Knowledge Base

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37214

The patient came in having a thrombolysis catheter in place from the previous day. They did a contrast injection, documented findings, and decided to discontinue the thrombolysis at this time. Since they did not do any thrombolysis at this time, can we still bill code 37214 for the cessation of thrombolysis treatment?

Attempted TIPS Revision via Combined Transhepatic and Transjugular Routes

How would you code for this thrombosed TIPS stent? "The RUQ was prepped, and under fluoroscopic guidance an 18 gauge Hawkins needle was used to access the proximal aspect of the Viatorr stent. A guidewire was successfully advanced into the right atrium. Then a gooseneck snare was advanced, via a previously placed left neck sheath, and used to capture the end of the wire. The wire was pulled through the vascular sheath and into the TIPS over the wire. A second wire and a catheter were inserted through the sheath into the Viatorr stent. The sheath was successfully advanced after the transhepatic Glidewire was removed, and it was advanced into the peripheral aspect of the Viatorr stent; however, multiple attempts that were made to recannulate the bare metal stent were unsuccessful. Procedure was aborted."

PVI and Additional Lines

We are debating a case and need your expert advice. Our EP physicians are saying we should be able to bill code 93657 x 2 for both of the additional ablations, and they indicated the medical necessity in their dictation. Due to the allowed space, I have only sent you their conclusion. "Successful EP study with successful ablation of the mitral isthmus line, anterior line, and septal line. Successful ablation guided by 3D mapping. Left atrial recording successful. Uncomplicated transseptal puncture assisted by intracardiac echo. EP study after Isuprel infusion with induction of typical right atrial flutter. Successful ablation of cavotricuspid isthmus with bidirectional block demonstrated. Successful cardioversion out of atrial fibrillation at the start of the procedure to determine whether the previous lines were blocked." We billed codes 93656, 93613, 93622, 93623, 93655, and 93657 x 2. Is there any time that you can bill 93657 x 2? We don't see this very often and would appreciate your advice and direction.

Empyema Drain 2014

Initial Question: Can you please clarify whether an empyema drain would be reported with code 49405 or 32557 for 2014? Follow-Up Question: I have a question about your response I received. Code 49405 lists lung/mediastinum in parenthesis in the CPT Codebook, and I have heard this is the way to bill for an empyema drain. If not, when would it be appropriate to bill code 49405 for the lung/mediastinum?  Thoughts? 49405   Image guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous

Repositioning LV Lead on Same Day as Biventricular Generator and Lead Placement

"Patient in for an implantable biventricular ICD and left ventricular lead placement, which was successfully carried out (33249, 33225). Left ventricular lead was steadily withdrawn with patient experiencing phrenic nerve stimulation and only intermittent left ventricular capture. Returned to cath lab, removed retention sutures, recannulated the coronary sinus and advanced the left ventricular lead into proximal portion, and withdrew left ventricular lead from its initial position and repositioned it into the posterolateral branch with good lead stability. Suture sleeve of left ventricular lead was attached to chest wall in two locations, pocket was flushed with antibiotic solution, and left ventricular lead was reattached to the biventricular generator." Can repositioning code 33226 be reported on the same date of service as the generator and left ventricular lead placement codes 33249 and 33225? When code 33226 is reported, we get an NCCI edit with 33249 saying that 33249 is code two of a code pair with 33226 that is not allowed even with an appropriate NCCI modifier. How should this be reported?

Stent and Catheter Placements

In your 2014 Interventional Radiology Coding Reference, page 196, example #2, there is a thrombolytic therapy procedure that ends with a venous stent placement. The venous stenting codes do not include the catheter placement, and according to the CPT manual you should report those in addition to the stents (37238-37229). The example only has code 37238 and does not list a catheter placement CPT code. The thrombolytic catheter is removed, and a new catheter for the stent placement is inserted. Other coding references have stated that if a new catheter is placed even from the same access, you would report the catheter placement for the intervention. Wouldn’t you report the venous catheter placement in this example? And if so, what code would you use?

Balloon Angioplasty of Right Internal Jugular Vein

I'm trying to code for a balloon angioplasty of the right jugular vein, and I'm not sure of the correct code. Also with contrast veno of inferior vena cava, superior vena cava, and right internal jugular vein.

