Code Cardiovascular Procedures - Certified Professional Coder CPC

1. A cardiologist performs right heart catheterization, left heart catheterization, selective coronary angiography, left ventriculography, and bypass graft angiography in a patient with prior CABG. All five components are documented. Which CPT® code is reported?
   Answer: 93461 CPT® 93461 describes combined right and left heart catheterization with coronary angiography, intraprocedural injection for left ventriculography, and catheter placement in bypass grafts for bypass graft angiography — the most comprehensive cardiac catheterization code, applied when all five components are performed. Code 93460 describes right and left heart catheterization with coronary angiography and ventriculography but without bypass graft angiography; bypass graft angiography was performed here. Code 93459 describes coronary angiography with left heart cath, ventriculography, and bypass graft angiography but without right heart catheterization; right heart cath was performed here. Code 93457 describes coronary angiography with bypass graft angiography and right heart cath but without left heart cath or ventriculography. All five components together define 93461.
2. A cardiologist performs selective coronary angiography only, with catheter placement in the coronary arteries. No left or right heart catheterization and no left ventriculography are performed. Which CPT® code is reported?
   Answer: 93454 CPT® 93454 describes catheter placement in the coronary arteries for coronary angiography alone — the correct code when selective coronary injections are the only service performed, with no left or right heart catheterization and no ventriculography. Code 93458 describes coronary angiography with left heart catheterization including left ventriculography; neither left heart cath nor ventriculography was performed here. Code 93460 describes right AND left heart catheterization with coronary angiography and ventriculography; neither form of heart catheterization was performed. Code 93456 describes coronary angiography with right heart catheterization; no right heart cath was performed. When coronary angiography is performed without any hemodynamic left or right heart catheterization, 93454 is the correct selection.
3. A cardiac surgeon performs coronary artery bypass using a single saphenous vein graft to the right coronary artery. No arterial conduits are used. Which CPT® code is reported?
   Answer: 33510 CPT® 33510 describes coronary artery bypass using a single venous graft — the correct code when one vein graft is anastomosed to one coronary target and no arterial grafts are used. Code 33533 describes CABG using a single arterial graft; the saphenous vein is a venous, not arterial, conduit. Code 33511 describes CABG using two venous grafts; only one graft is performed here. Code 33534 describes CABG using two arterial grafts. The graft type (arterial vs. venous) and the number of grafts are the two axes that distinguish all CABG codes; correctly identifying the conduit as saphenous vein (venous) and the count as one selects 33510.
4. An electrophysiologist removes a patient's permanent pacemaker pulse generator and replaces it with a new generator. The patient has a single pre-existing pacemaker lead, which is retained and reconnected. No new leads are placed. Which CPT® code is reported?
   Answer: 33227 CPT® 33227 describes removal of a permanent pacemaker pulse generator with replacement in a single-lead system — the correct code when an existing generator is removed and a new one is connected to one pre-existing lead without placing any new leads. Code 33212 describes insertion of a new pulse generator only with an existing single lead; unlike 33227, code 33212 does not include the removal step and is not the appropriate code when the old generator is also explanted. Code 33208 describes insertion of a new complete dual-chamber pacemaker system with transvenous electrodes — this patient has a single-lead system and no new leads are placed. Code 33228 describes removal with replacement in a dual-lead system; this is a single-lead system. The number of pre-existing leads — one (33227), two (33228), or more than two (33229) — determines the correct removal-with-replacement pacemaker code.
5. A cardiologist performs a percutaneous coronary intervention with balloon angioplasty and intracoronary stent placement in the left anterior descending artery. No atherectomy is performed. Which CPT® code is reported?
   Answer: 92928 CPT® 92928 describes percutaneous transcatheter placement of an intracoronary stent with coronary angioplasty when performed, for a single major coronary artery or branch — the correct code when a stent is placed in one coronary artery without atherectomy. Code 92920 describes percutaneous transluminal coronary angioplasty (PTCA) with balloon only, without stent placement; a stent was deployed in this case, so 92920 is insufficient. Code 92933 describes PCI with atherectomy and intracoronary stent in a single vessel; no atherectomy was performed here. Code 92924 describes PTCA with atherectomy but without stent placement. The combination of stent placement without atherectomy in a single vessel identifies 92928.
