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2020 Coding For CPT Prep PHS > Chapter 10 - The Cardiovascular System > Flashcards

Chapter 10 - The Cardiovascular System Flashcards

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1
Q

Coronary sinus

A

Large vein that drains blood from the walls of the heart and drains into the right atrium.

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2
Q

Tricuspid valve

A

Atrioventrical valve on the right side of the heart

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3
Q

Mitral valve

A

Also called the bicuspid valve. Atrioventrical valve on the left side of the heart

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4
Q

Pulmonary valve

A

Between the right ventricle and the pulmonary artery.

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5
Q

Aortic valve

A

Between the left ventricle and the aorta

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6
Q

Systole

A

Contraction of the heart

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7
Q

Diastole

A

Relaxing of pressure of the heart

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8
Q

Chordae tendinae

A

Tendons that connect the inlet valves to papillary muscles of the inferior wall of the ventricles. Also called heart strings

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9
Q

Pacemaker cells

A

Ability to generate an electrical impulse and pass it to other cells. Shortens the fibers in the heart when receiving the impulse

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10
Q

Sinoatrial node

A

Pacemaker node in the right atrium near the superior vena cava.

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11
Q

Atrioventrical node

A

Located lower in the septal wall of the right atrium. Slows impulses to allow the atria to fill with blood before contracting the ventricles.

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12
Q

Bundle of His

A

Heart muscles specialized for electrical conduction. After the AV node.

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13
Q

Purkinje fibers

A

End of the bundle branches. Lie across the surface of the ventricles and signal the myocardium to contract the ventricles

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14
Q

Coronary arteries

A

Two arteries that emerge from the aorta and split into left and right segments. Supply oxygen and nutrient rich blood to the myocardium

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15
Q

Left coronary artery

A

1 inch long and about the diameter of a soda straw. Splits into left anterior descending and left circumflex coronary arteries.

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16
Q

Left anterior descending artery

A

Embedded in the surface of the front side of the heart

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17
Q

Left circumflex coronary artery

A

Circles around the left side of the heart and is embedded in the surface of the back of the heart.

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18
Q

Right coronary artery

A

Travels along the atrioventrical groove between the right atrium and ventricle. Gives rise to the acute marginal branch as it wraps around the right side and branches into smaller branches that penetrate the heart muscle

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19
Q

Acute marginal branch

A

Split from the right coronary artery and covers the anterior portion of the right ventricle

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20
Q

Systemic circulation

A

Blood that circulates throughout the body

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21
Q

Pulmonary circulation

A

Blood travels from the heart to the lungs, and back to the heart

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22
Q

Coronary circulation

A

Blood that travels through the tissues of the heart

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23
Q

Aneurysm/o

A

Aneurysm

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24
Q

Angi/o, vas/o, vascul/o

A

Vessel

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25
Q

Aort/o

A

Aorta

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26
Q

Arter/o, arteri/o

A

Artery

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27
Q

Arteriol/o

A

Arteriole

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28
Q

Ather/o

A

Yellowish, fatty plaque

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29
Q

Atri/o

A

Atrium

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30
Q

Carcin/o

A

Cancer

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31
Q

Coron/o

A

Coronary

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32
Q

Endocardi/o

A

Endocardium

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33
Q

My/o

A

Muscle

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34
Q

Phleb/o, ven/o

A

Vein

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35
Q

Scler/o

A

Hard

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36
Q

Sept/o

A

Septum

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37
Q

Sin/o

A

Sinus

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38
Q

Steth/o, thorac/o

A

Chest

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39
Q

Venul/o

A

Venule

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40
Q

Valv/o, valvul/o

A

Valve

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41
Q

Brady-

A

Slow

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42
Q

Tachy-

A

Fast

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43
Q

-edema

A

Swelling, accumulation of fluid

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44
Q

-ium

A

Membrane, structure

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45
Q

-oma

A

Tumor

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46
Q

-sclerosis

A

Hardening

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47
Q

-stenosis

A

Narrowing, stricture, constriction

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48
Q

Acute rheumatic fever

A

Complication of strep throat with Group A streptococci that is left untreated. Rare but life threatening condition. Fever, muscle aches, and swollen and painful joints. Can lead to rheumatic heart disease

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49
Q

Rheumatic heart disease

A

Sequelae of rheumatic fever that leads to issues with heart valves and in rare circumstances heart failure

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50
Q

Hypertension

A

High blood pressure. Classified as primary or secondary.