Procedure Documentation

I recently started working for a new practice and have found that the physicians are not documenting the technique/description of the procedure performed. They are only documenting the findings of the procedure. Is the documentation of techniques and equipment used required for the procedure report?

33210 with 33233 Zero Edit

I understand not using code 33210 when doing permanent pacemaker or ICD change and patient is pacemaker-dependent... but can you charge 33210-59 in the same setting as removal of generator (33233) and leads (33235) if not replacing leads and generator at that time due to infection?

Epicardial Ablation

I have a couple of ablation cases that are confusing to me and wonder if these should be considered unlisted codes or if they are like the other ablations and are diagnosis-driven. I have one case that is left atrial and right atrial ablation for numerous atrial macroreentrant atrial flutters, vein of Marshall alcohol ablation for mitral isthmus-dependent flutter, antral pulmonary vein isolation, and CAFE ablation for atrial fibrillation. The other case is an epicardial ablation with a subxyphoid access for VT. My question is, do we use unlisted codes for the alcohol ablation and the epicardial ablation to capture the extra work ? Or should I consider using a -22 modifier?

Repeat Diagnostic Imaging

Am I correct in assuming that if a patient has a liver chemoembolization, let's say 75726, 75774, 36247, 37243 was initially billed. Now the patient returns for a repeat chemoembolization a month or so later, maybe a few months...for that return visit, would it be correct to bill just 37243/36247 unless the diagnostic imaging was done for a different purpose? You wouldn't re-bill the diagnostic imaging, correct?

Cardiac Device Checks

We are receiving denials for CPT codes 93293, 93294, 93295, and 93296 when they are performed more than once per 90-day period. However, these are being performed because the patient has received an alert or the programing information being reviewed by the provider indicates a potential problem. We are coding these with the ICD-9 code(s) 996.01/996.04 and V45.01 or V45.02 at the recommendation of the cardiac device rep. We have appealed these feeling they are medically necessary, but have been unsuccessful in getting the denials overturned. Do you have any advice or recommendations on proper coding for these instances?

Revision of Two Transvenous Leads

Should code 33215 be billed twice when the physician repositions both the right atrial and right ventricular lead at the same setting? The code description reads Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode. However, the instructional notations for Pacemaker or Pacing Cardioverter-Defibrillator reads Repositioning of a pacemaker electrode, pacing cardioverter-defibrillator electrode(s), or a left ventricular pacing electrode is reported using 33215 or 33226, as appropriate. In the code description it has a singular electrode. In the instructional notes it states electrode(s).

Aortobifemoral Bypass and Jump Graft

My surgeon performed an aorto-bi-femoral bypass and jump graft from the aortic graft to interal iliac artery. All grafts were non-vein. We want to get your opinion to see if there is anything else we could bill for this scenario other than code 35646.

Ureteral Stent Exchange Confusion

Kindly provide your thoughts on coding the following report. I'm thinking code 50387. "A 79-year-old female with history bladder cancer and right ureteral stenosis relating to the anastomosis in the pouch. The patient presents for routine ureteral stent to change. A 45 cm 7 French ureteral stent has been utilized. The patient was placed supine on the angiographic table, and the area of the ostomy in the right lower quadrant was prepped and draped in a normal sterile fashion. Initial contrast injection showed a very mild hydronephrosis that has improved since the previous study 05/28/14. Following this, fluoroscopic guidance was utilized to place a wire through the catheter. The catheter was removed, and a new 45 cm 7 French ureteral stent was placed without difficulty. The patient tolerated the procedure well. 1) Initial nephrostogram shows mild hydronephrosis in the right kidney that is improved from previous study. 2) Fluoroscopic guidance utilized for ureteral stent exchange. 3) New 45 cm 7 French ureteral stent placed without difficulty."

Temporary Pacemaker on Separate DOS

If a temporary pacemaker is placed, and then within 72 hours a permanent pacemaker is placed, are we able to bill for both?

