Compliance Question of the Week – Cardiology

In the cardiology question of 4-17-17, the provider asked what codes would be assigned for explanting the dual-system permanent pacemaker and implanting and attaching two new leads to the existing pacemaker on the other side of the chest. You stated that codes 33222, 33235 and 33217 would be assigned, but these only cover the relocation of a skin pocket and the electrodes. Based on the question, is the whole pacemaker being removed, relocated, and then re-implanted with two new leads? If so wouldn’t you code 33233, 33235, and 33208?

One of our cardiologists performed the following: a left heart cath w/ coronaries, then a selective left subclavian angiogram to see whether there was a stenosis in the subclavian, and then a selective left internal mammary artery (LIMA) looking at it for a possible grafting site. How would we code this?

We explanted the dual-system permanent pacemaker and then we implanted two new leads and attached them to the existing pacemaker on the other side of the chest. I can’t find one CPT code that captures what we did. Can you offer me insight into how you would code this?

We performed an electrophysiology (EP) study with intracardiac echocardiogram (ICE) and coronary sinus (CS) and left atrial (CS/LA) pacing and ablation for supraventricular tachycardia (SVT). Which code(s) can we report?

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)?

Can we bill the following injection codes for drug administration during a cardiac catheterization procedure?
96373      Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial
96374      Intravenous push, single or initial substance/drug

Can we bill the following injection codes for drug administration during a cardiac catheterization procedure?
96373      Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial
96374      Intravenous push, single or initial substance/drug

If we perform a left-sided atrial fibrillation (a-fib) ablation (93456) and then, after diagnostic maneuvers, we get an atrial flutter on the right side and ablate that, would code 93655 also be reported?

The patient presents for a diagnostic left heart catheterization (LHC), left ventriculogram and selective coronary angiography. The physician determines that hemodynamic assessment should be performed before and after exercise to assist in the clinical diagnosis. The patient is given a pair of 2.5-pound dumbbell weights then asked to exercise by extending the arms and bringing the arms with the weights to their chest. The patient exercises for three to five minutes. Does this type of exercise meet the criteria for billing code 93464?

The American Society of Nuclear Cardiology recommends nuclear medicine imaging code 78803 or 78800 with A9538 (for PYP) for patients with cardiac amyloidosis. Would either of the 788XX codes above be the correct CPT for this exam?

Can we bill codes 93620 and 93656 (both relate to comprehensive electrophysiologic evaluation) together? Are there any other codes that may be billed with 93656, or is it all encompassing?

I can’t find a specific rule, but I thought that we could code and bill for the insertion of a temporary pacemaker but should not code or bill for the removal of the temporary device. Is this correct?