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

2018 Change to Bone Marrow Biopsy Coding

Oct 31, 2017 12:05:48 AM

On January 1, 2018, long-utilized HCPCS code G0364, Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date aof service, will be retired. 

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - August 2017

Aug 28, 2017 2:22:00 AM

August 2017 Q & A

Question: Repair of EVAR with Deployment of 2 Gore Excluder Limbs

This patient developed a type III endoleak due to component separation of the left iliac limb from a prior EVAR. To repair this, our physicians first used an Excluder limb across both graft defects followed by a second Excluder limb in the patient's iliac, to bridge the separation of components. I would normally code this with 34825, 75953.

However, I am not sure how to code for a second graft in this case or if I can code for it at all because I am not positive that the second graft is considered a separate vessel and qualifies for the 34826. There is no mention of it being placed in either the external or internal iliac.


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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 - 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

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