SBS Chapter 21 – Flashcards
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pericardium
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membranous sac enclosing the heart and ends of the great vessels
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cardiopulmonary
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refers to the heart and lungs
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bypass
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to go around
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pacemaker
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electrical device that controls the beating of the heart by electrical impulses
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single-chamber device
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electrode of the pacemaker is placed only in the atrium or only in the ventricle, but not in both places
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dual-chamber device
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elecytrodes of the pacemaker are plaaced in both the right atrium and the right ventricle of the heart
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electrode
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lead attached to a generator that carries the electrical current from the generator to the atria or ventricles
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ventricle
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chamber in the lower part of the heart
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atrium
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chamber in the upper part of the heart
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cardioverter-defibrillator
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surgically placed device that directs an electrical current shock to the heart to restore rhythm
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artery
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vessel that carries oxygenated blood from the heart to the body tissues
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vein
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vessel that carries deoxygenerated blood to the heart from the body tissues
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aneurysm
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a sac of clotted blood or fluid formed in the circulatory system
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embolism
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blockage of a blood vessel by a blood clot or other matter that has moved from another area of the body through the circulatory system
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thrombosis
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blood clot
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endarterectomy
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incision into an artery to remove the inner lining to remove disease or blockage
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angioplasty
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surgical or percutaneous procedure on a vessel to dilate the vessel open, used in treatment of artherosclerotic disease
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injection
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forcing of fluid into a vessel or cavity
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catheter
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tube placed into the body to put fluid in or take fluid out
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arteriovenous fistula
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direct communication (passage) between an artery and vein
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anomaly
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abnormality
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ischemia
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deficient blood supply caused by obstruction of the circulatory system
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cardiopulmonary bypass
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blood bypasses the heart through a heart-lung machine during open heart surgery
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fistula
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abnormal opening from one area to another area within the body or to outside of the body
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shunt
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divert or make an artificial passage
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intracardiac or external
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codes for excision of cardiac tumors are divided based on whether the tumor is located.........or...........
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pacemaker and cardioverter-defibrillator
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names of two devices that are inserted into the body to electrically shock the heart into regular rhythm
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epicardial and intranvenous
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the two approaches used to insert devices that electrically shock the heart into regular rhythm
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modifier 78
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if the patient is returned to the operating room for repositioning or replacement of a pacemaker, which modifier is used?
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modifier 24
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when you bill E/M services unrelated to a pacemaker implantation during the allowable follow-up days, what modifier would you use
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pulmonary semilunar, tricuspid, aortic and mitral (bicuspid)
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what are the four cardiac valves
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patient activated event recorder
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device that can be surgically implanted into the subcutaneous tissue in the upper left quadrant to record heart rhythms when the patient depresses a button - 33282-33284
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coronary arteries
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what arteries feed the heart
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reversible ischemia
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condition when a heart artery is clogged and the heart muscle performs at a low level as a result of a lack of blood
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non-reversible ischemia
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condition when a heart artery is clogged and the heart muscle dies
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embolus
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a mass of undissolved matter in the blood that is transported by the blood current is a(n)
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contrast media
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local anesthesia, catheter introduction and injection are procedures that are included in a vascular injection
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TTE
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transthoracic
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TEE
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transesophogeal
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coronary heat disease CAD
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narrowing of the coronary arteries; blood flow is restricted or stops
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artheroslerosis
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fatty material and a substance called plaque build up on the walls of your arteries
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artherothrombosis
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blood clot in the artery
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lipoprotein profile
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measures the level of cholesterol in the blood
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myocardial infarction MI
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artherothrombosis stops an area of the heart muscle receiving blood and oxygen, leading to permanent damage (heart attack)
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angina
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type of chest discomfort caused by poor blood flow through the coronary vessels
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myocardium
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heart muscle
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alpha blockers
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work through autonomic nervous system by blocking alpha nerve receptors
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ace inhibitors
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prevents production of the hormone, angiotensin II
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antiarrhythmic drugs
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correct an irregular heartbeat and slow a heart that is beating too fast
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anticoagulants, antiplatlatelets, thrombolytics
