CARDIOVASCULAR
1. A 62-year old
female with three-vessel disease and supraventricular tachycardia, which has
been refractory to other management. She previously had pacemaker placement and
stenting of the coronary artery stenosis, which has failed to solve the
problem. She will undergo CABG with autologous saphenous vein and a modified
MAZE procedure to treat the tachycardia. The risks and benefits have been
discussed and the patient wishes to proceed. She is brought to the cardiac OR
and placed supine on the OR table. She is prepped and draped and adequate
endotracheal anesthesia is assured. A median sternotomy incision is made and
cardio- pulmonary bypass is initiated. The endoscope is used to harvest an
adequate length of saphenous vein from her left leg. This is uneventful and
bleeding is easily controlled. The vein
graft is prepared
and cut to the appropriate lengths for anatomosis. Three bypasses are
performed, one to the LAD, one to the circumflex and another distally on the
circumflex. A modified maze procedure was then performed and the patient was
weaned from bypass. Once the heart was once again beating on its own again, we
attempted to induce an arrhythmia and this could not be done. At this point,
the sternum was closed with wires and the skin reapproximated with staples. The
patient tolerated the procedure without difficulty and was taken to the PACU.
Choose the procedure code(s) for this service.
A. 33519, 33508,
33254-51
B. 33512, 33508,
33999-51
C. 33512, 33508,
33254-51
D. 33512, 33508-51,
33254-51
2. At the patient’s
bedside in the hospital, a PICC line is inserted. Using Xylocaine local
anesthesia, aseptic technique and ultrasound guidance, a 21 gauge needle was
used to aspirate the right cephalic vein of a 72-year-old patient. When blood
was obtained, a 0.018 inch platinum tip guidewire was advanced to the central
venous circulation. A 6 French dual lumen PICC was introduced through a 6
French peel-away sheath to the SVA RA junction and after removal of the sheath,
the catheter was attached to the skin with a STAT-LOCK device and flushed with
500 units of Heparin in each lumen. A sterile dressing was applied and the
patient was discharged in improved condition. Code the procedure(s).
A. 36565
B. 36556, 76942-26
C. 36561, 76942-26
D. 36569, 76942-26
3. The patient is a
67 -year-old gentleman with metastatic colon cancer recently operated on for a
brain metastasis, now for placement of an Infuse-A-Port for continued
chemotherapy. The left subclavian vein was located with a needle and a guide
wire placed. This was confirmed to be in the proper position fluoroscopically.
A transverse incision was made just inferior to this and a subcutaneous pocket
created just inferior to this. After tunneling, the introducer was placed over
the guide wire and the power port line was placed with the introducer and the
introducer was peeled away. The tip was placed in the appropriate position
under fluoroscopic guidance and the catheter trimmed to the appropriate length
and secured to the power port device. The locking mechanism was fully engaged.
The port was placed in the subcutaneous pocket and everything sat very nicely
fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk
stitch. What code should be used for this procedure?
A. 36556, 77001-26
B. 36558
C. 36561, 77001-26
D. 36571
4. 79-year-old male
with symptomatic bradycardia and syncope is taken to the Operating Suite where
an insertion of a DDD pacemaker will be performed. A left subclavian
venipuncture was carried out. A guide wire was passed through the needle, and
the needle was withdrawn. A second subclavian venipuncture was performed, a
second guide wire was passed and the second needle was withdrawn. An oblique
incision in the deltopectoral area incorporating the wire exit sites. A
subcutaneous pocket was created with the cautery on the pectoralis fascia. An
introducer dilator was passed over the first wire and the wire and dilator were
withdrawn. A ventricular lead was passed through the introducer, and the
introducer was broken away in the routine fashion. A second introducer dilator
was passed over the second guide wire and the wire and dilator were withdrawn.
An atrial lead was passed through the introducer and the introducer was broken
away in the routine fashion. Each of the leads were sutured down to the chest
wall with two 2- 0 silk sutures each, connected the leads to the generator,
curled the leads, and the generator was placed in the pocket. We assured
hemostasis. We assured good position with the fluoroscopy. What code should be
used for this procedure?
A. 33208, 76000-26
B. 33212
C. 33226
D. 33235, 76000-26
5. This 67 year-old
man presented with a history of progressive shortness of breath, mostly related
to exercise. He has had a diagnosis of a secundum atrioseptal defect for
several years, and has had atrial fibrillation intermittently over this period
of time. He was in atrial fibrillation when he came to the operating room, and
with the patient cannulated and on bypass, The right atrium was then opened. A
large 3 x 5 cm defect was noted at fossa ovalis, and this also included a
second hole in the same general area. Both of these holes were closed with a
single pericardial patch. What CPT and ICD-10 codes should be reported?
A. 33675, Q21.0
B. 33647, R06.02,
Q21.1
C. 33645, Q21.2,
R06.02
D. 33641, Q21.1
6. The patient is a
59-year-old white male who underwent carotid endarterectomy for symptomatic
left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90%
left internal carotid artery stenosis extending into the common carotid artery.
