Knowledge Base

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Catheter Placement for Embolization of Coronary Artery Fistula

Patient with two coronary fistulae had a preliminary LT coronary arteriogram in AP, RT anterior oblique with caudal angulation working projections, predetermined from review of patient’s previous cardiac cath, no interval changes (no mention of when previous cath was performed). Origins of both coronary artery fistulae visualized, guiding cath into distal circumflex with control arteriogram through it, then axium coils placed. Left coronary arteriogram confirmed occlusion. Embolization of proximal circumflex coronary artery fistula in same manner. We reported codes 37204, 75894, and 75898. As catheter placement for embolization is supposed to be assigned, can we use code 93454? Or will the “guiding cath” not be coded due to mention of prevous heart catheterization?

HCPCS 2014

Do you have any information on what code will be replacing deleted HCPCS code G0275?

Betadine Injection in a Hip Seroma

We have a patient with a hip seroma post soft tissue lipoma removal. The ordering physician has requested we place a catheter in the seroma and inject betadine through the catheter to sclerose it. On the patient's first visit, we used contrast and placed the tube under fluoroscopy. I used codes 76000 and 10160. I am not sure what to use on her next to visits where no contrast was injected, only betadine. Would you code this like a sinus tract injection with a -52 modifier?

Psoas Muscle (Abscess) Aspiration

Psoas muscle (abscess) aspiration - what is the CPT code for this procedure? Site muscle unlisted code 20999 or what?   How does this related to the "findings" description?  INDICATION: Left central and muscle fluid collection r/o abscess. PROCEDURE: Patient placed lateral decubitus on CT gantry couch. After induction of anesthesia, pre-procedure scan performed to select an appropriate entry site. Mark placed on the skin overlying left lower axilla, which was prepped in the usual fashion with wide barrier chlorhexidine preparation. Site then anesthetized with 1% lidocaine. Under fluoroscopic guidance, an 18 gauge trocar needle was inserted from 6 x 4 cm cystic fluid collection in the left psoas muscle. Approximately 52 mL of series fluid was aspirated. Needle withdrawn. Patient tolerated the procedure well without procedural complication. Multiple fluoroscopic spot images confirmed intra-articular location of contrast. FINDINGS: A well-circumscribed cystic fluid collection measuring 6 x 4 cm in the left upper pelvis/left lower quadrant of the abdomen. Impression: 1. Successful and uneventful CT-guided left psoas muscle aspiration. 2. 52 mL of serosanguinous fluid collected and sent for culture analysis and cell count.

Peg Tube Removal in Radiology

The radiology department has submitted code 49460 for the following case, which we are not sure is correct. Will you review and offer how this service should be reported? "History: G tube removal, unable to deflate balloon at bedside, no longer needed. Using sterile technique, the existing PEG tube was injected with contrast and multiple images were obtained catheter within the gastric lumen. A 035 Amplatz guidewire was then advanced through the catheter into the stomach lumen. Gentle pulling traction was applied to the catheter coupled with the Amplatz guidewire. The retention dome was then easily pulled through the gastrostomy site. The catheter was removed intact. A sterile dressing was applied."

Vena Cava Filter and Thrombolysis

The patient has extensive RLE DVT and failed anticoagulation. The doctor placed a vena cava filter through an internal jugular vein access. He then accesses the popliteal vein, injects contrast, and does a RLE venogram. He places the catheter to the external iliac vein and injects contrast again, then angioplasties the femoral vein. He places an EKOS thrombolysis catheter from the external iliac vein to the popliteal vein. I know that the filter placement usually bundles catheter placements and imaging; however, since a separate access was used, can I code for the catheter placement and venography of the lower extremity? I'm thinking code 37191 for the filter placement, code 37212 for the thromboysis catheter initiation, codes 35476 and 75978-26 for the venoplasty of the femoral vein, and possibly code 75820-2659 for the venography of the RLE.

