Modifier 26 is required for the professional service. Look in the CPT® Index for Aortography/Aorta Imaging and you are referred to 75600, 75630, 93567.

Question 22

A 35 year-old patient presented to the outpatient hospital for PTA of an obstructed hemodialysis AV graft in the venous anastomosis and the immediate venous outflow. The procedure was performed under moderate sedation administered by the physician performing the PTA. The physician performed all aspects of the procedure, including radiological supervision and interpretation. Code for all services performed.

Answer 22

d.
36902

Response Feedback:
Rationale: PTA is the abbreviation for percutaneous transluminal angioplasty. This procedure involves the peripheral dialysis segment, which in the upper extremity extends through the axillary vein or the entire cephalic vein in the case of cephalic venous outflow. The correct code is 36902, which includes angioplasty and all radiological supervision and interpretation. Moderate sedation is not included in this code; however, 99152 is not reported, because the documentation does not indicate who monitored the patient, the medication, the dosage, or the time of the moderate sedation.

Question 23

Patient undergoes a three artery CABG. A surgical assistant procures the artery used for the grafts. What CPT® coding is reported for the assistant surgeon.

Answer 23

b.
33535-80

Response Feedback:
Rationale: Procurement of the arterial conduit is bundled into 33535 and reported with modifier 80 for the surgical assistant according to the guidelines. An add-on code, 35600, is used for harvesting an artery of the upper extremity; however, there is no mention of this in the report. The guidelines in the codebook above 33535 instruct you to use modifier 80 when a surgical assistant performs an arterial graft procurement. Look in the CPT® Index for Coronary Artery Bypass Graft (CABG)/Arterial Bypass referring you to 33533-33536. There are three arterial grafts; therefore, 33535 is correct.