This is a follow-up question from Question ID# 5436. You mentioned in your answer that "we may still need to utilize an unlisted code 37799 for facial direct access venous and lymphangiomatous malformation therapy" for direct access sclerotherapy of facial AV malformation. You didn't like codes 37241 or 61626, but recommended code 37799. Have you heard different? Is your recommendation still to use code 37799? Also in the same coding scenario, would you use code 36005 or 36000 for venous access for AV malformation treatment of the face?
On occasion we have patients that require general anesthesia due their condition (e.g., Parkinson's, CP) and therefore need to be recovered by PACU staff. This is a deviation from conscious sedation and falls outside CMS general guidelines. Would you recommend charging for the recovery time, or should we continue to follow CMS guidelines for cardiac catheterization regardless of the form of anesthesia?
Severe stenosis of right pulmonary artery with hypoplasia. Conduit stenosis and insufficiency. Balloon RPA and balloon conduit. Can you code both the conduit and the RPA angioplasties or just one code for both?
We placed a nephrostomy tube last week and then received an order to place a nephroureturostomy tube this week. We inserted a wire into the nephrostomy tube down into the bladder. We removed the nephrostomy tube. We then placed an internal/external nephrouretuostomy tube over the wire and injected contrast to verify placement. Since we basically already had access from the previously placed nephrostomy tube, do we use a modifier on code 50393?
How would you could an atherectomy of the TPT, angioplasty of the peroneal, and atherectomy of the anterior tibial?
During the conference in Las Vegas in December you mentioned Lariat can be reported with code 93799; however, we are getting info within our organization stating to use code 0281T... is this correct? I thought code 0281T was an older code and not payable as for investigational, whereas code 93799 is unlisted and is possibly reimburasble.
A patient has an existing biventricular ICD that was previously repositioned into the abdominal area from its original location in the pectoral region. The old ICD lead was capped and left in the pectoral pocket. Now the patient presents with the abandoned lead ”externalized” (a small portion of the lead having made its way outside of the body). The patient was taken to the OR and placed under sedation by anesthesia. The surgeon made an incision parallel to the externalized (old abandoned) lead. Then the surgeon dissected the lead out to where the yoke of the old trifurcated defibrillator lead rested. The ”externalized” lead was cut down as far as possible and then also capped. The pocket was freed up of extensive scar tissue, but no sign of infection was present in the pocket or tunneled areas. At that point, the surgeon placed as much of the leads as possible back in the pectoral pocket in an antibiotic sleeve and the pocket was closed. What would be the appropriate CPT code(s) to report?
Question from a Vascular Surgery practice: A Primary Care Provider has referred a patient to us for headaches with the request for a temporal artery biopsy to confirm a diagnosis of temporal arteritis. The biopsy is done as an outpatient basis the next day. Since the temporal arteritis is not a confirmed diagnosis until the pathology results come back 2-3 days later, what should the diagnosis for the office visit be, and what should the diagnosis for the temporal artery biopsy be? Is it okay to code the visit and the biopsy as temporal arteritis before the confirmed diagnosis?
While dilating the origin of the left iliac artery stent, a 7 mm balloon was simultaneously insufflated in the proximal right iliac system with both balloons extending into the aorta in a kissing fashion to protect the right iliac origin and dilated distal aorta. Since this is done to protect the artery, can I report code 37220-59 for one side along with the stent placement on the opposite side?
If a patient has a mastectomy and returns for an ultrasound of the axilla, what code should be used for the exam?
Can a facility charge for screening x-rays prior to an MRI to ensure there is no metal in the body if the patient is unable to confirm? Although not diagnostic in nature, it would seem to meet some medical necessity component for safely performing an MRI. Some sites want to set up pre-MRI screening charges generating CPTs for x-rays of the head, chest, abdomen/pelvis. I referenced your Diagnostic Radiology Coding Reference, but I could not find it stated in there.
Patient supine on table puncture right common femoral artery advanced to the abdominal aorta and then catheterization of the celiac w/ arteriogram then cath splenic artery with arteriogram. then select 2 branches of the superior division of the splenic artery w/arteriogram,with bland embolization to stasis followed with subselection of 2 branches of the inferior splenic artery w/ arteriogram and bland embolization. would we use for cath codes 36247 one branch of superior division, 36248x3 for 2nd branch superior division and for 2 inferior division branches 75726 and 75774 x4 and 37242 for the embolization code.