IR Procedure for Liver Tumors Treated with Brachytherapy

Is there an IR procedure for treating liver tumors using brachytherapy, Ytrrium 90? It is a form of radiation that is injected into the tumor bed? Is there a dosimetry charge that can be billed? If so, is there any specific FDA-approved treatment planning or wordage that is necessary? Also, what about the use of SPECT/CT or PET/CT being reimbursed afterwards?

Coding for Endoleak

A patient had an EVAR done and is now returning due to an endoleak. Do you consider this a complication or more extensive repair of the original AAA? I am trying to determine whether correct coding for the endoleak should be billed with 996.1 and a -78 modifier, or whether the original AAA dx 441.4 with a -58 modifier should be used.

Second Stage Brachial Vein AV Transposition for Hemodialysis

"The patient had a previous brachial vein to brachial artery anastomosis created near the right antecubital region. The patient is brought in now for a planned second stage transposition fistula. A long incision was made in the right arm, and the brachial vein was dissected free from the antecubital region up to the axillary region. Branches were divided with clips and ties. We divided the vein from the previous anastomosis at the antecubital region and tunneled that through the superficial tunnel in the brachial artery that was dissected free. A venogram was then performed demonstrating no evidence of kinking or twisting of the brachial vein. An anastomosis was then performed to the brachial artery with running prolene suture in an end-to-side fashion. Clamps were released, hemostasis obtained, drain was placed, and the wound was closed."

Code 93325

For code 93325, Doppler echocardiography, color flow velocity mapping, will documentation of “no PFO by color Doppler” or “color Doppler” listed in the TEE findings support this code? What documentation is necessary to support code 93325?

Intra-Arterial Administration of 6.5 mCi Technetium 99m Labeled MAA

I have a radiology physician who does pre-Y90 mapping and MAA shunt evaluation when he infuses the intra-arterial administration of 6.5 mCi Technetium 99m labeled MAA for the shunt evaluation. Is there a way we can capture this charge? I am only coming up with a HCPC code C1204 for this, and I'm wondering if there is an additional CPT code we can use to capture this.

Left Atrial Flutter and Fibrillation Ablation

Rapid atrial pacing induced left A-flutter into A-fibrillation back into A-flutter into A-fibrillation. Ablation of the roof near the LSVP terminated the A Fib. Ablation contined down the posterior antrum of the L atrium which induced A-Flutter. We ablated around the entire L antrum, the tachycardia continued. We ablated the roof of the LA, from LSPV to RSPV as well as the posterior line from the L antrum to the R antrum and the left A-flutter terminated. The left flutter was posterior wall dependent. Multiple ablations were done in the mitral isthmus region and the corresponding contralateral CS region. After ablation was complete, EPS was done with no inducible atrial tachydysrhythmia. Adenosine bolus was given to induce pulmonary vein fascicles. None were induced. Post op dx are atrial fibrillation and two different left atrial flutter. Should this be coded to 93656, 93657 x 2 or 93653, 93656, 93657 x 1? In this case, would 93623 be billed for the adenosine?

Pacing AICD without Pacing Function

The patient has a pacing defibrillator with the tachycardia detections turned off for several years. The underlying rhythm is complete heart block, so he relies on the pacing function, and the device is at elective replacement indicator status. He comes in to get this replaced with a dual chamber pacemaker. Leads are atrial and ventricle, and only the generator was changed. Would you recommend coding it as a downgrade from AICD to pacemaker or as a pacemaker change?

RF Ablation of Left Subclavian Vein Using Power Wire

Is there special coding for using RF ablation for recannulization of a CTO in the left subclavian vein? Baylis Power Wire was used. PTA and stent placed after RF ablation performed. Initial access via right groin, second access left arm vessel. I've read the material for the Power Wire, but that does not provide any information for coding. I'm thinking all we can code for is the accesses, possibly the PTA if documentation supports this, and the stent placement.