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51
Q

Primary hypertension

A

High blood pressure for which no medical cause can be found. 90-95% of cases

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52
Q

Secondary hypertension

A

Caused by other conditions affecting the kidneys, arteries, heart, or endocrine system. 5-10% of cases

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53
Q

Hypertension with heart disease

A

Assumed causal relationship and are a combination code unless documentation is specific that they are unrelated. If heart failure code type of heart failure as well

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54
Q

Hypertension and chronic kidney disease

A

Assumed relationship. Use additional codes for heart failure and stage of chronic kidney disease

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55
Q

Hypertensive cerebrovascular disease

A

Code first the cerebrovascular condition then the hypertension code

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56
Q

Hypertensive retinopathy

A

Two codes necessary. Code from hypertensive retinopathy and a code to indicate type of hypertension

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57
Q

Secondary hypertension

A

Two codes. A code for the underlying condition and a code for hypertension. Sequences based on reason for the encounter

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58
Q

Myocardial infarction

A

Heart attack. Sudden decrease in coronary artery blood flow resulting in the death of the heart muscle. Provider often orders labs to determine levels of phosphokinase and troponin in the blood. Elevation in these levels can indicate damage to the heart muscle. 5 different classifications

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59
Q

Elevated phosphokinase and troponin labs coding

A

Code from the category Abnormal Findings

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60
Q

Type I myocardial infarction

A

Related to ischemia due to primary coronary event such as plaque erosion and/or rupture fissuring, or dissection. Prototypical heart attack. Can be STEMI or NSTEMI

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61
Q

STEMI

A

ST elevation myocardial infarction. Coronary artery is completely blocked and virtually all heart muscle supplied by the affected artery starts to die.

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62
Q

NSTEMI

A

Non-ST elevated myocardial infarction. Plaque or blockage only partially occluded the affected artery.

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63
Q

Type 2 Myocardial Infarction

A

Myocardial infarction secondary to ischemia due to either decreased supply or increased demand. Code for underlying cause if known

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64
Q

Type 3 Myocardial Infarction

A

Sudden, unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of ischemia, accompanied by presumably new ST elevation, new left bundle branch block, or fresh thrombus in a coronary artery. Death occurred before samples could be obtained.

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65
Q

Type 4a-4c myocardial infarction

A

Myocardial infarction associated with revascularization procedures

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66
Q

Type 5 Myocardial Infarction

A

Myocardial infarction associated with coronary artery bypass graft surgery

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67
Q

Ischemia

A

An inadequate blood supply to an organ or part of the body, especially the heart muscles.

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68
Q

Arteriosclerosis

A

Hardening of the arteries. Verify is it is a native artery, bypassed artery, or transplanted heart. Verify presence of angina pectoris.

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69
Q

Endocarditis

A

Inflammation of the endocardium.

70
Q

Heart failure

A

Occurs when the heart cannot pump enough blood to supply the other organs. Shortness of breath, orthopnea, and edema of the lower legs and feet.

71
Q

Pericarditis

A

Inflammation of the pericardium. Caused by infection. Chest pain on inspiration, and often worse when lying down.

72
Q

Peripheral artery disease

A

Similar to coronary artery disease but affects arteries outside the heart and brain. Verify presence of diabetes and gangrene

73
Q

Valve stenosis

A

Narrowing of a heart valve. Restricts the flow of blood in the heart. Verify if congenital or rheumatic, acute, or involves multiple valves.