Acute GI Bleed

When a patient has an embolization due to a GI bleed (because of tumor), and bleed is not located but embolization is done, would the embolization code for hemorrhage be used (even though they did not locate the bleed)? I see this frequently, as we are a cancer hospital and tumors frequently cause hemorrhage. Here is an example: "Multiple attempts to access right gastric artery were attempted without success. Splenic artery was accessed with microwire and renegade catheter, which was placed distal to area of irregularity. 3 mm coils were placed. Findings: Tumor encasing splenic artery without active bleeding identified. Right gastric artery originates from tortuous left hepatic artery, and multiple attempts were made to access right gastric without success. No active bleeding identified from right gastric." Would cases like this be coded as hemorrhage (since reason was GI bleed), tumor (since the tumor is the cause of bleed and it states "tumor encasing splenic", which was embolized), or non-tumor? Please advise.

Vein Patch Angioplasty with Open Thrombectomy

What code(s) are appropriate to use when my physician performs an open thrombectomy in below-knee popliteal artery and proximal tibial/peroneal trunk using a saphenous vein harvested? I'm coming up with code 35304. I'm also looking at codes 37228, 35571, 35700, and 35572. Just need some direction.

CPT 96450

How would you code the lumbar puncture if the puncture is by the interventionalist and the chemotherapy injection is by the oncologist through the same access?

75630 vs. 75716 and 75625

Would codes 36200, 75716-26, and 75625-26 be correct for the following case? Or would codes 36200 and 75630-26 be correct? "Patient placed in supine position. Bilateral groins prepped and draped in usually sterile fashion. Patient had easily palpable femoral pulses. The left common femoral artery was carefully anesthetized with 1% xylocone. The common femoral artery was punctured. A glide wire was placed under fluoroscopic guidance, and a 5 French sheath was placed over the glide wire. We then did an abdominal aortogram using 10 milliters a second of half strength contrast. The catheter was pulled down the aortic bifurcation, and we did a non-selective run-off of the bilateral lower extremities. We were concerned about the integrity of the right common femoral artery, so we did an RAO and LAO projection to look specifically at the common femoral artery. At completion all catheter wires and sheaths were removed."

EP Ablation Procedures

Is it appropriate to assign EP codes 93620, 93653, and 93656 when it is not necessary to induce an arrhythmia? In some cases, the patient presents for the procedure with an arrhythmia, such as atrial flutter, already present.

TAVR and Cutdown

We need clarification on the catheter access that is performed for a TAVR procedure. Our vascular surgeons are providing the access for the cardiovascular physicians for their TAVR procedures. We have been billing the access through our vascular physicians. We listened to a webinar that states we should not be billing the access separately even though the physicians involved are of different specialties. What is your opinion on this?

Portal Vein

What is included in code 36481? Is it the main portal, right and left portal, and any of the portal branches? I know if we select the veins off the portal (i.e., SMV, IMV) we can use codes 36011/36012, but does that apply to the portal branches if they are selected?

37215 vs. 35475

The following procedure was performed status outpatient. Code 35475 may not apply here, but what about 36222? "Patient in supine position...pigtail cath passed to level of ascending aorta and an arch arteriogram performed... Vertebral catheter used to select out left CCA. Cath advanced to the bifurcation level... to the left CCA level. Vertebral cath removed, and a 6.5 mm Accunet was passed up across the ICA high-grade stenosis into the mid-portion of the extracranial internal carotid artery. Attemped to pass a 7 to 10 Acculink stent across the area of disease involving the proximal left ICA but unable was to pass the stent into position due to critical stenosis present. Removed stent and passed 4 x 20 mm balloon up into position. It was inflated to 14 atmosphere pressure, and I did not see any improvement in the degree of stenosis of the proximal ICA. With no ability to pass the stent and my concern over the calcification of the ICA, I felt it best not to pursue further work at this point and to stop. Subsequent arteriogrm demonstrated no real change in the degree of stenosis."

LD Stent Via Right and Left Femoral Accesses

Would you report codes 92928-LD and 92928-59LD for the following case? "Right femoral access: Stent to the LD with subsequent angio showing excellent results. Removed wires and started to close groin when patient went into cardiac arrest. Angio showed thrombosis of LD. Could not access left femoral for IABP. Had to pull wires from right to insert IABP. With chest compression and IABP support we were finally able to access left common femoral and place a stent across LD thrombosis."

Items 276 to 300 of 2175 total

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