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blood thinners - inhibit the ability of the blood to clot
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beta blockers
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reduce the output of blood flow from the heart
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calcium channel blockers
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blocks the passage of calcium into the muscle cells that control the size of blood vessels
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statins
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used to treat high cholesterol that cannot be controlled with diet and exercise alone
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digitalis
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strengthens the force of contractions in weakened hearts
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diuretics
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"water pills" lowers BP by increasing the kidneys excretion of sodium and water which reduces the volume of blood
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nitrates
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potent vein and artery dilators
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left heart catherterization LHC
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approach usually through the Arterial system
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retrograde movement
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if the catherter is moving toward the heart, against the usual flow of blood
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right heart catherterization RHC
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approach usually through the Venous system; right atrium-right ventricle, pulmonary artery
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cardiac catheterization codes; diagnostic procedure
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includes introduction, positioning and repositioning of catheter, intracardiac and intravascular pressures, obtaining blood samples and cardiac output measurements, final evaluation and report of the procedure
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two code families
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1.congenital heart disease 2.all other conditions
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4 coronary vessels
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right coronary artery RCA left main conorary artery LMCA left anterior descending artery LAD left circumflex coronary artery LCX
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Medicare recognizes 3 vessel codes
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right coronary artery RC left anterior descending artery LD left circumflex coronary artery LC
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hierachy for procedures done in the same coronary vessel
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1.stenting - highest coding 2.atherectomy 3.angioplasty
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cardiac/coronary work coded from?
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CPT Medicine Section - 9
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Peripheral vascular coding from?
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Surgery and radiology - 3 & 7
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non-selective procedures
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remain in the same artery or vein that was accessed - 36000
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selective procedures
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catheter accesses branches; second order, third order, etc. - 36012
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cardiac valve procedures found?
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in the CPT manual index under the valve type - 33400-33478
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electrophysiologic EP
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study of the electrical system of the heart; most codes in the medicine section of CPT
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33265-33266 used for?
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to report endoscopic approach for EP procedures
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33250-33266
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apply to the surgical repair of a defect that causes an abnormal rhythm
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aortic valve stenosis
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narrowing of the valve, blood flow restricted
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33361-33369
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transcatheter aortic valve replacement TAVR and transcatheter aortic valve implant TAVI
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selective codes 32615-36218
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selective procedures above the diaphram
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selective codes 36245-36248
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selective procedures below the diaphram
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coronary artery bypass grafting CABG
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one way to increase the flow of blood to the heart
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percutaneous transluminal coronarty angioplasty PTCA
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a procedure in which a balloon is expanded inside the artery
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to correctly report cornoary bypass grafts...
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you must know whether an artery, a vein or both plus how many bypass grafts are being performed
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saphenous vein
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in the leg, most often used for the graft in cornonary bypass surgery
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33510-33516
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Only for coronary artery bypass
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G codes
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found in HCPCS Level II book, for cardiac
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36011-36012
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only two codes available for selective venous catheterizations
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vascular families are found....
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in Appendix L in CPT Coding book
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non-coronary transcatheter therapy guidelines
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code all diagnostic angiography procedures in addition to the therapies; flllow up includes except for embolization and occlusion (use 75898)
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non-coronary transcatheter therapy general guidelines
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. angioplasty done only to dilate a stent is NOT separately billable . multiple stent deployments in the same vessel are only coded as one stent . embolization is coded only once per operative field .olny ONE method of clot removal is coded for thrombolysis (for filter use 37799)
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coding cardiovascular system
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radiology: diagnostic studies - 7 Medicine: nonsurgical and percutaneous - 9 Surgery: open and percutaneous - 3
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invasive procedures
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enters the body
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non-invasive procedures
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procedures that do not break the skin
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electrophysiology EPS
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study of electrical system of the heart
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nuclear cardiology
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diagnostic and treatment specialty, uses radioactive substances for cardiac condition
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pericardiocentesis
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percutaneeous withdrawal of fluid from pericardial space
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pacemaker/pacing cardioverter-defibrillator leads
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placement: atrium chamber - single - one lead ventricle chamber - single - one lead both chambers - two leads biventricular, both ventricles and right atrium - 3 leads
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epicardial approach
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open procedure to place on heart
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transvenous approach
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through vein to place in heart
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use 78 modifier
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return to operating room during global period
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coding selective placement for any procedure
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report the fullest extension into one vascular family.
