In the past, the coding recommendation for direct sclerotherapy/embolization of lymphatic malformations was to use unlisted codes. With the new embolization codes for 2014, would code 37241 be a possibility for these procedures? I looked at code 37244, but since that is referring to extravasation, it doesn't appear to match the intent of the sclerotherapy/embolization. Although code 37241 doesn't use the term "lymphatics", both the CPT Codebook and CPT Insiders refer to these embolization codes to be used when "arteries, veins, and lymphatics may all be the target of embolization". Would you recommend continuing to use the unlisted codes or using one of the 2014 codes?
When an iliac stent (37221) is coded outside the treatment zone when doing a AAA endograft (34802), is the catheter (36200) and open cutdown (34812) bundled on that side? My final codes are (not adding my co-surgeon modifier): 34802, 34812-59 (no bilateral modifier due to one side is bundled), 37221-59, 36200-59 (no bilateral modifier due to one side is bundled), and 75952. I am getting contradicting answers from the resources I have.
Are you aware of a CPT code we can bill for putting in a conduit on the axillary artery for Impella placement? Or should we bill an unlisted code?
With regards to Question ID #5346, when we have a heart catheterization (for instance 93458) with non-selective renal angiograms, and we assign code 75625-52, we get an NCCI edit on 93458 - that a comprehensive code is paired with another CPT component code to trigger OCE edit 0040 plus 75625-52 with edit of code 2 of a code pair with 93458 that would be allowed if an appropriate NCCI modifier were present. Our options are adding a -59 modifier to 75625-52 or not billing for 75625-52. Will code 75625-5952 be our best choice?
I have two questions on the following case. The physician performed imaging of the cervical carotid and cerebral imaging from a cervical carotid catheter position. He then advanced the catheter into the MCA (no imaging) and initiated tPA infusion over a period of 2.5 hrs. Since we no longer have code 37201, would this infusion be reported with code 37799? And since there was no imaging of the MCA, would you report the highest catheterization (code 36224)?
For services of 2014, what is the suggested code for the Lariat suture of the atrial appendage, transcatheter?
With the new drain codes I am confused on why and when would we use code 75989 or 77012 with 10022 versus 10030, 49405-49407?
Would you report code 37186 twice if clots noted as rescue but documented in femoral and common iliac? What about common iliac and external iliac? I believe this code should be charged once per extremity.
Is a mammogram done after a breast biopsy (19081-19086) or breast localization (19281-19288) separately reportable? Or is it included in the new codes?
I have a question on new code 37236. The surgeon did a selective placement of each renal artery. Due to stenosis he then placed stents in each renal artery. Is it to correct to report codes 37236, 36252, 37237, 36245-LT, and 36245-RT?
Does code 37241 replace your previous recommendation for direct puncture access and treatment of lymphatic/vascular malformations? (Previous recommendation: "We recommend codes 76496, 36299, and 37799 for direct puncture access and treatment of lymphatic/vascular malformations as described here, regardless as to in the face, tongue, arm, or foot. Pricing will be based on complexity and the report.")
The doctor did a FEVAR (with the graft covering the entire abdominal aorta) with placement of stents into bilateral renals and bilateral femoral exposure. One side was inserted through the "scallop" and the other through the fenestration. Is this reported with code 34846? Or with codes 34845 and 37236?
In Changes in the NCCI Manual for 2012 it is noted you longer recommend reporting temporary pacemaker insertion during procedures from 33202-33249 or 93600-93662. Previously we were advised to report 33210-59 if patient was pacemaker-dependent. Can we no longer report this with a generator replacement?
When an ICD (right ventricular) lead is repositioned, and then the defibrillator is tested, would that be reported with codes 33215 and 93641? Nothing is technically implanted. Although it is a surgical procedure, I did not know if code 93641 would be appropriate. Code 93462 did not seem appropriate since it is with an invasive procedure. Or, am I looking at an unlisted code?
Is it okay to use code 35571 for distal bypass graft to dorsalis pedis artery using cryopreserved saphenous vein? Or should we use code 35671?
Is code 0075T appropriate for transcatheter intrathoracic carotid stent placement when embolic protection is unable to be used? If not, what is the appropriate code?
