ZHealth News

ZHealth Coding Newsletter - May 2017

May 28, 2017 2:22:00 AM

May 2017 Q & A

Question: 96374 with an Ablation

We had a case where Ibutilide was administered during an atrial flutter ablation procedure (93653). The Medicare claims processing manual, chapter 4, section 230.2 discusses this and says, "Hospitals should report all HCPCS codes that describe the drug administration services provided, regardless of whether or not those services are separately paid or their payment is packaged." 93653 had a "J1". 96374 has an SI of "S".

In your opinion, Ibutilide is inherent or not inherent to an ablation procedure, in which it's not always used as part of the procedure, to lets say contrast to an diagnostic angiography, is it then ok to bill 96374 for an IV push, and 96365 for an infusion, if they are given Ibutilide as part of an ablation for a flutter or A-Fib?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - April 2017

Apr 20, 2017 2:22:00 AM

April 2017 Q & A

Question: Left Dorsalis Pedis an Additional Artery on Left Anterior Tibial?

An angioplasty was performed on the left dorsalis pedis artery...an angioplasty with atherectomy was performed on the left anterior distal tibial artery. Is the left dorsalis pedis angioplasty an add-on to code 37229, or is it part of code 37229? Is just code 37229 reported, or 37232 and 37229?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - March 2017

Mar 17, 2017 2:22:00 AM

March 2017 Q & A

Question: Treating Tibioperoneal Trunk with PTA and SFA

I have heard that it may be possible to code for an intervention in the tibioperoneal trunk in the following two scenarios: 1. It is the only vessel treated; 2. It is separately treated in addition to an intervention in the anterior tibial artery. My patient has focal stenoses of the mid and distal SFA treated with angioplasty. A patent popliteal artery. Focal high grade stenoses in the superior aspect of the tibioperoneal trunk and within the distal tibioperoneal trunk at the bifurcation of the peroneal and tibial artery. These stenoses were treated with angioplasty as well.

Can I report code 37228 for the tibioperoneal trunk in addition to the SFA angioplasty (37224)? I'm a bit confused because the CPT code book indicates the tibioperoneal trunk would be considered part of the tibial/peroneal territory, but not a separate 4th segment of vessel. Does this mean if it is the only segment of vessels in the tibial/peroneal territory it is billed? Even if another territory is billed? 


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Posted in Free Newsletters By Sondra Dunn

February 2017 Q & A

Question: C2623 vs 37220

We have been getting edits when codes C2623 (Catheter, transluminal angioplasty, drug-coated, non-laser) and 37220 (Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty) are on the same claim, but I can find nothing to indicate that this code pair should create an edit. Edit reads: when C2623 is on the claim then 37224 or 37226 must also be on the claim?

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Posted in Free Newsletters By Sondra Dunn

Special Edition Newsletter: Moderate Sedation

Revision to 'Professional Billing of Moderate Sedation by the Physician Performing the Procedure When in a Facility Site of Service'

The codes for reporting moderate sedation performed by a physician or other qualified health care professional other than the one performing the procedure do not have different RVUs for the facility and non-facility sites of service. The RVUs are the same. There is also an NA in the NON-FAC NA INDICATOR column of the RVU file. From the CMS document explaining the NA in this field: An “NA” in this field indicates that this procedure is rarely or never performed in the non-facility setting.

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Posted in Free Newsletters By Sondra Dunn

January 2017 Q & A

Question: 32551 vs 32557

IR chest tube placement. 

Indication: Large symptomatic right pneumothorax status post CT-guided lung biopsy. 

Technique: The patient was placed supine on the fluoroscopy table. The right hemithorax was prepped and draped in a sterile fashion. The fifth and sixth rib interspace was localized with fluoroscopy, and 1% lidocaine was utilized for local anesthesia. A Cook pneumothorax 9 French drainage catheter was placed into the right pleural space using a trocar under direct fluoroscopic surveillance. The drain was then connected to a Heimlich valve, and good reexpansion of the right lung was achieved after the patient coughed. Postprocedural images demonstrate a small residual right apical pneumothorax with the drainage catheter overlying the anterior midlung zone. 

Impression: Successful placement of 9 French chest tube with satisfactory re-expansion of the right lung.

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Posted in Free Newsletters By Sondra Dunn

ZHealth Special Edition Newsletter

Jan 20, 2017 2:22:00 AM

Special Edition Newsletter: Moderate Sedation

Professional Billing of Moderate Sedation by the Physician Performing the Procedure When in a Facility Site of Service

In the physician RVU file there is a column labeled “PCTC IND” which designates when a code is technical-only or professional-only. The add-on code for each additional 15 minutes of moderate sedation by the physician performing the procedure (99153) is indicated as technical-only (3) in this field. In addition, there is an NA in the RVU file column titled “FACILITY NA INDICATOR”. The NA indicates “that this procedure is rarely or never performed in the facility setting”. Since code 99153 is technical only, a physician cannot report this code when performed in the facility setting.  

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Posted in Free Newsletters By Sondra Dunn

December 2016 Q & A

Question: Fractional Flow Reserve without Catheterization

Physician performs LHC at another facility and then transfers the patient to the cath lab at the hospital to perform fractional flow reserve (93571). The physician thinks that 93571-26-XE will get us paid by Medicare and for commercial insurance to bill coronary angiography only with 93571 to get paid.
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Posted in Free Newsletters By Sondra Dunn

Job Posting

Dec 29, 2016 2:04:00 AM

ADVOCATE, a growing Fortune 5000 healthcare medical billing company, is looking for a part-time Interventional Radiology Medical Coder.

ADVOCATE Radiology Billing & Reimbursement Specialists is an innovative leader in the national radiology reimbursement and management sector of healthcare. We contribute outstanding technical insight with client-friendly services to help our clients achieve optimal top line revenue performance. Visit www.radadvocate.com for more information.

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Posted in News By Sondra Dunn

November 2016 Q & A

Question: Cutting Angioplasty with Perforation

Under fluoroscopic guidance, the upper arm dialysis access fistula was catheterized and fistulogram was obtained. There was a greater than 50% stenosis within the mid cephalic vein that was dilated with an 8 mm angioplasty balloon and high pressure angioplasty balloon with no effect. The lesion was then dilated with a cutting balloon. Following angioplasty with a cutting balloon there was a leak identified from the cephalic vein. Multiple attempts at balloon tamponade were performed, and these were unsuccessful at controlling the leak. An 8 mm x 6 cm fluency stent graft was then placed across the leak and dilated to 8 mm. Follow-up fistulogram was obtained and showed free flow of contrast through the stent. Cephalic arch and central veins are patent. The arterial anastomosis is widely patent. There is a small pseudoaneurysm in the cephalic vein near the arterial anastomosis.
I am assigning codes 36147 and 37238. Should something be stated about the perforation? If so, how should this be coded?

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Posted in Free Newsletters By Sondra Dunn

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