Compliance Question of the Week – Cardiology

How is the following scenario coded? A patient has a SVG anastomosed to the LC obtuse marginal (OM). Next, this graft “jumps” to the RC posterolateral branch. Through the vein graft, the OM lesion is treated with angioplasty and bare metal stenting and a second lesion in the posterolateral branch of the RC is treated with angioplasty.

I have a provider who billed 93015 for a cardiovascular stress test performed in the outpatient hospital setting, and the hospital billed the following code:

93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report

The provider’s claim was re-coded from 93015 to 93018. How should a cardiovascular stress test done in a facility when a physician provides supervision as well as interpretation and report?

Is code 92973 the appropriate code for aspiration of a thrombus within a coronary vessel?

Cardiology documented the following in a patient progress note on the second hospital day: “Troponins +, highest 6.4, needs cath STAT. + chest pain.” The chart has no further clarification, so what would be the principal diagnosis on discharge?

Per the CPT® description, code 36223 includes angiography of the extracranial carotid circulation. Does this mean that you would not code 36222 and 36223 together for the same side if both the cervical and cerebral arteries were imaged? Is CPT 36222 included in CPT 36223?

Is modifier -59 (distinct procedural service) or modifier -XU (unusual non-overlapping service) better to use for a diagnostic cardiac catheterization that led to a decision to place a coronary stent at the same session?

During a recent transcatheter mitral valve repair (TMVR), we used three prostheses. Can we assign code 33418 plus 33419 x 2?

I have a patient who received an implantable cardioverter-defibrillator (ICD) dual-chamber device from company A. During the defibrillation threshold testing (DFT) phase, the device would not convert the patient from ventricular fibrillation, and rescue shocks were performed. The patient returned the following day and a new ICD generator from company B was inserted. This device has a higher joule output that will allow the patient to be converted from the arrhythmia.

Can I assign the following CPT® code for an ICD generator change?

33263 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system

If a temporary pacemaker lead is inserted during a diagnostic heart cath, is it appropriate to charge for this lead placement if the patient does not leave the procedure room with it (the pacemaker lead)?

Is the coding of a diagnostic cardiac catheterization different based on the access into the body, for example: radial versus femoral artery?

Can a right heart catheterization (RHC) be billed on the same claim as a heart biopsy?

What code should be reported when only venous grafting is performed?