If a physician performs a left heart catheterization for 794.39 along with abdominal aortogram, checking the common, internal, and external iliacs, as well as popliteal arteries bilaterally, would you report this with code 75630? Or with codes 75625 and 75716? Can you explain when to use either codes please? And if this would bundle with the cath too.
When we do a congenital right and left retro catheterization (93531) and take sats in the LV, then later in the case they go across the ASD to the LA (and don't take sats), but go on into the pulmonary veins for pressures or angio, how do you code the catheterization??? With code 93531 or 93533? Is going across the septum for any reason cause to change to code 93533?
Our patient had bilateral tPA infusion catheters placed in each radial artery for frostbite in thumbs and fingers. On the subsequent day, follow-up angiography was done through each catheter. The catheter in the right arm was removed, as flow had improved. The catheter in the left arm was exchanged and tPA continued with hopes of improvement in flow to the digits in this hand. The plan is to return in the morning for another follow-up. I get edits if I try to put code 37213 for the left arm and 37214 for the right arm. What are your thoughts on how to charge this bilateral follow-up/cessation of the tPA infusion?
We have a patient who was scheduled for a cardiac ablation. The EPS catheters were inserted; however, when they got to the IVC they were unable to advance further. Imaging was done of the IVC, which showed occlusion. At this point, the procedure was cancelled. Do you recommend coding the ablation procedure with a -74 modifier (93653-74), or do you feel it would be more appropriate to code the venous catheterization with IVC imaging only? I'm not sure if what was done is enough to justify coding an attempted procedure.
The below SIR-Sphere procedure was reported with codes 37243, 36247, and 36245. Should modifier -59 be added to codes 36247 and 36245? PROCEDURES PERFORMED: 1) Celiac arteriogram. 2) Superior mesenteric arteriogram. 3) Selection of the replaced accessory hepatic artery with arteriogram. 4) Yttrium-90 SIR-Spheres radioembolization delivered via the replaced accessory right hepatic artery by operating IR in conjunction with the authorized user supervising the procedure. 5) Post embolization arteriogram of the replaced accessory right hepatic artery. 6) Fluoroscopic guidance for the above.
We are inquiring as to whether these procedures (36556, 36620, 93503) bundle, or are considered, inherent to the primary procedure (CABG). Below is an example of a report. PROCEDURE: 1) Urgent myocardial revascularization x3 with left internal mammary artery. 2) Left subclavian pulmonary artery catheter. 3) Right radial arterial line. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operative table. Preoperative antibiotics were given. He was sedated. A right radial A-line was placed. A left subclavian PA catheter was placed. He was then general endotracheally intubated. Arms were then tucked to his sides. His chest, abdomen, and pelvis were then prepped with ChloraPrep and a sterile field.
I have a question on coding an AP view of the bilateral hands and an AP view of the bilateral feet ordered by a rheumatologist. Is it correct to bill code 77077 x 2 for these exams?
If a breast biopsy is done using one modality and a surgical specimen exam using a different piece of equipment is done, can code 76098 be used? I know there is guidance to not use 76098 with codes 19081-19806, but what if different types of equipment were used?
What is the appropriate coding to charge out a renal stent along with a renal angiography? Is it appropriate to charge for both or just the stent? Please advise.
When a CVC is repositioned (indication: "Malposition of chest port") can cath placement, Sup vena cavagram, US access also be billed? What if the CVC is initially repositioned but then (after re-positioning/snared) it is removed and a new one placed in this location? Would this then be a replacement only or in addition to repositioning? I would reallly appreciate your expertise as we are trying to better understand the correct billing of these?
Can a CT scan can be billed and paid as part of a pre op for a lead extraction - inpatient or outpatient?
We did a right Elbow Complete 73080 and a left Elbow Complete 73080 for comparison purposes only. Are comparisons able to be billed seperately? Do I add a modifier? Some say do not charge and some others say yes charge if you have print views, or charge if the doctor order. Please advise.
Can you help clarify what CPT code should be used for this new injectable reveal device? There is contrversy over unlisted vs CPT code 33282.