What is the difference between a limited Doppler (93321) and a complete Doppler (93320)?
We are having a debate at my facility... When the breast MRIs state CAD with 3-D for Non-Medicare, wouldn't this be reported with codes 77059 and 0159T for example, and an MC would have the C-code and 0159T? "INDICATION: Bilateral breast MRI new on-set microcalcifications patient history of breast CA. TECHNIQUE: The patient was positioned in the dedicated bilateral breast coil. Pre-Gadolinium sequences: Axial T2 TIRM, axial T2 turbo spin echo and axial T1 3D gradient echo. Post Gadolinium sequences: Following bolus intravenous administration of 10 ml of Gadavist, a dynamic series of T1 weighted 3D gradient echo sequences was obtained at one minute intervals out to 5 minutes. A high resolution sagittal T1 weighted series was also obtained. The images are submitted to the CAD stream dedicated breast MRI work station. The data from the dynamic series was used to construct angiogenesis maps displaying the enhancement characteristics. In addition coronal reformatted images were produced along with thin MIP, axial, sagittal and coronal images derived from the subtraction images as well as whole breast bilateral MIP reconstructions."
Physician performed: 1) Left carotid endarterectomy with patch repair - 35301. 2) Intraoperative carotid arteriogram (no cath placement documented). 3) Intracranial parenchymogram on the left side. I cannot find any information on what a parenchymogram is other than it has something to do with the capillaries. As it stands I can only see reporting code 35301.
Is code 37607 used only when the AVF is completely ligated? Example: On page 363 of your Vascular & Endovascular Surgery Coding Reference, we are directed to use code 36832 for ligation of collateral veins that are preventing maturation. If the vein in the AVF is ligated due to steal of the flow, is 36832 still the correct code?
Patient presented to the ER after biliary drain fell out. Initially the tract was recanalized with a Kumpe catheter and a Benston wire. Following a diagnostic study, the tract was dilated, and a new 8.5 Dawson Mueller external biliary drain was replaced. Can we report this with codes 47500/74320 and 47510/75980? Or report this as a replacement with code 47525? If we code this as a replacement, how do we capture the diagnostic study?
I have a question about abscessogram with drainage placement. Patient's drainage catheter was removed in prior surgery. Now after three days sinogram was done, and it showed continuted fistulous connection with the J pouch, so a drainage catheter was placed. Since there is no existing catheter, I do not think we can bill code 49424 for abscessogram... but can we bill codes 20501 and 76080 with codes 49021 and 75989 for this case?
In your Interventional Radiology Coding Reference book (page 275) it states that if the stenosis is not hemodynamically significant to not code the venoplasty. What is considered hemodynamically significant? Our physicians frequently do venoplasty in the AV fistula for mild stenosis. What is considered "prophylactic"?
I read the AMA Errata April 1, 3013 for ablations and the way it is worded... I thought that we no longer had to use modifier -52 or -74 (hospital) on the ablations codes where the EP portion is incomplete. But, I am told by a specialist that we still need to modify the ablations if there is not a complete EP study done. Is that correct?
Patient had seizure earlier in day and is nonresponsive. CTA demonstrates basilar artery embolus, so a vertebral artery angiogram is done and confirms the occlusion, and then thrombectomy is performed. This angiography does not sound diagnostic to me, so is there any code for 2013 that can be billed for the catheterization of the artery in addition to the thrombectomy code (as code 36226 is for catheterization and angiography)? These new cerebral codes are very confusing.
AMA has clarified information on EP coding, but CMS Transmittal 2636 conflicts with the AMA's revision, so I'm questioning if we will continue to see issues with these codes until CMS updates their information. NCCI also lists a bundling issue with codes 93623 and 93653, and I'm not sure that it would be appropriate to append a modifier to unbundle. Thoughts?
I have a chart where the doctor is stating procedure reason is "to place internal stent". The history says, "Patient returns for diagnostic antegrade pyeloureterogram and stent placement." The dictation says, "The contrast through existing tube. Cath was cut and removed. Fluoroscopy confirms uretral stone. Double J stent placed, new percutaneous catheter was placed, contrast confirmed position, and tube placed to gravity drainage." (I am shortening this a lot.) In the findings, doctor says pyelogram shows decompression and dilation of ureter, 1 cm stone that has migrated, ureter is obstructed at the level of the stone, and calcified uterine fibroid noted in pelvis. I know I can report codes 50393/74480 and 50398-59/75984, but is this enough info to also report codes 50394/74425? Your book says it has to be diagnostic to be coded, and I feel this is diagnostic, but I'm not sure. Can you explain what I need to look for to be able to code diagnostic grams?