6. A surgeon explants a permanent pacemaker pulse generator only. No new generator is inserted at this session and no pacemaker leads are removed. Which CPT® code is reported?
   Answer: 33233 CPT® 33233 describes removal of a permanent pacemaker pulse generator only — the correct code when only the generator is taken out without simultaneous lead removal and without replacement of the generator at the same session. Code 33234 describes removal of a single transvenous pacemaker electrode (lead), which is not performed here; the leads are retained. Code 33235 describes removal of dual transvenous pacemaker electrodes; again, the leads are not removed in this session. Code 33228 describes removal of the pulse generator with replacement using a new generator in a dual-lead system — no replacement is performed here. When only the generator is explanted and no new generator is inserted and no leads are removed, 33233 is the correct standalone code.
7. An electrophysiologist implants a new permanent pacemaker system with a single transvenous electrode placed in the right ventricular apex and a pulse generator. No atrial lead is placed. Which CPT® code is reported?
   Answer: 33207 CPT® 33207 describes insertion of a new permanent pacemaker with a single transvenous ventricular electrode — the correct code for a single-chamber ventricular pacemaker system (generator plus one ventricular lead). Code 33206 describes insertion of a permanent pacemaker with a single transvenous atrial electrode; the lead here is placed in the right ventricular apex, not the atrium. Code 33208 describes insertion of a dual-chamber (AV) pacemaker with both atrial and ventricular transvenous electrodes; only one ventricular lead is placed here. Code 33212 describes insertion of a pulse generator only with a pre-existing single lead; the lead is newly placed in this case. The chamber(s) in which leads are placed — atrial only (33206), ventricular only (33207), or both (33208) — distinguish new pacemaker system codes.
8. A cardiac electrophysiologist removes an ICD pulse generator and replaces it with a new device. The patient has a single pre-existing ICD lead, which is retained and reconnected. No new leads are implanted. Which CPT® code is reported?
   Answer: 33262 CPT® 33262 describes removal of an ICD pulse generator with replacement in a single-lead system — the correct code when the existing generator is exchanged and only one pre-existing ICD lead is connected to the new device. Code 33263 describes ICD generator replacement in a dual-lead system; this patient has a single lead. Code 33264 describes ICD generator replacement in a multiple-lead (three or more) system. Code 33249 describes insertion or replacement of a complete ICD system including transvenous lead placement; since no new lead is placed, 33249 is incorrect. Accurate lead counting — single (33262), dual (33263), or multiple/three or more (33264) — is the critical distinction among ICD generator replacement codes.
9. A cardiac surgeon performs coronary artery bypass using two saphenous vein grafts to two separate coronary targets. No arterial conduits are used. Which CPT® code is reported?
   Answer: 33511 CPT® 33511 describes coronary artery bypass using two venous grafts — the correct code when two vein conduits are anastomosed to two separate coronary targets and no arterial conduits are used. Code 33533 describes CABG using a single arterial graft; saphenous vein is a venous, not arterial, conduit. Code 33510 describes CABG using a single venous graft; two grafts are performed here. Code 33512 describes CABG using three venous grafts; only two grafts were placed. The venous vs. arterial conduit classification and the accurate graft count are the two axes that drive CABG code selection; two venous grafts with no arterial conduits identifies 33511.
10. A cardiac electrophysiologist implants a new dual-chamber (AV) permanent pacemaker system, placing transvenous electrodes in both the right atrium and right ventricle along with a new pulse generator. Which CPT® code is reported?
    Answer: 33208 CPT® 33208 describes insertion of a new permanent pacemaker system with transvenous electrodes in both the atrium and ventricle (AV or dual-chamber) — the correct code when both an atrial and a ventricular lead are placed along with a pulse generator. Code 33206 describes insertion of an atrial single-chamber pacemaker with a transvenous electrode (atrial lead only). Code 33207 describes insertion of a ventricular single-chamber pacemaker with a transvenous electrode (ventricular lead only). Code 33212 describes insertion of a pulse generator only with an existing single lead — no new leads are placed with 33212. The dual-lead (AV) pacemaker system requires 33208, which should be distinguished from single-chamber atrial (33206) and single-chamber ventricular (33207) systems.
11. A cardiologist performs rotational atherectomy followed by intracoronary stent placement in the circumflex artery during the same session. No other vessels are treated. Which CPT® code is reported?
