If both the right and left subclavian veins are angioplastied (patient has SVC syndrome), is this coded as one venous PTA (35476/75978) or two? The CPT mentions that you can only code for one central vein lesion no matter how many are lesions are treated. But, it also goes on to mention (page 206 in the 2013 professional edition) that regardless of the distinct lesions treated within this segment. What do they mean by the words "this segment"? Does it matter if the catheter has been advanced beyond the SVC to the contralateral side of the body? I can report codes 36011/75791 instead of code 36147, but I wanted confirmation on if this is truly just one PTA. Thank you.
What code should we use when a TriVex system is used to resect varicosities? Should this be reported with code 37799, 37765, or 37785?
Could you please describe in detail what is included in a complete abdominal aortogram? I frequently code abdominal aortograms with bilateral leg run-offs with findings of the abdominal aorta and renal arteries only. Am I to add modifier -52 to code 75625 because the mesentary arteries weren't mentioned? Or are the findings for aorta and renals sufficient for a complete abdominal aortogam?
If just aortic pressures are taken (during a catheterization without mention of where the catheter ended up/placed), would that constitute charging/coding a left heart catheterization?
Occasionally, a neurosurgeon will order a shunt survey on a previous placed shunt. At my hospital, the radiologist just has the technologist x-ray the skull, c-spine, chest, and abdomen to view the entire shunt. We do not inject contrast. Currently we have a bundled charge that includes each of these codes (and charge a lesser dollar amount). Should we use CPT code 78645 instead?
When performing common and internal carotid angiography from the common carotid, how can you determine whether it is intra-or extra cranial? For example: would this be reported with code 36222 or code 36223? "The catheter was then removed over the wire, and an Biomet catheter advanced over the wire and pulled back to engage the left common carotid artery. The wire was removed. Carotid angiography was performed, given the patient had an occluded right carotid artery and moderate disease in the left internal carotid artery. 1. There is diffuse atherosclerotic plaque disease in the common carotid artery of 30% to 40%. There is calcification present. The internal carotid artery is patent with 40% plaque disease present."
Can you please tell me what the documentation requirements are for code 76998 so it can be charged? We have a case where the physician did a D&C using ultrasound guidance. The provider clearly documented the use of the ultrasound in the operative note as well as the findings, yet there was no permanent film taken. Does an intraoperative ultrasound require permanent images?
Can you please explain the rationale behind code 50393 with an MUE of 1, and its coding pair 74480 with an MUE of 2? I find this contradictory if bilateral stents are inserted. Thank you.
Would it be appropriate to report code 50387 for a patient who, in IR, has a nephroureteral catheter removed OTW and two wires and a sheath left in place to provide access for a nephrolithotomy to be done in OR later in the day? Since the work of creating the access was done in a separate session, code 50395 doesn't seem appropriate.
I am confused about the 2013 cervicocerebral coding. The more I look, the more confused I get. For hospital billing, when bilateral ICA arteriograms are done, do we use the -50 modifier, or do we charge code 33224 twice? The 2013 CPT Code Book and ZHealth Publishing books say to use the -50 modifier when performed bilaterally. The back side of the anatomical chart from ZHealth says to report the codes twice. When I looked online, the latest question answered about this subject only said, "For hospital billing, these codes are assigned status indicator Q2, so only one is reimbursed by Medicare when multiple cervicocerebral codes are submitted." But, that doesn't really tell me which way I should be coding this. Please help me with this very confusing subject!
In the 2013 Medicare physicians fee schedule, procedure code 19295 has had the PC/TC indicator changed from a 0 to a 3, which only allows payment for technical component, and now we are receiving rejections for our radiologists who are doing the clip placements. Do you know why Medicare changed this indicator, or if they are going to change it back? How/can we fight this rejection?
Can we charge for non-coronary IVUS when using the Pioneer catheter to re-enter a peripheral vessel during peripheral intervention? The Pioneer utilizes Volcano IVUS technology; however, no images are archived to WITT/PACS. Basically, the IVUS helps guide the physician to enter the true vessel when they are sub-intimal. I don't think so, based on the premise that ultrasound procedures generally must have images, but I wanted your take on this. Thanks!
I didn't see this scenario in your data base. The patient has a dual outflow with the major basilic vein outflow and the anastomosis from the brachial artery to the antecubital vein. The physician ligates the distal basilic vein, but the desired results weren't achieved, so he decides to place a coil in the distal basilic vein. Can only the embolization codes (37204/75894/75898) be assigned, or is it appropriate to code for the ligation (36832) as well? When Medicare says to code for the completed procedure, does this mean to only code for the procedure that produced the desired results? Thank you!
Is code G0269, the closure device, bundled in cervicocerebral angios?
Patient has a renal cyst that is being drained by a catheter which is left in. Code 50390 is needle aspiration, and code 50021 is abscess drainage. Would you consider this an unlisted renal procedure? Another question... I don't know why some patients come to the hospital for foley catheter changes, but they do. These are done over guide wire exchange transurethral... suggestions?
We have a patient whorecently underwent a TEE for the evaluation of a patent foramen ovale. It was inconclusive, and patient was then sent for an intracardiac echo and an agitated saline contrast study. The CPT code for the ICE is an add on-code. How should we bill for the contrast study... 93799? If so then will we be able to bill for the ICE add-on code 93662? Thank you for your help.
