Knowledge Base

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Status Indicator N Specifically on 95940

We report code 95940 for IOM monitoring in the operating room. In our system the techs are reporting the total number of minutes of monitoring. I think this should be converted to 15 minutes = 1 unit for reporting on the UB04. Since it is status indicator N, Medicare is not going to pay. Is the correct way to report this in units or minutes? I see in your book that it is important to be reported accurately. Can you explain so that I can explain it to them?

Lead Interrogations

There are several different CPT codes for pacemaker and defibrillator interrogations, and they are separated by the description of single, dual, and multiple leads. Sometimes we have a patient who has a biventricular device with three leads, but one of the leads is turned off, so during the visit you only do threshold testing on two of the leads. Should this be coded as a dual lead check instead of a multiple lead check?

VP Shuntogram

I have a patient with a diagnosis of hydrocephalus. We are performing an injection of the indwelling ventriculopleural shunt. The only code I see is for the peritoneal (78291 and 49427). What are your thoughts?

Thrombectomy, Fasciotomy, and Arteriogram

I need assistance please. Is the arteriogram considered a separate procedure and billable? I'm thinking of codes 34201, 27602, 75710-2659. The thrombectomy was descrbed in detail. "After completing thrombectomy and we had good inflow, we closed the common femoral with running 5-0 prolene sutures and restored flow to the right lower extremity. The patient, however, had no improvement in perfusion and no signals in the right foot. Having found this disappointing outcome after thrombectomy, we removed the prolene sutures and placed a sheath into the right common femoral artery and then did an arteriogram. C-arm came in for this procedure, and we did a number of studies of the right lower extremity using visipaque. Superficial femoral and popliteal arteries were essentially clot free, then we had a "string sign" of the remaining vasculature with what appeared to be vasospasm. After giving verapamil into the sheath and repeat arteriogram, there still showed vasospasm. We decided to perform four compartment fasciotomy." (This procedure is explained in detail.)

Angioplasty of Superior Gluteal Artery

For the following case, would you code additionally for the superior gluteal artery angioplasty? If so, what code would you use? "Thrombectomy (37184) is perfomed of the superior gluteal artery and the main trunk of the internal iliac artery. Following thrombectomy, there is residual thrombus at the origins of both anterior and posterior division branches, in addition to superior gluteal stenosis and weblike origin stenosis of the internal iliac artery. 4 mm angioplasty was performed of the entire thrombectomized segment, including the two stenoses. The internal iliac artery is stented (37221). Additional thrombectomy was performed of the superior gluteal artery followed by additional angioplasty. tPA is infused along with additional angioplasty. No significant change. Follow-up angio is performed again, and an acceptable result was obtained with good flow."

Occlusion of Left Iliac Limb of the Endovascular Aneurysm Stent Graft

Please advise on the following case example: "Cutdown left common femoral artery. AngioJet device was positioned in the iliac limb. 10 mg of tPA was infused with the pulse generator of the AngioJet into the thrombus of the left iliac limb. We then ballooned that area with a Reliant balloon. We still had thrombus at the top of the main body of the graft overhanging the origin of the left iliac limb. We decided to extend. We got percutaneous access using ultrasound guidance on the right side. We then deployed an aortic extension cuff just below the renal arteries. We then deployed a right and left iliac extension. We pulse dilated with kissing Reliant balloon."

Unsuccessful Placement of ASD Occluder Device

Is the following considered a reduced or discontinued service, as the closure was not completed? "Device was deployed across the AS defect; however, after the sheath was sutured in place, a quick fluoroscopy revealed the device was freely moving in the left atrium. Multiple attempts were made to snare the ASD device, but we were unable to pull the device into the sheath. Emergent CT surgery consult and sent to OR for retrieval."

FFR Repeat Coronary Angiography

The patient first had a left heart catheterization with angiography at his doctor's office owned by our hospital (93458). The patient then was sent over to the hospital for FFR of the LAD and RCA. Our hospital cath lab charged code 93454 for the coronary angiography and codes 93571, 93572 for the FFR. When computing, we are getting an edit stating that code 93454 is a component of 93458 (because the charges for the two facilities are being combined). Is it acceptable for the hospital cath lab to charge for the coronary angiography once again (with the -59 modifier) since it was already performed by the physician office during the heart cath the same day? Or should the hospital cath lab only charge for the FFR? Current charges are: 93458, 93454, 93571, 93572.

CPR with Heart Cath

If while performing a diagnostic or interventional heart cath the patient requires emergent CPR, do we code for the CPR separately in addition to the heart cath procedure? Or is it considered part of the procedure?

XU Modifier

With the new modifiers that go into effect starting on January 1, 2015, could you clarify which modifier we would use in a case where the physician performs a bilateral lower extremity angiogram (75716-26) and then crosses over the bifurcation and performs a POP angioplasty (37224)? Would we still use the -59 modifier on code 75716-26, or would we need to use one of the new modifiers? If so, which one would be appropriate?

ECMO

Are codes 33946 and 33947 for physician use only? Should codes 33951-33954 be used for facility billing of placement of cannula in the cath lab setting even on first day, or are they only for subsequent cannulas (after day 1)?