    Answer: 92933 CPT® 92933 describes percutaneous transcatheter coronary revascularization with atherectomy (open or rotational) and intracoronary stent placement in a single major coronary artery — the correct code when both atherectomy and stent placement are performed in the same vessel during the same session. Code 92920 describes PTCA (balloon only) without atherectomy or stent; both atherectomy and stent were used here. Code 92928 describes PCI with stent placement only, without atherectomy; rotational atherectomy was performed prior to stenting, requiring the atherectomy code upgrade. Code 92924 describes atherectomy with balloon angioplasty but without stent placement; a stent was deployed. When both atherectomy and stent placement are performed in a single coronary artery, 92933 captures both components and supersedes the stent-only (92928) or atherectomy-only (92924) codes.
12. A cardiologist performs right heart catheterization, left heart catheterization, selective coronary angiography, and intraprocedural left ventriculography in the same session. No bypass graft angiography is performed. Which CPT® code is reported?
    Answer: 93460 CPT® 93460 describes combined right and left heart catheterization with coronary angiography, including intraprocedural injection for left ventriculography when performed — the correct code when both right and left heart catheterizations are performed with coronary angiography and ventriculography, but without bypass graft angiography. Code 93456 describes coronary angiography with right heart catheterization only — no left heart cath is included in 93456. Code 93461 adds bypass graft angiography to the full right and left heart cath; no bypass graft angiography was performed here. Code 93458 describes coronary angiography with left heart cath and ventriculography but without right heart cath; both right and left heart caths were performed here. The simultaneous presence of right AND left heart catheterization distinguishes 93460 from 93456 and 93458.
13. A cardiac surgeon performs coronary artery bypass using three separate saphenous vein grafts to three coronary targets. No arterial conduits are used. Which CPT® code is reported?
    Answer: 33512 CPT® 33512 describes coronary artery bypass using three venous grafts — the correct code when three vein conduits are anastomosed to three coronary targets without any arterial grafts. Code 33533 describes CABG using a single arterial graft; the saphenous vein is venous, not arterial. Code 33511 describes CABG using two venous grafts; three grafts were performed here. Code 33513 describes CABG using four venous grafts. Venous graft CABG codes increase in one-graft increments: 33510 (one), 33511 (two), 33512 (three), 33513 (four), 33514 (five), and 33516 (six or more). Correctly counting the number of grafts and identifying the conduit type (venous) selects 33512.
14. A cardiac surgeon performs coronary artery bypass using the left internal mammary artery (LIMA) to the LAD and two saphenous vein grafts to the RCA and obtuse marginal branch (3 total bypasses). Which CPT® codes are reported for the bypass grafting?
    Answer: 33533 and 33518 When CABG uses both arterial and venous conduits, the arterial graft code (33533–33536) is the primary code and the venous graft add-on codes (33517–33523) are reported additionally. One LIMA plus two saphenous vein grafts requires: 33533 (CABG using one arterial graft, primary code) plus add-on code 33518 (CABG using two venous grafts). Code 33510 describes single-venous-graft CABG reported alone and ignores the arterial conduit entirely. Code 33511 describes two-venous-graft CABG reported alone — also omits the arterial conduit. Code 33534 describes two-arterial-graft CABG only and would ignore the venous conduits. Reporting a single code for a mixed-conduit CABG constitutes incorrect coding; the arterial primary code and the appropriate venous add-on code must always be reported together when both conduit types are used.
15. A cardiac surgeon performs coronary artery bypass using four arterial conduits — the LIMA, RIMA, and two radial artery segments — each anastomosed to a separate coronary target. No venous grafts are used. Which CPT® code is reported?
    Answer: 33536 CPT® 33536 describes coronary artery bypass using four or more arterial grafts — the correct code when four arterial conduits (LIMA, radial artery, RIMA, and a second radial artery segment) are each anastomosed to separate coronary targets with no venous grafts. Code 33535 describes CABG using three arterial grafts; four arterial grafts are used here. Code 33534 describes CABG using two arterial grafts. Code 33533 describes CABG using a single arterial graft. The arterial CABG codes increase in one-graft increments: 33533 (one), 33534 (two), 33535 (three), and 33536 (four or more). Identifying all four conduits as arterial conduits and counting them accurately selects 33536.
