ATCR.book Page 1 Tuesday, November 20, 2012 3:07 PM Coding Companion for Cardiology/Cardiothoracic/ Vascular Surgery A comprehensive illustrated guide to coding and reimbursement 2015 ATCR.book Page i Tuesday, November 20, 2012 3:07 PM Contents Getting Started with Coding Companion .............................i Diaphragm ......................................................................586 Chest Wall ...........................................................................1 Esophagus .......................................................................589 General Musculoskeletal ......................................................2 Abdomen ........................................................................635 Neck and Thorax .................................................................4 Thyroid Gland .................................................................640 Larynx ...............................................................................24 Parathyroid......................................................................641 Trachea and Bronchi ..........................................................28 Nervous System...............................................................644 Lungs and Pleura ...............................................................56 Medicine .........................................................................651 Heart and Pericardium .....................................................129 Appendix.........................................................................718 Arteries and Veins ............................................................293 Evaluation and Management ...........................................775 Lymph Nodes ..................................................................579 Index...............................................................................795 Mediastinum ...................................................................582 CPT © 2013 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding Companion for Cardiology/Cardiothoracic/Vascular Surgery Contents reported separately. Any additional repair or hypertension first: 402.0-402.9, with 33945 resection procedures on the donor heart are fifth-digit 1 or 404.0-404.9 with fifth 33945 Heart transplant, with or without recipient also reported separately, see 33300, 33310, digit 1 or 3) 33320, 33400, 33463, 33464, 33510, 33641, cardiectomy 428.22 Chronic systolic heart failure — (Code, 35216, 35276, or 35685. Donor cardiectomy and any backbench work, repair, or resection if applicable, heart failure due to procedures on the donor heart are usually the hypertension first: 402.0-402.9, with financial responsibility of the recipient. fifth-digit 1 or 404.0-404.9 with fifth digit 1 or 3) ICD-9-CM Procedural 428.32 Chronic diastolic heart failure — 00.93 Transplant from cadaver (Code, if applicable, heart failure due 37.51 Heart transplantation to hypertension first: 402.0-402.9, with fifth-digit 1 or 404.0-404.9 with 39.61 Extracorporeal circulation auxiliary to fifth digit 1 or 3) open heart surgery 428.42 Chronic combined systolic and Anesthesia diastolic heart failure — (Code, if 33945 00580 applicable, heart failure due to hypertension first: 402.0-402.9, with ICD-9-CM Diagnostic fifth-digit 1 or 404.0-404.9 with fifth 398.0 Rheumatic myocarditis digit 1 or 3) 412 Old myocardial infarction — (Use 429.0 Unspecified myocarditis — (Use additional code to identify presence additional code to identify presence of hypertension: 401.0-405.9) of arteriosclerosis) 414.00 Coronary atherosclerosis of 429.1 Myocardial degeneration — (Use unspecified type of vessel, native or additional code to identify presence graft — (Use additional code to of arteriosclerosis) identify presence of hypertension: 429.2 Unspecified cardiovascular disease — Heart and Pericardium Explanation 401.0-405.9) (Use additional code to identify The patient is placed on cardiopulmonary 414.01 Coronary atherosclerosis of native presence of arteriosclerosis) bypass. Cardiac transplantation may be coronary artery — (Use additional 746.9 Unspecified congenital anomaly of performed by one of two techniques: total code to identify presence of heart orthotopic heart replacement or heterotropic hypertension: 401.0-405.9) implantation. A total orthotopic heart 414.02 Coronary atherosclerosis of CCI Version 18.3 replacement involves excising the ventricles, 0213T, 0216T, 0228T, 0230T, 12001-12007, autologous vein bypass graft — (Use atrial appendages, and most of the coronary 12011-12057, 13100-13153, 32100, 32422, additional code to identify presence sinus from the donor heart. The recipient heart 32551, 33210-33211, 33310-33315, 35226, is then opened. The atria, aorta, and