My physician placed a bifurcated endovascular stent graft for an abdominal aortic thrombus (not aneurysm). Should I use the endovascular codes (34800-34805), or would it be better to use code 37799? I'm really stumped on this one.
Should we bill code 37195 if "catheter was advanced in common carotid artery, and it was difficult to cross the extreme tortuosity of the cervical internal carotid artery, then intraarterial TPA was adminsted in common carotid artery. A total 15mg TPA was administered and angiography was done 10 and 15 minutes after the administration." I think for us to bill code 37195 the physician should document that the tPA is running over 15 minutes. Please advise.
Patient came for transjugular liver biospy. Order is for trasnjugular liver biopsy with hepatic vein pressure gradient. Report as follows: "Balloon occlusion catheter was advanced over-the-wire. Venogram was performed using catheter followed by inflation of the balloon and the catheter was wedged in the hepatic vein. Pressures well documented. Then two 20 gauge core biopsies were obtained from the right hepatic veins. No findings for the venogram." Can we charge this with codes 37200, 75970, 36012, and 75889-74 (for the pressure measurements)? Or nothing for hepatic venogram?
In the process of creating an AV fistula, the physician removes a thrombus from the basilic vein with a Fogarty balloon. He goes on to anastomose the basilic vein with the brachial artery. Would it be appropriate to report the thrombectomy with code 36831 and the creation of the fistula with code 36819-59?
I am helping out with some surgical procedures while they look for a coder, and I wanted your opinion on the following situation: "Physician does open heart surgery. In the operating room are two first assistants who are both PAs. One of the PAs assists with the open heart surgery, while the second PA does the vein harvesting only. I would bill the charges for the surgeon. Bill first assist using the -AS modifier. You cannot bill a second assist. But the second PA in the room harvested the vein. Would you bill code 33508 with him as the billing provider? Or would you bill code 33508 under the surgeon and bill code 33508 with modifier -AS under the first assist and bill nothing for the PA who actually performed the harvesting? Or would you bill the surgeon's codes and the PAs' using the -AS modifier and then bill code 33508 only using the second PA's provider numbers who actually did the harvesting? The surgeon and both PAs are employed by the hospital. What do you think?
Can we report both codes 75630 and 36251/36252 together with clear findings of the distal aorta, both iliacs, femorals, and selective right/left renal angiography with findings for the renal artery? The only instruction we have in the book is "do not code 75625 and 36251/36252 together".
When I read about code 76001 in the 2013 diagnostic book, I understood that as a hospital-based radiology department that the department cannot use code 76001 for any fluoro exam. The radiologist have their own billing that is separate from the hospital. So I sent: "01-01-13 76001 is non-reportable by hospital billing. Delete from CDM" to the chargemaster analyst. I received back: "The CPT code 76001 is reportable but just not paid by OPPS. Reimbursement Code 76001 - FLUOROSCOPE EXAM EXTENSIVE Date Of Service 2013-01-01 Wage Index 0.82870 Status Indicator - B Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x). Not paid under OPPS. May be paid by fiscal intermediaries/MACs when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS. An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x) may be available." So now I am confused. Should it stay in our CDM or not?
This patient came in for PICC placement. However, angioplasty of the subclavian vein was performed because it was occluded. My question is, can I report code 36005 for access to the extremity prior to angioplasty and still report code 36569 for PICC placement? "The patient's right arm was prepped and draped using sterile technique. 1% Lidocaine solution was used for anesthesia. Under real-time ultrasound guidance, a 21 gauge needle was used to puncture the right basilic vein and 0.018-inch wire was passed into the right subclavian vein. The needle was then exchanged for a 5 French peel-away sheath system. Through the peel-away sheath dilator venogram was performed, which demonstrates at least two focal high-grade stenoses within the right subclavian vein and a focal high-grade stenosis at the right subclavian vein/brachiocephalic vein junction. The superior vena cava appears patent. Then over a 0.018-inch wire a PICC line was advanced into the right subclavian vein however the PICC line could not be advanced through the stenoses in the right subclavian vein. PICC line was removed. A 5 French Kumpe catheter was advanced into the right subclavian vein, and a 0.018-inch Glidewire was advanced into the superior vena cava through the multiple stenoses and into the superior vena cava. Then the catheter was exchanged for a 5 mm x 4 cm in diameter balloon. Then the focal high-grade stenosis in the right brachiocephalic vein as well as the right subclavian vein were angioplastied to 5 mm diameter. This was done to accommodate the new PICC line. Then the balloon catheter was removed. A new 5 French dual-lumen power PICC line was advanced over the guidewire into the superior vena cava, and the tip was positioned close to the cavoatrial junction. The PICC line functioned well at the time of insertion. The peel-away sheath was removed. The PICC line was secured to the patient's right arm. It was flushed using saline and heparin."
I have a patient who developed breast cancer. The physician wanted to place a port, so the pacemaker was removed from one side and replaced on the other side. Old leads capped, new leads inserted. I wanted to report it with the removal code 33233 and the insertion with code 33208. I am now getting an edit to add a device "C" code. My concern is we did not add a new device; we used the existing pacemaker. How should I code this case?