16. A cardiologist performs percutaneous transluminal coronary balloon angioplasty of the right coronary artery. No stent is deployed and no atherectomy device is used. Which CPT® code is reported?
    Answer: 92920 CPT® 92920 describes percutaneous transluminal coronary angioplasty (PTCA) using a balloon catheter in a single major coronary artery, without stent placement and without atherectomy — the correct code when balloon dilation alone achieves the therapeutic result. Code 92928 describes PCI with intracoronary stent placement (with or without angioplasty); no stent was deployed in this case. Code 92933 describes PCI with atherectomy and stent placement in a single vessel; neither atherectomy nor stent was used here. Code 92924 describes PTCA with atherectomy but without stent; no atherectomy device was used. Balloon-only PTCA without stenting (92920) must be clearly distinguished from stent-based PCI (92928) on the basis of whether a stent was deployed.
17. An electrophysiologist removes a patient's permanent pacemaker pulse generator and replaces it with a new generator. The patient has two pre-existing pacemaker leads, which are retained and reconnected. No new leads are placed. Which CPT® code is reported?
    Answer: 33228 CPT® 33228 describes removal of a permanent pacemaker pulse generator with replacement in a dual-lead system — the correct code when an existing pacemaker generator is removed and a new one is inserted connected to two pre-existing leads. Code 33212 describes insertion of a new pulse generator only with existing dual leads; this code does not include the removal component, whereas 33228 covers both the removal and the replacement. Code 33227 describes removal with replacement in a single-lead system; this patient has two leads. Code 33229 describes removal with replacement in a multiple-lead (more than two) system. The number of pre-existing leads — one (33227), two (33228), or more than two (33229) — is the differentiating factor among pacemaker generator removal-with-replacement codes.
18. A cardiologist performs selective coronary angiography combined with hemodynamic right heart catheterization. No left heart catheterization or left ventriculography is performed. Which CPT® code is reported?
    Answer: 93456 CPT® 93456 describes coronary angiography with right heart catheterization — the correct code when both selective coronary angiography and hemodynamic right heart catheterization are performed, without any left heart catheterization or left ventriculography. Code 93454 describes coronary angiography only; since right heart catheterization was also performed, 93454 is insufficient. Code 93460 describes right AND left heart catheterization with coronary angiography and left ventriculography; no left heart catheterization was performed here. Code 93458 describes coronary angiography with left heart catheterization and ventriculography; only right heart catheterization was performed in this case. The presence of right heart catheterization without left heart catheterization, combined with coronary angiography, defines 93456.
19. A vascular specialist performs transcatheter placement of an intravascular stent in the cervical carotid artery. A distal embolic protection filter wire is deployed to capture debris during the procedure. Which CPT® code is reported?
    Answer: 37215 CPT® 37215 describes transcatheter placement of an intravascular stent in the cervical carotid artery with distal embolic protection — the correct code when a carotid stent is placed percutaneously and an embolic protection device (filter wire) is deployed to capture debris. Code 37216 describes carotid artery stenting without distal embolic protection; an embolic protection device was used here, requiring 37215. Code 35301 describes open carotid endarterectomy via neck incision — an open surgical procedure, not a percutaneous stenting technique. Code 35475 describes percutaneous balloon angioplasty of the brachiocephalic trunk or branches without stent placement; a stent is placed here. The presence or absence of a distal embolic protection device is the sole differentiator between 37215 and 37216.
20. A vascular surgeon performs an open carotid endarterectomy via a neck incision, removing atheromatous plaque from the internal carotid artery and closing the arteriotomy with a patch graft. Which CPT® code is reported?
    Answer: 35301 CPT® 35301 describes thromboendarterectomy (including patch graft if performed) of the carotid artery via a neck incision — the correct code for open surgical carotid endarterectomy with plaque removal and patch angioplasty closure. Code 35475 describes percutaneous transluminal balloon angioplasty of the brachiocephalic trunk or branches; the procedure here is an open surgical endarterectomy, not a percutaneous balloon dilation. Code 37215 describes transcatheter placement of an intravascular stent in the cervical carotid artery with distal embolic protection — an endovascular technique (carotid artery stenting), not open endarterectomy. Code 37216 describes carotid stenting without distal embolic protection — also endovascular. Open endarterectomy (35301) and endovascular stenting (37215/37216) are distinct procedures for carotid artery disease.

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