ZHealth News

November 2017 Q & A

Question: Infrarenal AAA

My provider did infrarenal AAA, using US guidance, he accessed both femoral arteries. He deployed a Gore endovascular stent with careful attention not to encroach the left renal artery. Then, the Gore limb was placed into the right common iliac artery. An extender device was placed from the main body limb, just above the left hypogastric. My question: is it appropriate to code 34825 since he used another limb extension?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - July 2017

Jul 30, 2017 2:22:00 AM

July 2017 Q & A

Question: Superior Mesenteric Artery to Rt Hepatic Artery

A 5 Fr sheath was placed and attached to a heparinized saline infusion. Exchange was made for a SOS catheter and selective DSA performed in the superior mesenteric artery. Superselective catheterization of the replaced right hepatic artery was then performed using a 3 Fr Progreat Microcatheter and wire. Can a catheter reach the right hepatic artery from the SMA or does the catheter need to go through the celiac artery?

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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

October 2016 Q & A

Question: Femoral Stent to Stop Bleeding

A patient had a TAVR procedure and had continued bleeding of the femoral artery, so a femoral artery stent was deployed. What code do I use for this service? I see that the CPT book states, "Codes 37220-37235 are to be used to describe lower extremity endovascular revascularization services performed for occlusive disease," so I know that these codes do not apply since the stent was deployed for hemostasis. Is this a billable service?

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Posted in Free Newsletters By Sondra Dunn

September 2016 Q & A

Question: Brachial Cutdown Not Involving AAA Repair

I have used 34834 for a brachial artery cutdown for AAA repair. Can you please advise on CPT Code for cutdown of brachial artery for repair of SFA aneurysm with a Viabahn Stent?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - June 2016

Jun 26, 2016 2:20:00 PM

June 2016 Q & A

Question: Upper Extremity Angiography with Thoracic Aortography

Using direct ultrasound guidance, the right common femoral artery was accessed with a micropuncture needle. Through this access, a 5 French sheath was placed. A flush catheter was advanced into the ascending thoracic aorta. Aortography was performed. 5 French catheter and wire were advanced into the left subclavian artery. Arteriography was performed. There was poor visualization of the arteries beyond the fistula anastomosis. 36215-59 for subclavian, 36221 for thoracic aortogram?
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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - May 2016

May 25, 2016 2:20:00 PM

May 2016 Q & A

Question: Angioplasty of the iliac with the sheath?

Can we bill 37220 for an angioplasty of the iliac artery with the sheath? I don't think so, but I just wanted to double check because the CPT description does not use the word "balloon".
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Posted in Free Newsletters By Sondra Dunn

September 2015 Q & A

Question: 36228 with Pipeline Embolization

Following diagnostic cerebral angiogram with bilateral internal carotid artery catheter and 3D angiogram requiring separate work station, angle projections for treatment of the cavernous segment of the right internal carotid artery aneurysm were obtained. Navien catheter was positioned within the intracranial segment of the right internal carotid artery, and Marksman catheter was navigated into the right middle cerebral artery. Then pipeline embolization was done on the right cavernous carotid segment. At the completion of the coiling procedure, cerebral angiogram was performed via the right internal carotid artery. Besides 36224-50, can I add 36228 in this case even though the embolization was at cavernous carotid? I also coded 61624, 75894, 75898, and 76377. Are these the right codes for this case?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - June 2015

Jun 13, 2015 7:58:00 AM

June 2015 Q & A

Question: Balloon Dilatation and Stenting of Intrathoracic Innominate Artery

The doctor would like to charge 36217, 37218, 75710-26 for this procedure: 1. Right femoral artery cannulated in retrograde fashion. 2. Catheter into orgin of the innominate. 3. Then catheter passed selectively into the origin of the common carotid artery. 4. Then catheter selective out into the subclavian and selctive angiography was performed and confirmed subclavian widely patent. 5. Balloon dilatation performed and did not get good result. 6. Stent placed over ostial and proximal portion of innominate artery.

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Posted in Free Newsletters By Sondra Dunn

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