Chapter K Heart

Question 1

Does the code K63.2 Angiocardiography of right side of heart NEC classify angiography of right coronary arteries?

Answer 1

No, code K63.2 classifies right chamber angiography; coronary artery angiography is classified at the code range K63.4-K63.6 (left and right coronary arteries are accessed from the left side, from the aorta)

Question 2

Code K60.3 Renewal of intravenous cardiac pacemaker system NEC includes renewal of pacemaker battery. Codes from category K73 describe renewal of specific types of pacemakers, but do not include renewal of pacemaker battery. Which category should we use to classify battery change of a double chamber pacemaker?

Answer 2

K73._ for specific type of pacemaker PCSK10

Question 3

Which approach code must be assigned following K26 for transapical/transventricular TAVI approach?

Answer 3

Y49.4 Transapical approach to heart PCSK1

Question 4

What does TAVI stand for?

Answer 4

Transcatherter Aortic Valve Implantation

Question 5

Which approach code must we assign following K26 for TAVI transluminal approach through artery?

Answer 5

Y79.- Approach to organ through artery PCSK1

Question 6

If open heart surgery has been carried out using both Cardiopulmonary bypass and Modified ultrafiltration adjunct to cardiopulmonary bypass, which subsidiary codes must we add with open procedure codes?

• Y73.1 Cardiopulmonary bypass only or
• Y73.1 Cardiopulmonary bypass and Y73.4 Modified ultrafiltration adjunct to cardiopulmonary bypass or
• Y73.4 Modified ultrafiltration adjunct to cardiopulmonary bypass only

Answer 6

Only Y73.4 Modified ultrafiltration adjunct to cardiopulmonary bypass is required PCSY8

Question 7

Coronary lithotripsy without stent insertions is classified using combination

K50.8 Other specified other therapeutic transluminal operations on coronary artery

Y17.3 Lithotripsy of lesion of organ NOC

When coronary lithotripsy is carried out with stent insertions, which code would be assigned following K75_ classifying stent insertions?

Answer 7

Y17.3 Lithotripsy of lesion of organ NOC, K50.8 is not coded PCSK9

Question 8

Intravascular Ultrasound of coronary arteries is classified at diagnostic category K51._. If therapeutic angioplasty and/or stent insertions are carried out using IVUS guidance in combination with other type of image control, how must we identify IVUS and where must it be sequenced?

Answer 8

We must use the code Y53.2 Approach to organ under ultrasonic control. It must be sequence after therapeutic codes (inc. Y14) and before other types of image control codes. PCSK4

Question 9

Category K49 Transluminal balloon angioplasty of coronary artery does not have specific codes at 4th character or includes notes to classify Drug Eluting Balloon (DEB). What is the best way to identify that type of balloon if used?

Answer 9

Using subsidiary code Y37.2 Introduction of substance into organ using drug-eluting balloon NOC

Question 10

When an angiocardiography (ventriculography) of the heart (codes K63.1-K63.3) is carried out at the same time as a coronary arteriography (codes K63.4-K63.6) during the same theatre visit, which of the procedures should be coded?

• Coronary arteriography on its own
• Both angiocardiography of the heart and coronary arteriography
• Angiocardiography of the heart on its own

Answer 10

Both procedures should be coded, code from the range K63.1-K63.3 and code from the range K63.4-K63.6

Question 11

For the insertion of a ventricular assist device (VAD) via open approach code K54.- Open heart assist operations is used in primary position. Which other subsidiary code is assigned by default for and open VAD?

Answer 11

Y70.5 Temporary operations PCSK5

Question 12

If a percutaneous transluminal procedure on the heart has no devoted code in the percutaneous transluminal category at 4th character, which category would we use to indicate approach through artery? Where must Y53/Y68 code be sequenced in such cases - straight after the code from Chapter K?

Answer 12

Y79_ Approach to organ through artery , codes Y53/Y68 must be sequenced after Y79_ PChSK1

Question 13

If a CRT-D device using 2 leads is implanted, which code must we use:

K59.2 Implantation of cardioverter defibrillator using two electrode leads

or

K59.6 Implantation of cardioverter defibrillator using three electrode leads?

