AAPC - American Academy of Professional Coders Cardiovascular System Coding Questions and Answers — 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?
- 33533 for the arterial graft and +33517 for the venous graft. (Correct answer)
- 33533 for the arterial graft and 33510 for the venous graft.
- 33517 for the combined grafts.
- 33535 for two coronary artery grafts.
Correct answer: 33533 for the arterial graft and +33517 for the venous graft.
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?
- 33213 for the pulse generator and 33217 for the leads.
- 33206 for the atrial lead and 33207 for the ventricular lead.
- 33208 (Correct answer)
- 33249
Correct answer: 33208
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?
- 93452
- 93458 (Correct answer)
- 93451, 93454
- 93456 and 93454
Correct answer: 93458
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?
- 92928-RC, 92920-LD (Correct answer)
- 92920-LD, 92921-RC
- 92933-RC, 92920-LD
- 92928-RC, +92929-LD
Correct answer: 92928-RC, 92920-LD
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?
- Intracardiac echocardiography (ICE)
- 3D mapping
- A comprehensive electrophysiology (EP) study (Correct answer)
- Ablation of a second, distinct arrhythmia
Correct answer: A comprehensive electrophysiology (EP) study
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.
Question 6: A patient with a previously implanted dual-chamber pacemaker presents for a pulse generator change due to battery depletion. The physician makes an incision over the old pocket, removes the existing pulse generator, tests the integrity of the existing leads, connects the leads to a new dual-chamber pulse generator, and closes the pocket. How is the removal and replacement of the pulse generator coded?
- 33208
- 33228 (Correct answer)
- 33233 and 33213
- 33235 and 33208
Correct answer: 33228
CPT® code 33228 is specifically for the removal of a permanent pacemaker pulse generator with replacement of the pulse generator; dual lead system. This single code captures both the removal of the old generator and the insertion of the new one. Reporting separate codes for removal (33233) and insertion (33213) would be incorrect, as a combination code exists. Code 33208 is for a complete new system including leads.
AAPC - American Academy of Professional Coders Cardiovascular System Coding Questions and Answers
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?