Deleted Code G0275 (Renal Angiography with Cardiac Cath)

I've been told that as of 2014 that HCPCS G0275 is being deleted and the replacement code is 75625 (abdominal aortogram). I'm having a hard time believing this, but if it's correct, do I also charge for catheter placement (36200)? And what does the physician need to dictate for reimburse of code 75625 during a catheterization?

Clarification in Charging Aortography

I would appreciate clarification in charging aortography followed by: 1) Selective celiac artery catheterization/angiography and non-selective SMA angiography (shot from aorta, description of findings). Would that be reported with codes 36245 x 1 and 75726 x 2? Or, 36245 x 1 and 75726 x 1? 2) Selective celiac artery catheterization/angiography and selective SMA catheterization/angiography. Would that be reported with codes 36245 x 2 and 75726 x 2? 3) Considering either of the above two scenarios, would there be anything additionally reportable for non-selective left renal angiography (if findings were documented)?

Radial and Brachial Angiograms from an Ipsilateral Radial Access Following Iliac Angiograms

Patient had an abdominal aortogram, selective bilateral common iliac artery angiograms, and runoffs from a left radial artery access. We know these are reported with codes 36245-50, 7625, and 75716-59. Following this, catheter was withdrawn into the left brachial artery with angiography performed and left radial artery with angiography performed here too. As these are “pull-backs”, my first thought was that they would not be reported. Is this correct? If incorrect, how will they be reported?

Fenestrated Codes for 2014

My question is regarding the new codes for fenestrated grafts for repair of the visceral aorta. Am I assuming these codes apply to grafts from the manufacturer and ones that are custom made by the surgeon in the OR suite?

Radioembolization Codes

With the new embolization code 37242 (arterial embolization) for radioembolization procedures, is it appropriate to also bill for a visceral angiogram (75726)? Should you report code 75726 when performing a mapping pre-procedure for radioembolization?

Code 75989 in 2014

What will code 75989 be used for in 2014 now that there have been extensive changes to percutaneous drainage in 2014 that include RSI bundling (i.e., 49405-49407)?

Thyroid Biopsy Using Capillary Technique

I have a physician who does all of his thyroid biopsies using "capillary technique". In researching this type of procedure, the only thing I was able to find was that this would be considered an FNA. Specimen is actually contained in the needle without using aspiration. Clearly it is not a core biopsy, but would you still consider it an FNA?

Spinal Marker

How do I code for a fluoroscopically-guided spinal marker placement at the T8 level over the left pedicle?

Additional Order

I was just at the conference in Las Vegas. Outstanding. Great information. You mentioned something related to when you, as a radiologist, could order further tests, and I am asking if you have further guidance regarding this issue. When is a radiologist required to contact the referring physician before performing additional tests? I know you mentioned that if the radiologist was the treating physician, further tests could be performed without an order. Do you have anything is a little more clear? My radiology director is a great guy, but I have discussed this with him and he hasn't been able to clarify it for me. Any further help will be appreciated.

Measuring Interstitial Pressure

An IR doctor has asked me if we can bill for measuring interstitial pressure with a device. They will be doing a biopsy of a tumor, and the plan is to place a needle to measure pressures in a tumor. A component of the tumor pressure is transmitted arterial pressures. The plan is to simultaneously measure the pressures when the biopsy is done. What code(s) can be billed for this (in addition to the biopsy/guidance for biopsy)? I would appreciate any recommendations you may have for billing this additional procedure.

CPT Changes for 2014 for Imaged-Guided Breast Procedures

I have a question regarding the 2014 NCCI narrative instruction Chapter 9, subsection D, #11, and I would like to get your opinion on what this means for outpatient radiology facilities. It is regarding post procedural mammograms and that there should not be a separate charge reported when the breast procedure is done with mammographic guidance. Does this mean that if the breast procedure (biopsy or needle loc) is done by ultrasound or MRI guidance that a post-procedure mammogram can be reported?

Items 276 to 300 of 1928 total

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