ZHealth Coding Newsletter - March 2017

Mar 17, 2017

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?

Tags:

tibioperoneal, trunk, PTA, SFA, intervention, vessel, artery, code, peroneal, tibial, stenoses

ZHealth Coding Newsletter - October 2016

Oct 25, 2016

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?

Tags:

femoral, stent, bleeding, TAVR, procedure, artery, cpt, code, hemostasis, vessel, coils, embolization, occlusive, non-occlusive

ZHealth Coding Newsletter - March 2016

Mar 30, 2016

March 2016 Q & A

Question: Angioplasty or Primary Thrombectomy with No Stenosis Documented

Patient is on Day 2 of lower extremity arterial thrombolysis with EKOS catheter. The patient was placed on the angio table and the catheter was injected showing significant residual heavy clot burden. The physician ballooned the thrombus in the anterior tibial, posterior tibial and peroneal arteries with a 3mm balloon, then used an aspiration catheter in each vessel post ballooning due to loose clot seen within these vessels. There is no physician documentation of any underlying anatomical stenosis in these vessels. Thrombolysis was restarted with the EKOS catheter and sent to the floor for overnight monitoring. On Day 3, the patient is brought back for AngioJet thrombectomy, repeat ballooning of the peroneal along with thrombolytic spray through the AngioJet for 20 min. This is repeated in the posterior tibial artery. Follow-up angiography demonstrates a flow limiting dissection requiring stent placement.

Day 2 was coded as ...

Tags:

arterial, thrombolysis, ekos, catheter, angio, thrombus, tibial, arteries, angiography, stent, balloon, vessel, vessels

ZHealth Coding Newsletter - February 2016

Feb 26, 2016

February 2016 Q & A

Question: Vasospasm

Six vessel diagnostic cerebral exam performed. Decision made to treat vasospasm of RICA & LICA. Discussion is whether or not the catheter selections for the bilateral ECA vessel selections are still chargeable since the catheter selections of the RICA & LICA are bundled into 61650. I don't feel they are since they are add on codes to 36224, bilateral in this case.

Tags:

vessel, diagnostic, cerebral, vasospasm, rica, lica, catheter, eca, bilateral, carotid, vertebrals

Items Tagged: vessel

ZHealth Coding Newsletter - March 2017

ZHealth Coding Newsletter - October 2016

ZHealth Coding Newsletter - March 2016

ZHealth Coding Newsletter - February 2016

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