74
Q

Valve regurgitation

A

When the valve does not close properly and blood back flows into the heart chamber

75
Q

Valve prolapse

A

Occurs when valves prolapse into the heart chamber.

76
Q

Pericardiocentesis

A

Involves drawing off collected fluid, with a specialized needle, built up inside the double layered pericardial sac. If not resolved can lead to cardiac tamponade.

77
Q

Cardiac tamponade

A

Cardiac tamponade puts pressure on the heart and keeps it from filling properly. The result is a dramatic drop in blood pressure that can be fatal.

78
Q

Pericardiotomy

A

Incision into the pericardium for clot/foreign body removal. Verify method used to reach the pericardium (thorascopic? See code 32658)

79
Q

Pericardiectomy

A

Removal of the pericardium surrounding the heart. Verify if cardiopulmonary bypass is used.

80
Q

Transmyocardial laser revascularization

A

Surgical procedure to treat severe angina. Thoracotomy incision and laser is inserted. Laser is fired at a viable ischemic area. Increased blood flow to severely damaged muscle and stimulates the growth of new blood vessels within the myocardium

81
Q

Pacemakers

A

Verify whether procedure is insertion, revision, or removal. Verify temporary or permanent. What components are being worked on (electrodes, pulse generator). How many leads and placement of the leads.

82
Q

Cardiac Assist Devices

A

Pacemaker, and implantable defibrillators. Cardiac assist devices is where to find these codes in the index of the CPT book.

83
Q

Subcutaneous cardiac rhythm monitor

A

Event recorder that is activated during irregular cardiac activity.

84
Q

Wireless pressure sensor for hemodynamic monitoring.

A

Sensor placed in the pulmonary artery to monitor hemodynamics

85
Q

Mitral regurgitation

A

Backwash of blood into the left atrium. Blood cannot move efficiently through the heart to the rest of the body leading to fatigue or shortness of breath

86
Q

Aortic stenosis

A

Narrowing of the aortic valve due to disease or aging. Narrowing causes left ventricular hypertrophy because of the increased pressure necessary to blood through the stenotic valve

87
Q

Aortic regurgitation

A

The aortic valve does not close properly and blood leaks back through the valve. Causes an overload of the left ventricle, resulting in an eventual decrease in muscular elasticity necessary for effective pumping.

88
Q

Annuloplasty

A

Repair of the ring (annulus) of a heart valve

89
Q

Valvuloplasty

A

Repair of a valve with sutures, patches, or rings. Involves work on the whole valve including work on the leaflets and the annulus.

90
Q

Valve replacement

A

Replacement with either a mechanical or biological prosthesis. Report procedures for each valve worked on. Verify if cardiopulmonary bypass is included in the procedure.

91
Q

Transcatheter aortic valve replacement procedure

A

Replacement of the aortic valve with a prosthetic valve. Catheter is placed in an artery and threaded to the heart. Requires 2 surgeons and modifier 62. Verify if cardiopulmonary bypass is used.

92
Q

Infundibulum

A

The outflow tract that extends to the pulmonary artery. If this tract is stenosed blood backs up into the right ventricle.

93
Q

Transcatheter pulmonary valve implantation

A

Percutaneous implantation of a prosthetic valve. Lots of procedures include in this service.

94
Q

Commissurotomy

A

Surgical opening or division of a fibrous ring. Used when a valve must be opened and the outflow tract augmented.

95
Q

Ramus intermedius

A

5th coronary artery which is a variant coronary artery resulting from trifurcation of the left main coronary artery

96
Q

Fistula

A

Abnormal opening from a hollow organ to the surface or from one organ to another.

