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2024 Physician Coding for CPC Preparation
Ch 10 - Review
1. According to the ICD-10-CM coding guidelines which condition has a causal
relationship with hypertension?
Answer: Chronic Kidney Disease (CKD)
Rationale: ICD-10-CM Coding Guideline I.C.9.a indicates that there is a presumed
causal relationship between hypertension and chronic kidney disease.
2. Which main coronary artery bifurcates into two smaller ones?
Answer: Left
Rationale: The left main coronary artery branches into two slightly smaller arteries:
the left anterior descending coronary artery and the left circumflex coronary artery.
3. _________________ is a term standing for enlargement of the heart.
Answer: Cardiomegaly
Rationale: Cardio = heart, megaly = enlargement
4. What part of the cardiovascular system is responsible for the one-way flow of blood
through the chambers of the heart?
Answer: Heart Valves
Rationale: Heart valves are made of flaps (cusps/leaflets) opening and closing like
one way swinging doors, preventing blood from flowing back.
5. Patient presents to her physician 10 weeks following a true posterior wall
myocardial infarction. The patient is still symptomatic and is diagnosed with
ischemic heart disease. What is (are) the correct ICD-10-CM code(s) for this
condition?
ICD-10 Code: Z51.89 and CPT Code: I25.9
Rationale: Because it is past four weeks since the myocardial infarction and the
patient is still symptomatic, ICD-10-CM guideline, I.C.9.e.1, indicates that the
appropriate aftercare code is assigned rather than a code from category I21. Look
in the ICD-10-CM Alphabetic Index for Aftercare referring you to Z51.89. Verify code
selection in the Tabular List. The instructional note under category Z51 indicates to
code also condition requiring care. Look in the Alphabetic Index for
Disease/heart/ischemic (chronic or with a stated duration of over 4 weeks)
directing you to I25.9. Verify in the Tabular List.
6. A physician states he performed a comprehensive EP study with induction of
arrhythmia in the hospital. The report shows bundle of His recording, pacing and
recording of the right atrium, and induction of arrhythmia by electrical pacing.
What CPT® coding is reported?
CPT Codes: 93600-26, 93602-26, 93610-26, 93618-26
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2024 Physician Coding for CPC Preparation
Ch 10 - Review
Rationale: Although the physician stated a comprehensive EP study was
performed, the right ventricular pacing and recording, and left atrial pacing and
recording from the coronary sinus or left atrium were not done. The components
must be billed separately. Look in the CPT® Index for Electrophysiology Procedure
directing you to 93600-93660. The procedure was performed in the hospital;
therefore, modifier 26 is appended to all the codes to report the professional
service.
7. A patient in the ED was found to have a ruptured abdominal aortic aneurysm. He
was taken to emergency surgery; a physician performed a direct repair. The
physician documented that the aneurysm involved the common iliac. Select the
proper CPT® code for this procedure.
CPT Code: 35103
Rationale: You must read the question carefully because this is a ruptured aortic
aneurysm involving the common iliac not a ruptured aneurysm of the common
iliac. Look in the CPT® Index for Aneurysm Repair/Abdominal Aorta referring you to
multiple codes. On review of the code ranges, code 35103 is correct. Code 35102
is a repair of an aneurysm not ruptured.
8. A physician performs a four-vessel autogenous (one venous, three arterial)
coronary bypass graft on a patient who had a previous CABG two years ago. The
saphenous vein, radial artery (harvested in an open procedure), and the left and
right internal mammary arteries were utilized. What CPT® coding is reported for
this procedure?
CPT Codes: 33535, 33530, 35600, 33517
Rationale: The patient had a coronary bypass graft on one vein and three arteries
making it a combination graft. Look in the CPT® Index for Coronary Artery/Bypass
Graft (CABG)/Arterial-Venous Bypass which refers you to 33517-33519, 33521-
33523. Look at the first set of codes, 33517-33519. These codes fall within the
subcategory for Combined arterial-venous grafting for coronary bypass. The
instructions say to report two codes: 1) a code from 33517-33523 for the combined
arterial-venous graft code (33517-33523) and 2) the appropriate arterial graft code
(33533-33536). 33517-33523 are add-on codes to report the venous portion of the
graft. In this case, one vein was grafted making +33517 correct. Below 33517,
there is a parenthetic instruction to report +33517 in conjunction with 33533-
33536. Code selection is based on the number of arterial grafts. In this case, three
arteries were grafted making 33535 the correct code. The instructions for arterial
grafting for coronary artery bypass indicate that the procurement (harvesting) of
the arterial grafts is included in this set of codes except when an upper extremity
artery is harvested. In this case, the radial artery was used, which is an upper
extremity artery. To report this, 33509 or 35600 is reported depending on if the
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2024 Physician Coding for CPC Preparation
Ch 10 - Review
procedure is open or endoscopic. The radial artery was harvested in an open
procedure making 35600 the correct code. One last code needs to be reported.