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vascular families
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first order; the main artery second order; is the branch off the main artery third order; is the next branch off the second order and so on
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electrophysiologic operative procedures
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chest opened to full view - incision
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right coronary artery RCA has two branches
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right marginal right posterior descending PDA
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left main coronary artery LMCA has seven branches
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leftt anterior descending diagonal septal circumflex LCX obtuse marginal OM prosterior descending posteriolateral
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obtaining artery for grafting...
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procuring an upper extremity artery (i.e. radial artery) coded separately (35600)
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reporting combined arterial-venous grafting
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divided based on number of grafts use two codes: appropriate combined arterial-venous code AND appropriate arterial graft code (33533-33536); modifier 51 NOT used
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thrombolysis
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percutaneous procedure; clot is destroyed by drug that physician injects through catheter
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intravascular ultrasound of coronary
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can be reported with two codes 92978-92979; needle is inserted percutaneously into the vessel w/ultrasound done
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intracoronary stent placement
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92928-92929; a catheter reinforces a coronary vessel, with a stent that has collapsed or is blocked
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valvoplasty
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procedure opens a blocked valve by using a balloon, which is inflated near the blockage
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cardiography
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93000-93278;
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stress test
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performed to assess the edequacy of the amount of oxygen getting to the heart muscle
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Holter monitor
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similar to an eledtrocardiogram ECG; leads atached to the patient; records ECG for 24 hours
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signal-averaged electrocardiography SAECG
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signal is recorded during nine periods, each lasting 10 to 20 minutes
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telephonic transmission
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external patient-activated electrocardiogram records irregular rhythms
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cardiovascular stress test
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used to evaluate and diagnose chest pain, to screen for heart disease, evaluate irregular rhythms, investigate many other cardiovascular abnormalities
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implantable and wearable cardiac device evaluations
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diagnostic service that may be performed in person or using technology to access cardiovascular data
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echocardiography
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noninvasive diagnostic method that used ultrasonographic images to detect the presence of heat disease or valvular disease
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intracoronary brachytherapy
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use of radioactive substances as a therapy for in-stent restenosis of a coronary vessel
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pacing
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regulation of the heart rate
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recording
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record of the electrical activity of the heart taken by means of ECG
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mapping
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done during an open surgical procedure in which the surgeon opens the chest and exposes the heart
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ablation
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tissue is destroyed when the tip of catheter that emits electric current, is placed on tissue
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rediofrequency
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energy to burn away the abnormal areas of the heart
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cryoablation
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a very cold substance is used to freeze the cells that are creating problems
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endocardial resection
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removes a section of the thin layer of the heart where the abnormal rhythms originate
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peripheral arterial disease rehabilitation
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physidal exercises done to build the patient's cardiovascular endurance
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ambulatory blood pressure monitoring
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outpatient procedure that is conducted over a 24-hour period by means of a portable device worn by the patient
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global service
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the clinic provies the total service
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contrast material
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commonly used with radiology procedures
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MRI
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Magnetic Resonance imaging
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therapeutic servises
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cardiopulmonary resuscitation CPR cardioversion; changing/coverting an abnormal heart rhythm
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cardiac catheterization
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diagnostic medical procedure performed on the heart
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noninvasive vascular diagnostic studies
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procedures that are coneducted to study veins and arteries other than the heart and great vessels
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embolectomy
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embolus; dislodged thrombus removal of embolus
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thrombectomy
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thrombus; mass of material in vessel, in place of formation
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balloon removal
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threaded into vessel, inflated under mass, pulled out with mass
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venous reconstruction
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types of repair -valve of femoral vein -vena cava -saphenopopliteal vein anastomosis
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aneurysm
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ballooned or weakened area of vessel
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coil replacement
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tiny, flexible, platinum coil pushed into aneurysm and forms "ball" to obstruct blood flow into aneurysm
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endovascular repair
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from inside vessel - 34800-34900
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endovascular repair of Iliac aneurysm
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deployment of an endovascular graft for treatment of aneurysm, pseudoaneurysm, or arteriovenous malformation or trama of the iliac artery