97
Q

Atreriovenous fistula

A

Communication between a vein and an artery allowing oxygenated and deoxygenated blood to mingle. Can develop into an AV aneurysm or bulging pouch. One of the of the fistula is closed by surgery

98
Q

Takeuchi procedure

A

Holes are made in the aorta and pulmonary artery at the level of the anomalous artery and where the vessels touch each other. Holes are sewn together to form a direct aortopulmonary opening. Blood is then diverted from the aorta to the anomalous coronary artery

99
Q

Coronary artery bypass grafts

A

Surgical procedure to bypass blockages of coronary arteries to improve blood flow to the heart. Verify # of grafts, how many were arteries or veins and what arteries and veins were used. A few vessels get add on codes. Endoscopic harvesting of vessels is an add on code as well.

100
Q

Secundum

A

A hole between the right and left atria. Most common is a ostium secundum which is normal for a developing fetus but closes at birth

101
Q

Tetralogy of Fallot

A

Congenital heart condition with four anomalies

  1. Stenosis of the infundibulum. (Outflow passage from the right ventricle to the pulmonary artery
  2. Ventricular septal defect
  3. Abnormally positioned aorta causing a mixture of arterial and venous blood
  4. Hypertrophy of the right ventricle
102
Q

Subclavian to pulmonary shunt procedure

A

Also known as Blalock-Taussig procedure. Palliative procedure for children who do not get enough O2 in their blood. To little blood to the lungs. Used for complicated defects like tricuspid atresia.

103
Q

Transposition of great vessels

A

Aorta and pulmonary are reversed. Must be shunted for the patient to survive.

104
Q

Truncus Arteriosus

A

Common arterial trunk opening out of both ventricles in the heart while the fetus is in early stages of development in utero. Usually divides on its own, but if not surgery is needed. Common to have other abnormalities with this condition

105
Q

Aneurysm

A

Local abnormal dilation of an artery due to congenital defect or weakness of the vessel wall. Can be caused by atherosclerosis, trauma, or infection. Can cause ruptured, emboli to the peripheral artery, pressure on surrounding tissue, or obstruction of blood flow.

106
Q

Pseduoaneurysm

A

False aneurysm. Blood vessel wall is injured causing blood to be contained in surrounding tissue. Can occur due to injury or surgical complications.

107
Q

Dissection

A

Tear in the innermost layer of the aorta. Rare to be isolated to the abdominal aorta.

108
Q

Penetrating aortic ulcer

A

Plaque from atherosclerosis wears away the arterial wall lining causing a penetration of the vessel.

109
Q

Traumatic disruption

A

Tear or rupture in the aorta. Causes severe hemorrhaging.

110
Q

Endovascular repair of the abdominal aorta and/or iliac arteries

A

Open or percutaneous femoral or iliac artery exposure and access to place a device to treat the abdominal aortic defect. Coded based on vessels involved, type of endograft, and whether the vessel has ruptured.

111
Q

Direct repair or aneurysm or excision and graft for aneurysm, pseudo aneurysm, ruptured aneurysm, and associated occlusive disease

A

Codes 35001-35152 include artery preparation and endarterectomy. Codes 35201-35286 are for excision and replacement with a graft.

112
Q

Deep vein thrombosis

A

Can be temporary or permanent. Causes distal vessels damage due to pressure, hypoxemia, stretch, and malnutrition. Edema can result. Can also cause clots in response to inflammation and trauma.

113
Q

Thrombus

A

Blood clot. Can break loose and become an embolism. Most often lodge in pulmonary capillaries.

114
Q

Thrombophlebitis

A

Inflammation of a vein, usually in the leg due to presence of a thrombus. Causes calf pain and tenderness.

115
Q

Thromboendartectomies

A

Used when calcified plaque or clot formations do not respond to angioplasty procedures. Thrombus is removed along with inner lining of the artery. Codes based on site needing surgery

116
Q

Angioplasty

A

Opens narrow or blocked vessels. Verify if used on coronary arteries. Those are coded in a different section of the CPT book.