Answer 13

K59.6 Implantation of cardioverter defibrillator using three electrode leads PCSK7 (an extra lead could be added later, ‘CRT-D upgrade’, but the device is the same)

Question 14

If a percutaneous transluminal procedure on the heart has no devoted code in the percutaneous transluminal category 4th character, which code would we use to indicate approach through vein? Where must Y53/Y68 code be sequenced in such cases - straight after the code from Chapter K?

Answer 14

Y76.8 Other specified minimal access to other body cavity , codes Y53/Y68 must be sequenced after Y76.8 PChSK1

Question 15

If coronary artery angioplasty has been carried out on the Left Anterior Descending Artery, which code can we use to capture the term Left?

Answer 15

None - Z94.- Laterality of operation must not be assigned in addition to procedures in Chapter K PChSK2 (

Question 16

When the percutaneous ablation of the heart and 3D mapping are carried out together, which of the procedures should be coded?

• 3D mapping on its own
• Percutaneous ablation on its own
• Both 3D mapping and percutaneous ablation

Answer 16

Percutaneous ablation on its own, PCSK6

Question 17

A percutaneous transluminal procedure on the heart has been performed and has no devoted code in the percutaneous transluminal category 4th character. Approach was through vein and artery. Which code would we use to indicate approach?

Answer 17

Both Y79_ Approach to organ through artery and Y76.8 Other specified minimal access to other body cavity PChSK1 example

Question 18

For the insertion of a ventricular assist device (VAD) using a percutaneous approach code K56.2 Transluminal insertion of heart assist system NEC is assigned in primary position. If image control is used, which subsidiary codes should be assigned in addition and how should they be sequenced?

Answer 18

1. Image control codes from categories Y53/Y68 2. Y70.5 Temporary operations PCSK5

Question 19

If multiple percutaneous transluminal procedures on the heart took place and none of them can be captured with devoted percutaneous transluminal codes 4th character, how many times must we code approach codes Y79_ (artery) or Y76.8 (vein) with open procedure codes?

Answer 19

Codes from category Y79 or code Y76.8 must be assigned after each open procedure code PChSK1

Question 20

When Pressure wire study, also known as Fractional Flow Reserve (FFR) is carried out together with coronary angiography, in which position should the code Y44.2 Monitoring of pressure in organ NOC be assigned following K63.4 - K63.6 Coronary arteriography?

Answer 20

In 3rd, it cannot enhance coronary arteriography codes, as it is not part of the angiogram. Therefore K51.8 Other specified diagnostic transluminal operations on coronary artery has to be assigned in secondary position, followed by Y44.2

PCSK3

Question 21

Which chapter classified the procedure Evaluation of cardioverter defibrillator?

Answer 21

Chapter X

Question 22

1. Is TAVI carried out via transapical, transventricular or transluminal approach to heart?
2. Which of the above terms describe the same approach?

Answer 22

1. Any of them
2. Transapical and transventricular desribe approach through the left ventricle

PCSK1

Question 23

When Pressure wire studies are carried out before insertion of coronary artery stents, which chapter K category codes should be sequenced before Y44.2 Monitoring of pressure in organ NOC?

Answer 23

Any codes from category K75 - insertion of stent. K51 must not be used in this case, as it is a diagnostic category and K75 is therapeutic.

PCSK3

Question 24

When a combination of different types of stents have been inserted into the coronary artery including drug-eluting, but 4th character codes choice is only between drug-eluting or NEC, how must the stent insertions be captured?

Answer 24

1. K75.1/K75.2 to identify number of drug eluting stents
2. Y14 codes to identify other types of stents
3. Y53/Y68 image control codes PCSK2

Question 25

What is a VAD (Ventricular Assist Device)? (outside of NCCQ syllabus)

Answer 25

It is a mechanical circulatory support device that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body

Question 26

Why is VAD implantation always coded with a subsidiary code Y70.5 Temporary Operations? (outside of NCCQ syllabus)

Answer 26

It is indicated for patients with Heart Failure, in cases where they

• have a temporary heart failure
• are waiting for a heart transplant and need temporary support see Implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplantation (nice.org.uk)