of hypertension: 401.0-405.9) 36000, 36400-36410, 36420-36430, 36440, pulmonary artery of the recipient heart are 414.04 Coronary atherosclerosis of artery 36600, 36640, 37202, 39000-39010, 43752, anastomosed to the donor heart. The sinoatrial bypass graft — (Use additional code 51701-51703, 62310-62319, 64400-64435, nodes of both the donor and recipient heart to identify presence of hypertension: 64445-64450, 64479, 64483, 64490, 64493, are left intact. In a heterotropic implantation, 401.0-405.9) 64505-64530, 69990, 93000-93010, the donor's organs are placed by sewing the 93040-93042, 93318, 94002, 94200, 94250, 414.8 Other specified forms of chronic left atrium of the donor heart to the left atrium 94680-94690, 94770, 95812-95816, 95819, ischemic heart disease — (Use of the recipient, and then sewing together the 95822, 95829, 95955, 96360, 96365, 96372, atrial septums and the right atrium. The donor additional code to identify presence 96374-96376, 99148-99149, 99150 of hypertension: 401.0-405.9) aorta is then trimmed to an appropriate length Note: These CCI edits are used for Medicare. and sewn to the ascending aorta of the 422.91 Idiopathic myocarditis Other payers may reimburse on codes listed recipient. Immunosuppressive drugs may be 422.92 Septic myocarditis — (Use additional above. given to the patient before, during, and after code to identify infectious organism) the operation. Cardiopulmonary bypass is Medicare Edits discontinued when the donor heart begins 422.93 Toxic myocarditis Fac Non-Fac functioning in the recipient. 425.0 Endomyocardial fibrosis RVU RVU FUD Status 425.3 Coding Tips Endocardial fibroelastosis 33945 145.58 145.58 R90 425.4 Other primary cardiomyopathies Heart transplantation involves three distinct MUE Modifiers 428.0 Congestive heart failure, unspecified components. Code 33945 includes only 33945 8062*N/A511 transplant of the cadaver donor heart with or — (Code, if applicable, heart failure * with documentation without recipient cardiectomy and care of the due to hypertension first: Medicare References: 100-2,15,50.5; recipient. Cadaver cardiectomy (33940) is 402.0-402.9, with fifth-digit 1 or 100-2,15,60.3; 100-3,260.9; 100-4,3,90.2.1 reported separately. Backbench work (33944), 404.0-404.9 with fifth digit 1 or 3) which involves preparation of the cadaver 428.1 Left heart failure — (Code, if donor heart allograft prior to transplant, is also applicable, heart failure due to CPT © 2013 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding Companion for Cardiology/Cardiothoracic Surgery/Vascular Surgery Heart and Pericardium — 279 Explanation Explanation 36400 A needle is inserted through the skin to puncture a The physician performs a push transfusion on a child 36400 Venipuncture, younger than age 3 years, vein of a person 3 years of age or older. The needle 2 years old and under. The physician calculates the necessitating the skill of a physician or is inserted into the vein and used for the withdrawal amount of blood to be transfused and slowly injects other qualified health care professional, of blood for diagnostic study or for the therapeutic it into the patient using a needle or existing infusion of intravenous medication. A soft flexible catheter. not to be used for routine venipuncture; catheter may be placed for prolonged therapy. Once femoral or jugular vein the procedure is complete, the needle or catheter 36450-36455 is withdrawn and pressure is applied over the 36450 Exchange transfusion, blood; newborn Explanation puncture site to control bleeding. Use this code 36455 other than newborn A needle is inserted through the skin to puncture when the venipuncture necessitates the skills of a the femoral or jugular vein of a child younger than physician or other qualified health care professional. age 3. The needle is inserted into the vein and used Do not use this code when routine venipuncture is Explanation for the withdrawal of blood for diagnostic study or performed. The physician performs an exchange transfusion on for the therapeutic infusion of intravenous a newborn. The physician calculates the blood medication. A soft flexible catheter may be placed Coding Tips volume to be transfused. A needle is placed in an for prolonged therapy. Once the procedure is This code has been revised for 2013 in the official artery or in an existing arterial catheter. The patient's complete, the needle or catheter is withdrawn and CPT description. blood is removed and replaced simultaneously to pressure is applied over the puncture site to control maintain blood pressure. Report 36455 if the child bleeding. Use this code for venipuncture when it is other than a newborn. necessitates the skill of a physician or other qualified 36415-36416 health