Question

Respiratory and Cardiovascular CPT coding

1. Explain how to code for sinus endoscopies and bronchoscopies, give examples.

2. Review the guidelines that pertain to the insertion of central venous access, explain types, and guidelines that apply to the insertion of these devices.

3. Discuss in detail the guidelines that apply to the coding of pacemakers and implantable defibrillators, first time insertion, revisions and replacements give examples

4. Explain in detail how to code for coronary bypasses, only venous and combined, give an example

Answer 1

Ans) 1)31276, Nasal/sinus endoscopy, surgical, with frontal sinus exploration, with or without removal of tissue from frontal sinus. 31287, Nasal/sinus endoscopy, surgical, with sphenoidotomy. 31288, Nasal/sinus endoscopy, surgical, with removal of tissue from the sphenoid sinus.

- For CPT this procedure is coded: 31628, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed, diagnostic, with cell washing, when performed; with transbronchial lung biopsy(s), single lobe.

2) Secure and reliable central venous access is a cornerstone in the care of hospitalized patients (eg, critical monitoring, drug infusion), as well as for a variety of outpatient situations (eg, parenteral nutrition, fluid therapy).

●Central venous access devices are generally classified based upon duration of catheter use (ie, acute, chronic), type of insertion (ie, central, peripheral), location of insertion (eg, jugular, brachial), number of lumens (ie, single, double, triple), as well as whether the catheter is implanted or not, and to what extent (eg, tunneled, totally implanted).

As the number of lumens increases, the overall diameter of the catheter increases, and the diameter of the individual luminal channels generally decreases. Catheter gauge and catheter-to-vein ratio are important determinants of fluid flow rates and catheter-related venous thrombosis. The number of catheter lumens is an important predictor of infectious and thrombotic complications for both centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs). Selecting catheters with the least number of lumens clinically necessary is important to avoid complications.

3) The Current Procedural Terminology (CPT) code 33249 as maintained by American Medical Association, is a medical procedural code under the range - Pacemaker or Pacing Cardioverter-Defibrillator Procedures.

4) The Current Procedural Terminology codes have a surgical section for heart operations with instructions on coding. CABG procedures are represented by codes 33510- 33536.