Overview
This lecture provided a comprehensive overview of cardiology, focusing on anatomy, common conditions, diagnostic and interventional procedures, key coding concepts, and real-world case examples for cardiology billing and coding.
Anatomy and Physiology of the Heart
- The heart has four chambers: right/left atria (blood enters) and right/left ventricles (blood exits).
- Blood flow: deoxygenated blood enters right atrium → right ventricle → pulmonary artery → lungs → left atrium → left ventricle → aorta.
- Key terms: systemic, coronary, pulmonary, portal, and lymphatic circulations.
- Cardiac conduction: SA node, AV node, bundle of His, Purkinje fibers coordinate heartbeat.
- Pacemaker leads: right atrial, right ventricular, and left ventricular (single, dual, multi-lead systems).
Common Cardiac Conditions and ICD-10 Coding
- Excludes 1 notes: conditions cannot be coded together; excludes 2: can be coded together if present.
- Atherosclerosis: plaque buildup in arteries; leads to coronary artery disease (CAD), myocardial infarction (MI), STEMI/NSTEMI.
- Chronic ischemic heart disease: classified by type and vessel; I25.1 for native artery, I25.2 for old MI, I25.5 for ischemic cardiomyopathy.
- Heart failure: systolic (I50.2), diastolic (I50.3), combined (I50.4); acute, chronic, or unspecified.
- Hypertension coding: link to heart disease (I11), kidney disease (I12), or both (I13); causality assumed unless documented otherwise.
- Myocardial infarction: I21 for acute MI, subsequent MI within 4 weeks, I25.2 for old MI.
Key Procedures and Cardiology Coding
- Diagnostic procedures: TTE (93306), TEE (93312), limited studies, and required documentation.
- Stress tests: chemical (e.g., Lexiscan) or exercise; codes depend on performed components.
- Cardiac catheterization: right (93451), left (93458), combined (93460), with or without graft evaluation.
- Percutaneous coronary intervention (PCI): primary (92928) and branch stents (92929), athererectomy (92933), STEMI interventions (92941).
- Pacemakers and ICDs: codes determined by number/location of leads and if new or replacement.
- EP studies and ablations: comprehensive studies (93619, 93620), ablation codes (93653 for SVT, 93654 for VT, 93656 for PVI), with specific add-on codes.
Case Examples Summary
- Stress test: bill 93016 (supervision), 93018 (interpretation) for professional component.
- PCI case: bill 99152 (mod sedation), 92928 (main vessel), 92929 (branch), both with vessel modifiers.
- PVI ablation: bill 93656 (PVI for A-fib), 93655 (add-on for distinct mechanism e.g., A-flutter), code diagnoses appropriately.
Key Terms & Definitions
- STEMI — ST-Elevation Myocardial Infarction: a complete blockage causing heart attack.
- PCI — Percutaneous Coronary Intervention: procedures to open narrowed coronary arteries.
- EP Study — Electrophysiology Study: tests electrical conduction in the heart.
- TTE/TEE — Transthoracic/Transesophageal Echocardiography: heart ultrasound types.
- Atherosclerosis — buildup of plaque in artery walls.
- Ischemia — reduced blood supply to part of the body, often the heart.
- Excludes 1/2 — ICD-10 notes indicating coding exclusivity or coexistence.
Action Items / Next Steps
- Review the latest CPT and ICD-10 guidelines for cardiology procedures and diagnoses.
- Practice coding with provided case examples and verify code selection with documentation.
- Familiarize yourself with vessel modifiers and add-on codes for PCI and EP procedures.
- Read assigned textbook sections on heart failure, MI, and cardiac procedures, as instructed.