Codes chosen by vessel. Lower extremity percutaneous transluminal angioplasty is coded from Endovascular Revascularization

117
Q

Bypass Grafts

A

3 types. Vein, In-situ vein, and other than vein. Must know anastomosis sites (where the vein is connected) and what type of graft (can be a combination of autologous and synthetic)

118
Q

Arterial transposition

A

Moving of an artery to another blood supply or anastomosis of a diseased artery to a healthy artery. Add on codes for reimplantation of a visceral artery to a infrarenal aortic graft

119
Q

Central venous access devices

A

Catheters placed in large veins for patients who require frequent access to the bloodstream. Catheter must terminate in the subclavian, braciocephalic, or iliac vein, the inferior or superior vena cava, or the right atrium.

120
Q

Central venous access procedure types

A

Insertion, repair, partial replacement, complete replacement, and removal.

121
Q

Central insertion sites

A

Jugular, subclavian, or femoral veins, or the inferior vena cava.

122
Q

Peripheral insertion sites

A

Basilic, cephalic, or other peripheral veins.

123
Q

Tunneled catheter

A

Tunnel made under the skin and the catheter is secured for long term access

124
Q

Intraosseous infusion

A

Insertion of a special needle through the skin, muscle tissue, and into the bone marrow cavity of the tibia or fibula. Used in infants who have inaccessible vessels and needs fluids to be infused into the bone marrow

125
Q

Dialysis circuit

A

Divided into two parts. Central and peripheral. Coding for this section is based on hierarchy with each more intensive service includes the services lower in the hierarchy

126
Q

Portal decompression procedures

A

Patients that develop portal hypertension due to occlusion of the portal vein. Decompressed by making anastomoses between portal vein and the listed combinations.

127
Q

Transvenous intrahepatic portosystemic shunt

A

Procedure used to reduce portal pressure. Catheter is threaded into the portal vein and a self expanding stent to bridge the portal and hepatic veins is placed to divert blood to the hepatic vein. Performed when pressure in the portal vein is so great it causes bleeding from vessels in the esophagus

128
Q

Transcatheter procedures

A

Subsection of vascular codes describes procedures to resolve a vascular condition cross the vessel. Vessel is accessed and a drug infusion, biopsy, or removal of a foreign body is performed inside the vessel.

129
Q

Ligation

A

the surgical procedure of closing off a blood vessel or other duct or tube in the body by means of a ligature or clip.

130
Q

Angiography

A

Radiographic visualization of blood vessels following the introduction of contrast material

131
Q

Antegrade

A

Moving or extending anteriorly,

Moving with the flow

132
Q

Contralateral

A

Situated on, pertaining to, or affecting the opposite side

133
Q

Digital subtraction angiography

A

Arteriography using electronics to remove the background of bone and soft tissues to show useful arteries only

134
Q

First order vessel

A

Primary branch of the main trunk of a vascular system

135
Q

Ipsilateral

A

Situated on, pertaining to, or affecting the same side

136
Q

Arterial main trunk

A

Aorta

137
Q

Venous main trunk

A

Vena cava

138
Q

Non-selective catheterization

A

Catheter placed in main trunk, contrast may be injected, images may be taken, but the catheter is not moved into any branches

139
Q

Retrograde

A

Moving backwards or against the usual flow

140
Q

Roadmapping

A

Overlaying of two images

141
Q

Second order vessel

A

Secondary branch that comes off a first order vessel

142
Q

Selective catheterization

A

Catheter is placed in the branches further off the main trunk

143
Q

Third order and higher vessels

A

Tertiary and higher vessels. Come off second order vessels

144
Q

Vascular family

A

Network of vessels arising from the aorta’s main branch or network of vessels arising from one primary branch off the access site

145
Q

Sclerotherapy

A

Obliterating veins through a reaction caused by chemical solution injected directly into the veins. Can be used after surgical removal of large veins to obliterate small residual spider veins

146
Q

Endovascular revascularization

A

Lower extremity services for occlusive disease only. Includes transluminal angioplasty, placement of stent, atherectomy, and placement of stent with atherectomy in the arterial areas: iliac, femoral/popliteal, and tibial/peroneal.