35883

Patient with common femoral thromboendarterectomy with patch graft performed above the fem-pop bypass. The artery was severely degraded and fell apart during patch angioplasty necessitating the need to go higher in the iliac requiring conversion to ilio-fem bypass. An 8 mm Gore-Tex graft was brought to the table. It was beveled and attached to the iliac with the distal end extending into the bypass graft and sliding nicely together. Would I code for both the endarterectomy and, say, a revision of the graft? Codes 35371 and 35883? Or 35876 alone?

Intended Procedure Cancelled After Anesthesia

I know I can report the intended procedure code using modifier -74, but can I also report the S&I if there is one?

Replacement of One Lead of a Dual Lead Pacemaker

Patient had dual lead pacemaker with RA lead dislodged. Generator was removed, and RA lead repositioning was attempted but was not effective. The RA lead was removed and replaced with an active fixation lead. Both leads were positioned carefully and the device returned and attached to leads. Only one lead was removed, but because this is a dual lead system, should I use code 33235? It was suggested to me that code 33234 should be used since only one was removed. Could you clarify please?

Electroporation with Nanoknife

I've done my share of research, but I can't find much information on the use of NanoKnife for tissue ablation. My initial thought is to use an unlisted code, but I just wanted to run it by you.

Repeated Stress Test

We have an EP physician who wants to do multiple treadmill stress testing (weekly, for approximately 3 to 4 weeks on same patient) for patients starting Flecainide. He is watching for QRS widening under stress. Is it appropriate for our physician to bill codes 93016 and 93018 (93017 for hospital) each time we do this test?

Stroke Protocol

With patients who have possible symptoms of stroke, we perform an MRI and MRA to rule out a stroke. If the MRI comes back negative, we then do an MRA. Can we charge for both or only one? If yes, what modifier would we use?

Nuclear Stress Test, Hospital Coding

The cardiologists in our practice have recently become employed by the hospital, and we need to start billing the nuclear stress test as a global procedure. The hospital was billing codes 93017 and 78452, as well as the radiopharmaceuticals and other drugs used. What codes should we be billing now to cover both the physician charges and the hospital charges? Also, are the injection and infusion codes billable from the hospital side? The place of service is hospital outpatient.

New Modifier Usage, XU Modifier

With the implementation of the new modifiers -XE, -XS, -XP, and -XU, which would be used to report when no previous diagnostic imaging was recently performed? Would modifier -59 still be used in this instance?

Breast Mammograms with Tomosynthesis, Coding CAD Additionally

If a hospital department is performing breast mammograms with tomosynthesis, would you say across the board that the CAD codes should not be coded additionally? The mammogram coded with the tomography code would become the base code for the CAD add-on code. We have checked, and some of the coding pairs (77062 & 77052 and 77063 & 77052) are on the NCCI edit list preventing their use together, but others (for e.g., 77061 paired with 77051) appear to be allowable. I have not been able to find any further guidance to help clarify. I would appreciate your help and expertise.

Femoroperoneal Bypass Graft with Graft Revision

I am hoping you can help with the following case. I don't believe that code 35879 should be billed at the same time as code 35566, but I am considering the use of a -22 modifier. "Once femoroperoneal bypass was completed, ultrasound Doppler was used to evaluate graft, and the graft was found to have relatively low velocities of 15cm/sec in the thigh. There was a significant flow difference noted with velocities of 80 cm/sec in comparison to adjacent velocities of 15cm/sec. Incision was made over the graft, graft was mobilized, and it was decided to proceed with patch angioplasty since abnormality was likely a frozen valve. A segment of residual GSV was harvested and opened longitudinally for patch purposes. Arteriotomy was made through the valve and fibrotic tissue debrided away from the wall. Standard onlay vein patch angioplasty was then performed. Repair was complete, flow restored, and duplex showed no abnormalities with significantly improved velocities. Total procedure time was 7 hours."

Documentation Issue, Paracentesis with Catheter Not Removed

We would sure appreciate your advice. We have a physician who performs paracentesis with an angiocatheter. She does not feel that is necessary to document that the catheter was removed at the end of the procedure because she states that "it is common sense that an angiocatheter cannot be left in the belly". Can we report this to as a paracentesis with code 49083, or do we need to use code 49406 because the documentation doesn't reflect that the catheter was removed? We also have a similar situation with a thoracentesis. She doesn't document removing the catheter (angiocatheter), and she is tellling us that "if she doesn't state it was sutured to the skin then she removed it". Please advise.

Stent of the Common Carotid Origin

One of our surgeons placed a stent at the origin of the left common carotid artery by open cutdown along with aortic arch angiogram. Pre and post angioplasties were performed of the common carotid origin as well. A filter was not used for this case, and the patient has Medicare. The question is, do we consider the procedure of the left common carotid artery origin to be a carotid stent code or unlisted code? Not sure how to properly code this one.

Midline Peripheral Catheter Placement

What is the correct for midline (peripheral) catheter placement? I keep hearing either that codes don't exist or they haven't been clarified. I'm having trouble getting clarification from anyone.

59 Modifier in 2015

I have cases in which two separate procedures were done on the same day by the same physician. For example, a GI tube was placed, and a port-a-cath was done. I have codes 49440, 36561, 77001, and 76937. The documentation is appropriate to what was done. Now I have an edit of code 77001 needing a modifier due to code 49440. With the new 2015 modifiers (-XE, -XS, -XP, and -XU), which one would I use instead of modifier -59?

Items 276 to 300 of 2223 total

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