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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 - 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

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

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

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 - July 2016

Jul 29, 2016 2:20:00 PM

July 2016 Q & A

Question: Does a CTO 92943 have to be staged?

Since a CTO is a CHRONIC total occlusion, does it need to be staged? They would know about it ahead of time, since it is chronic. But what if the doctor finds a CTO upon first diagnostic angiography, and is able to treat it with some type of intervention at that same session? Would that be billed as a 92943 along with the cardiac cath code (w/59)? Or, because it is the first time it was found, is the PCI code just the 92928, 92920, 92924, 92933 etc instead of 92943? Do we need to find prior documentation showing CTO was known about prior to intervention?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - April 2016

Apr 25, 2016 2:20:00 PM

April 2016 Q & A

Question: Popliteal Aneurysm

We are looking for a code for popliteal aneurysm (37236?). This is what one of our physicians said: "34900 code is an aneurysm procedure code, and although specifies iliac it is far more reflective of the procedure type and work, including large sheath placement that is involved with popliteal aneurysm repair. In fact the 2 procedures are almost identical except one is done at a more distal location." What code do you suggest we use for popliteal aneurysm and why?

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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

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