This is a reoperation. Look in the CPT® Index for Coronary Artery Bypass Graft
(CABG)/Reoperation and you are referred to 33530. This is an add-on code reported
to indicate this is a reoperation more than one month after the original procedure.
CPT® codes 33530 and 33517 are add-on codes, so modifier 51 is not appended.
CPT® code 35600 is modifier 51 exempt.
9. In the cath lab a physician places a catheter in the aortic arch from a right femoral
artery puncture to perform an angiography. Fluoroscopic imaging is performed by
the physician. What CPT® code(s) is/are reported?
CPT Code: 36221
Rationale: The aorta is the trunk of the system, so this is a non-selective
catheterization. Look in the CPT® Index for Angiography/Cervicocerebral Arch.
Only one code is reported for the catheterization and fluoroscopic imaging which is
36221.
10. In ICD-10-CM what is the default code for coronary artery atherosclerosis?
ICD-10: I25.10 Atherosclerosis heart disease of native coronary artery without
angina pectoris
Rationale: In the ICD-10-CM Alphabetic Index, look for
Atherosclerosis/coronary/artery referring you to I25.10. In addition, the coding for
ICD-10-CM requires the documentation to state when there is presence of angina
pectoris. If angina pectoris is present, the coder also needs to confirm if the
documentation mentions a spasm.
11. Aortography and bilateral extremity angiography were performed. The
physician placed the catheter in the aorta at the level of the renal arteries and
injected contrast for the aortography and repositioned the catheter just above the
bifurcation for angiography of the lower extremities. Which CPT® codes are
reported?
CPT Codes: 36200, 75625-26, 75716-26
Rationale: Because the catheter was repositioned, and separate studies were
performed, both the aortography and the extremity angiography are reported.
Look in the CPT® Index for Catheterization/Aorta referring you to 36160-36200. In
the CPT® Index see Aorta/Aortography referring you to 75600-75630. To locate
angiography of the lower extremities, look for Angiography/Leg Artery referring you
to 73706, 75635, 75710-75716. Modifier 26 reports the professional service.
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2024 Physician Coding for CPC Preparation
Ch 10 - Review
1. According to the ICD-10-CM coding guidelines which condition has a causal
relationship with hypertension?
Answer: Chronic Kidney Disease (CKD)
Rationale: ICD-10-CM Coding Guideline I.C.9.a indicates that there is a presumed
causal relationship between hypertension and chronic kidney disease.
2. Which main coronary artery bifurcates into two smaller ones?
Answer: Left
Rationale: The left main coronary artery branches into two slightly smaller arteries:
the left anterior descending coronary artery and the left circumflex coronary artery.
3. _________________ is a term standing for enlargement of the heart.
Answer: Cardiomegaly
Rationale: Cardio = heart, megaly = enlargement
4. What part of the cardiovascular system is responsible for the one-way flow of blood
through the chambers of the heart?
Answer: Heart Valves
Rationale: Heart valves are made of flaps (cusps/leaflets) opening and closing like
one way swinging doors, preventing blood from flowing back.
5. Patient presents to her physician 10 weeks following a true posterior wall
myocardial infarction. The patient is still symptomatic and is diagnosed with
ischemic heart disease. What is (are) the correct ICD-10-CM code(s) for this
condition?
ICD-10 Code: Z51.89 and CPT Code: I25.9
Rationale: Because it is past four weeks since the myocardial infarction and the
patient is still symptomatic, ICD-10-CM guideline, I.C.9.e.1, indicates that the
appropriate aftercare code is assigned rather than a code from category I21. Look
in the ICD-10-CM Alphabetic Index for Aftercare referring you to Z51.89. Verify code
selection in the Tabular List. The instructional note under category Z51 indicates to
code also condition requiring care. Look in the Alphabetic Index for
Disease/heart/ischemic (chronic or with a stated duration of over 4 weeks)
directing you to I25.9. Verify in the Tabular List.
6. A physician states he performed a comprehensive EP study with induction of
arrhythmia in the hospital. The report shows bundle of His recording, pacing and
recording of the right atrium, and induction of arrhythmia by electrical pacing.
What CPT® coding is reported?