147
Q

Atherectomy in the iliac area

A

Reported with CPT category III codes. Do not include accessing or selectively cathing the vessel, or closing the ateriotomy.

148
Q

S&I codes

A

Radiologic supervision and interpretation.

149
Q

Heart MRI and CT procedures

A

Different from regular MRI because it provides physiologic evaluation of the cardiac function. Only one procedure and one add on for flow velocity can be reported per session. Stress tests can be reported as well if appropriate

150
Q

Cardiac SPECT scans

A

Single photon emission computed tomography. Used to measure blood flow through the heart and detects areas of abnormal muscle.

151
Q

Cardiac blood pool imaging

A

Radioactive solution is introduced into the blood stream and is monitored as it travels through the heart. Can be performed at rest or stress tested (report if appropriate)

152
Q

Positron emission tomography

A

Nuclear imaging to evaluate heart function after administration of a natural biochemical substance. Can be used to look for coronary artery disease by examining blood flow through the heart or tissue after a heart attack.

153
Q

CPR

A

Code 92950. No time frame and not bundled into critical care services

154
Q

Cardioversion

A

Placement of defibrillator paddles. Can be internal and external. Review codes not be used with this code

155
Q

Thrombolysis of a coronary artery

A

Coded by method of administration. Can be intracoronary infusion or IV infusion

156
Q

Intravascular ultrasound or optical coherence tomography

A

Add on codes when performed during a diagnostic or therapeutic intervention. Ultrasound or light is used to examine coronary arteries and bypass grafts. Coded per vessel.

157
Q

Percutaneous coronary intervention

A

Percutaneous revascularization for occlusive disease of the coronary arteries, branches, and bypass grafts. One procedure reported then add on codes

158
Q

Percutaneous transluminal coronary angioplasty

A

Nonsurgical procedure to relieve narrowing and obstruction of coronary arteries. Ballon catheter inserted in groin or arm and advanced to the narrowing to flatten the accumulation of plaque. Add on code for additional branches.

159
Q

Percutaneous transluminal coronary atherectomy

A

Cutting devices is used to remove plaque build up from artery walls. Includes angioplasty when performed.

160
Q

Percutaneous intracoronary stent placement

A

Tube is placed on ballon catheter and once in place balloon is inflated and stent expands and is placed to keep artery open. Includes angioplasty when performed.

161
Q

PCI code hierarchy

A 
Acute MI
Chronic/total occlusion
Atherectomy and stent
Atherectomy
Stent
Angioplasty
162
Q

Modifier LC

A

Left circumflex coronary artery

163
Q

Modifier LD

A

Left anterior descending coronary artery

164
Q

Modifier LM

A

Left main coronary artery

165
Q

Modifier RC

A

Right coronary artery

166
Q

Modifier RI

A

Ramus intermedius coronary artery

167
Q

Cardiac resynchronization therapy

A

Used to treat delays in contraction between right and left ventricles. Electrode is placed through a cardiac vein into the left ventricle. Electrical impulse caused the ventricle to contact improving output

168
Q

Elective replacement interval

A

Battery levels getting low and will need replacement in a cardiac assist device

169
Q

Replacement of pacemaker due to battery life ICD code

A

Search for Admission (for) adjustment/device then type of device

170
Q

Atrial fibrillation

A

AV node is bombarded with electrical impulses from the atria which causes the ventricles to beat rapidly and irregularly

171
Q

Maze procedure

A

Surgical treatment for atrial fibrillation. Also know as surgical ablation. Various practices to create scar tissue to stop conduction pathways for atrial fibrillation. Excision or isolation of the left atrial appendage is considered part of the procedure

172
Q

Paroxysmal supraventricular tachycardia

A

Very fast heart rate that begins and ends abruptly. Occurs due to problems with the electrical connection between the atria and ventricles. Signals that begin in the atria and move to the ventricles can re-enter the atria resulting in extra heartbeats

2020 Coding For CPT Prep PHS (16 decks)

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