He is taken to the operating room for re-do left carotid endarterectomy. The
left neck was prepped and the previous incision was carefully reopened. Using
sharp dissection, the common carotid artery and its branches were dissected
free. The patient was systematically heparinized and after a few minutes clamps
applied to the common carotid artery and its branches. A longitudinal
arteriotomy was carried out with findings of extensive layering of intimal
hyperplasia with no
evidence of
recurrent atherosclerosis. A silastic balloon-tip shunt was inserted first
proximally and then distally, with restoration of flow. Several layers of
intima were removed and the endarterectomized surfaces irrigated with
heparinized saline. An oval Dacron patch was then sewn into place with running
6-0 Prolene. Which CPT code should be used?
A. 35301
B. 35301, 35390
C. 35302
D. 35311, 35390
7. The patient is a
77 year-old white female who has been having right temporal pain and headaches
with some visual changes and has a sed rate of 51. She is scheduled for a
temporal artery biopsy to rule out temporal arteritis. A Doppler probe was used
to isolate the temporal artery and using a marking pen the path of the artery
was drawn. Lidocaine 1% was used to infiltrate the skin, and using a 15 blade
scalpel the skin was opened in the preauricular area and dissected down to the
subcutaneous tissue where the temporal artery was identified in its bed. It was
a medium size artery and we dissected it out for a length of approximately 4 cm
with some branches. The ends were ligated with 4-0 Vicryl, and the artery was
removed from its bed and sent to Pathology as specimen. What code should be
used for this procedure?
A. 37609
B. 37605
C. 36625
D. 37799
8. A patient with a
diagnosis of bradycardia underwent placement of permanent atrial pacemaker, but
subsequently developed infection due to the battery after the surgery.
Therefore, he was taken to the operating room for replacement of the battery.
The patient was out of the postoperative period. The CPTcodes are:
a) 33212-78,
33233-51
b) 33212, 33233-51
c) 33227
d) 33206-78
9. A 15-day-old
preemie with birth weight of 2.5 kg underwent aortic valve plasty using
transventricular dilation with cardiopulmonary bypass. The CPT codes are:
a) 33391-63
b) 33390
c) 33390-63
d) 33391-22
10. A patient
underwent single transplant with cardiopulmonary bypass employed during the
procedure.
a) 32852
b) 32854
c) 32853
d) 32851
11. A patient with
severe coronary artery disease underwent coronary artery bypass surgery. The
surgeon performs repair of left anterior descending artery by procuring
saphenous vein and repair of right coronary artery by procuring radial artery.
Surgical assistance was required for procurement of saphenous vein. The
appropriate codes the surgeon should bill for are:
a) 33533, 33517-51,
35600, 35572
b) 33533, 33517,
35600
c) 33533, 33510-80,
35600
d) 33534,
33510-51-80, 35600
12. Donor undergoes
bone marrow harvesting for transplantation.
a) 38220
b) 38240
c) 38241
d) 38230
13. Which of the
following codes involves an arterial graft?
a) 33513
b) 33514
c) 33516
d) 33517
14. A surgeon
performs repair of abdominal aortic aneurysm, caused by high-grade
atherosclerosis.
a) 35081
b) 35091
c) 35001
d) 35082
15. Code for the
reposition of a single chamber transveous pacemaker electrode after 16 days
a) 33210
b) 33211
c) 33215
d) 33216
16. The bypass
graft was performed with axillary brachial vein
a) 35510
b) 33522
c) 35510, 35522
d) none of the answers
are correct
17. Code for
intramural unroofing of an aortic origin of coronary
a) 33504
b) 33505
c) 33506
d) 33507
18. Code for
endovenous ablation therapy of 4 incompetent veins, lower leg. Approach was
percutaneous. Technique used radiofrequency wave.
a) 36475
b) 36475 x 4
c) 36475, 36476
d) 36475, 36476 x 3
19. A 56-year-old
patient refractory ventricular tachycardia receives an implantable
cardioverterdefibrillator with leads placed transvenously into the right atrium
and right ventricle. This is the first time the patient is receiving such an
implant. What is the correct CPT codes to report this procedure?
a) 33208
b) 33208, 33225-51
c) 33249
d) 33249, 33217-51
20. A 62-year-old
patient with severe claudication of bilateral lower extremities undergoes a
percutaneous angioplasty of the left external iliac artery via right common
femoral approach using imaging guidance. Assign the correct CPT code(s) for
this procedure.
a) 37221
b) 37224
c) 37220
d) 37220, 37222
21. A patient with
significant coronary artery disease undergoes a coronary artery bypass graft
procedure. The surgeon performs the procedure using two venous grafts taken
from the saphenous vein and one arterial graft taken from the right internal
mammary artery. Assign the correct CPT codes for this procedure.
a) 33533, 33518
b) 33511, 33533,
35683
c) 33511, 33533
d) 33533, 33511,
35683
22. Complete the
following statement: To qualify as a central venous access device (CVAD), the
catheter:
a) must begin only
in the basilic or cephalic vein
b) tip must
terminate in the subclavian, brachiocephalic, iliac vein, the superior or
inferior vena cava or the right atrium
c) must have a pump
or port attached and placed in a subcutaneous skin pocket
d) can be placed
only via a tunneled method, non-tunneled devices are considered large
intravenous devices.
23. A 78-year-old
patient is seen for a poorly functioning ortacath. After evaluation, the
physician determines the catheter needs to be replaced. He removes the
tunneled, centrally inserted CVAD with a subcutaneous port and replaces the
same type through the same access site. Assign the correct CPT codes for this
procedure.
a) 36580
b) 36582
c) 36583
d) 36582, 36590-51