CPT Codes: 93600-26, 93602-26, 93610-26, 93618-26
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2024 Physician Coding for CPC Preparation
Ch 10 - Review
Rationale: Although the physician stated a comprehensive EP study was
performed, the right ventricular pacing and recording, and left atrial pacing and
recording from the coronary sinus or left atrium were not done. The components
must be billed separately. Look in the CPT® Index for Electrophysiology Procedure
directing you to 93600-93660. The procedure was performed in the hospital;
therefore, modifier 26 is appended to all the codes to report the professional
service.
7. A patient in the ED was found to have a ruptured abdominal aortic aneurysm. He
was taken to emergency surgery; a physician performed a direct repair. The
physician documented that the aneurysm involved the common iliac. Select the
proper CPT® code for this procedure.
CPT Code: 35103
Rationale: You must read the question carefully because this is a ruptured aortic
aneurysm involving the common iliac not a ruptured aneurysm of the common
iliac. Look in the CPT® Index for Aneurysm Repair/Abdominal Aorta referring you to
multiple codes. On review of the code ranges, code 35103 is correct. Code 35102
is a repair of an aneurysm not ruptured.
8. A physician performs a four-vessel autogenous (one venous, three arterial)
coronary bypass graft on a patient who had a previous CABG two years ago. The
saphenous vein, radial artery (harvested in an open procedure), and the left and
right internal mammary arteries were utilized. What CPT® coding is reported for
this procedure?
CPT Codes: 33535, 33530, 35600, 33517
Rationale: The patient had a coronary bypass graft on one vein and three arteries
making it a combination graft. Look in the CPT® Index for Coronary Artery/Bypass
Graft (CABG)/Arterial-Venous Bypass which refers you to 33517-33519, 33521-
33523. Look at the first set of codes, 33517-33519. These codes fall within the
subcategory for Combined arterial-venous grafting for coronary bypass. The
instructions say to report two codes: 1) a code from 33517-33523 for the combined
arterial-venous graft code (33517-33523) and 2) the appropriate arterial graft code
(33533-33536). 33517-33523 are add-on codes to report the venous portion of the
graft. In this case, one vein was grafted making +33517 correct. Below 33517,
there is a parenthetic instruction to report +33517 in conjunction with 33533-
33536. Code selection is based on the number of arterial grafts. In this case, three
arteries were grafted making 33535 the correct code. The instructions for arterial
grafting for coronary artery bypass indicate that the procurement (harvesting) of
the arterial grafts is included in this set of codes except when an upper extremity
artery is harvested. In this case, the radial artery was used, which is an upper
extremity artery. To report this, 33509 or 35600 is reported depending on if the
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2024 Physician Coding for CPC Preparation
Ch 10 - Review
procedure is open or endoscopic. The radial artery was harvested in an open
procedure making 35600 the correct code. One last code needs to be reported.
This is a reoperation. Look in the CPT® Index for Coronary Artery Bypass Graft
(CABG)/Reoperation and you are referred to 33530. This is an add-on code reported
to indicate this is a reoperation more than one month after the original procedure.
CPT® codes 33530 and 33517 are add-on codes, so modifier 51 is not appended.
CPT® code 35600 is modifier 51 exempt.
9. In the cath lab a physician places a catheter in the aortic arch from a right femoral
artery puncture to perform an angiography. Fluoroscopic imaging is performed by
the physician. What CPT® code(s) is/are reported?
CPT Code: 36221
Rationale: The aorta is the trunk of the system, so this is a non-selective
catheterization. Look in the CPT® Index for Angiography/Cervicocerebral Arch.
Only one code is reported for the catheterization and fluoroscopic imaging which is
36221.
10. In ICD-10-CM what is the default code for coronary artery atherosclerosis?
ICD-10: I25.10 Atherosclerosis heart disease of native coronary artery without
angina pectoris
Rationale: In the ICD-10-CM Alphabetic Index, look for
Atherosclerosis/coronary/artery referring you to I25.10. In addition, the coding for
ICD-10-CM requires the documentation to state when there is presence of angina
pectoris. If angina pectoris is present, the coder also needs to confirm if the
documentation mentions a spasm.
11. Aortography and bilateral extremity angiography were performed. The
physician placed the catheter in the aorta at the level of the renal arteries and
injected contrast for the aortography and repositioned the catheter just above the
bifurcation for angiography of the lower extremities. Which CPT® codes are
reported?
CPT Codes: 36200, 75625-26, 75716-26
Rationale: Because the catheter was repositioned, and separate studies were
performed, both the aortography and the extremity angiography are reported.
Look in the CPT® Index for Catheterization/Aorta referring you to 36160-36200. In
the CPT® Index see Aorta/Aortography referring you to 75600-75630. To locate
angiography of the lower extremities, look for Angiography/Leg Artery referring you
to 73706, 75635, 75710-75716. Modifier 26 reports the professional service.
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