We are having trouble with how to code for a pocket revision when the pocket is not relocated. It is our understanding that the revision is bundled into the placement or replacement of the pacemaker/AICD. What do we code if all that is performed is a revision of the pocket?
"Diagnosis of left arm pain. Femoral artery cannulated. Selective left subclavian arteriogram done. Results of left subclavian angiography show 99% stenosis beyond the origin of the LIMA. Intervention was done on this, balloon with angioplasty, and then a stent was placed." Is code 36215 with 75710 included in the stent placement of 37236?
We have a discussion going on regarding the coding of other ultrasound-guided procedures done at the same time as 19083. Can code 76942-59 be used for the other ultrasound-guided procedures (i.e., 38505, 19000, and 10160)? Some feel that since code 76942 can only be used once per encounter that it is implied with code 19083 and cannot be used. I would appreciate your advice.
Given the severity of the OM ISR, the AV circumflex stenosis, and the ostial PDA stenosis, a decision was made to perform an intervention. Through 6F guide, a coronary wire was advanced to the distal AV circumflex. A Sprinter OTW balloon was attempted to be advanced, however was unsuccessful as the AV circumflex was jailed by the previously placed ostial OM1 stent. Attention was then turned to the ostial OM1 ISR. A wire was advanced to the distal OM1. The ISR was dilated using a 3.0 x 10mm Angiosculpt OTW scoring balloon at 14 atm. Post angiography demonstrated an excellent angiographic result with TIMI 3 distal flow. Attention was then turned to the ostial PDA lesion. Through a JR4 6F guide, a coronary wire was advanced to the distal PDA. The ostial PDA lesion was dilated using a Sprinter 2.0 x 12mm OTW balloon at 14 atm for 78 seconds. Post-angiography demonstrated an excellent result with TIMI 3 distal flow in the PDA and minimal residual stenosis. How should this medicare case be coded? 92920 x 2 or 92920 & 92921? 2 consultants-2 different opinions
I do coding and billing at an MRI office, and recently we have had a few patients who have had MRIs done of the lumbar spine. Furthermore, the referring physician(s) have ordered another MRI of the lumbar spine, but this time using the technique of a sagittal STIR sequence imaging. So, how should we code procedurally, the second MRI visit with sagittal STIR, if the same area was scanned one month early?
For a left or right heart catheterization, my physician is currently documenting the following: "Access was obtained from the right femoral artery, and a left heart catheterization was done using standard guide wire approach using standard Judkins catheters." For correct coding guidelines, should the physician be more specific in stating where the catheter goes? Such as stating the complete path of the catheter through the femoral, iliac, aorta, and over the arch into the left marginal artery? Would this have anything to do with ICD-10 -PCS coming?
"Patient with recurrect CVAs. Hypercoagulable workup negative, TEE with postive bubble study, thought to have PFO. Presents for closure. PROCEDURE: 10 French venous sheath was placed in left femoral vein, and 8 French Lamp catheter was advanced with wire into SVC. Bolton catheter was used, and intra-atrial septum was interrogated with ICE catheter. We were unable to cross septum with multiple catheters. Lamp catheter was advanced and demonstrated tenting. Agitated bubble study x 3, 2x with Valsalva maneuver, and we saw no bubbles across septum. Detailed interrogation of septum showed no evidence of PFO. Agitated bubble study negative, and septum couldn't be crossed. Procedure was discontinued. Impression: No intra-atrial septal defect, no PFO identifed." Not sure how to code 93462-74 and 93662, but these are add-on codes with no base code. No pressures were taken. What are your suggestions on how to code?
What codes would you recommend for endovascular reconstruction of the aorto-bi-iliac vessels for occlusive disease? Exact same technique as an AAA repair, but not for aneurysm. Bilateral cutdowns. Bifurcated endoprosthesis deployed in aorta and bilateral iliacs, and iliac extender. Would you recommend unlisted? Or code it with the new stent codes (37236/37237)? According to the CPT Codebook, 348XX codes are exclusive to aneurysm repair.
Is a non-STEMI equal to an acute MI? The last response seen on this website was in January 2013 (question ID #4429).