This is my first time coding for a diagnostic cervical angio. I've done thoracic and lumbar. Are there specific codes for the cervical?
If we have a stent placement in the cervical ICA, we use codes 37215/37216. Do we use code 61635 if the stent is placed in the intracranial portion of the ICA?
Physician selectively catheterized the LCCA, left external carotid artery, and left occipital artery branch #1, #2, #3. Are codes 36223, 36227, and 36228 x 2 the appropriate ones to report? Please advise.
What code should we use for AV fistula aneurysm excision? The graft wasn't revised at the end, and the transection wasn't quite at the anastomosis, so it wasn't like they repaired the native vessel's defect (so I guess I can't code it as a vessel repair). I know I wouldn't code it as revision with 36832. The doctor is coding it as 35011, but I don't agree. Please advise.
Would you explain "inflow/outflow" and the "bypass zone"? Does the zone include the entire extremity or just the vessels and lesions that are contiguous to the graft? When would it be correct to code for other procedures (on the same extremity) during an open thrombectomy of a bypass graft?
Original Question: Can you help with this new (to me) device: EndoRE® Remote Endarterectomy Device. I have a doctor using this procedure from an endarterectomy with distal atherectomy. Is this still considered an endarterectomy, or should these be billed as a true atherectomy? PRODUCT Description: "The MollRing Cutter® Transection Device is a tool designed to transect and remove the plaque core at the designated endpoint or site of the reconstitution of the artery. MollRing Cutters provide the ability to cut the core of the wall of the artery without tearing. The rounded bottom edge of the cutter ring allows for a smooth advancement from the proximal arteriotomy to the designated endpoint." Follow-Up Question: Dr. Dunn answered a question for me last month. Is it possible to get a little more information? This group of doctors is doing an arteriotomy iliofemoral area. Doing an endarterectomy, then extending this "cutter" down and cutting the plaque in the popliteal and distally as far as the post tib. Should I be coding as endarterectomy iliofemoral and the popliteal etc.? Or when the cutting device is extended beyond the original vessels into seperately billable vessel, should I code these as atherectomy even though this isn't an approved device? These are all open procedures with an endarterectomy at the arteriotomy site, and then sometimes it is extended half way down the leg for a remote atherectomy.
Does the physician have to specifically state "CHRONIC total occlusion" to use CPT code 92943? What if they only state 100% occlusion?
I have a question regarding the use of the "branch" add-on codes for coronary interventions. If the patient has a stent placed into the RC and also has an angioplasty of the OM, would the OM be reported as a "branch", even though it is not a branch of the RC? Would this be reported with codes 92928-RC/92920 (OM), or would it be reported with codes 92928-RC/92921 (OM)? Thank you! You are our go-to guru!
Regarding question ID #4781 on the difference between codes 36832 and 37607... is it permissible to report both codes when the AV fistula is banded due to steal syndrome and parasitic veins are ligated during the same session?
Can both angioplasty and stenting be coded if performed in the same vein?
If, following an a-fib ablation, the physician performs nine CFAE ablation sites in the left atrium, would code 93657 be reported once for the one site of operation (left atrium)? Or would it be reported nine times for each specific site in the left atrium? Thanks for your assistance.
I would just to ask a follow-up question to question ID #4783. After the AV fistula aneurysm was excised, they didn't revise it anymore because the patient didn't need the dialysis access anymore. Do we still code that as revision even though the fistula wasn't revised? At the end of the case the fistula was nonfunctional or totally closed.
How would you code an internal cardioversion through an existing ICD? I understand code 92961 is an open procedure and would not apply, and code 92960 would not be correct either. Can you help?
What code should be used for a suprapubic catheter check? Existing suprapubic catheter was injected with contrast. No evidence of occlusion but clot like mucous in drainage bag, which was treated by exchange of new bag.