The physician did an EP study and did IV infusion of adenosine. Normally they would use Isuprel infusion. Is adenosine one of the drugs that can be charged with code 93623?
"CFA is accessed. SOS catheter is used to selectively catheterize the LRA. Following review, decision is made to embolize two of the three branches of the left renal artery using ProGreat microcatheter, and coil embolization is performed. Following embolization, the percutaneous neprostomy catheter is removed. During removal of this, the existing double-J was also inadvertently pulled through the tract. Removal of the double-J was not intentional and was accidental." Would we charge codes 37204/75984 twice? Also, would we charge for the accidental removal of the double-J tube? Not sure what all codes would be valid with this report.
Any suggestions for a replacement code for G0275?
Is the fistula anastomosis considered an arterial anastomosis or a vein anastomosis? I have been coding a stenosis in the fistula anastomosis (like a brachiocephalic fistula) with codes 35475/75962.
Drainage and catheter placement in hip and/or knee. Should you report code 20610 or 10160 with imaging code?
I have a case where the physician placed two separate VAC dressings on two separate wounds, same leg, same setting. I thought code 97606 would cover both, but he's thinking it should be x 2. What are your thoughts?
I need help coding the following scenario. Would you report codes 19000 and 76942? "Ultrasound-directed right breast cyst aspiration HISTORY: Nodule in the upper outer right breast. The patient initially was scheduled for biopsy. The procedure of breast biopsy was explained to the patient; consent was obtained. With the patient in the supine position, the skin overlying the upper outer aspect of the right breast was prepped and draped in the usual sterile fashion. While administering lidocaine, the lesion of interest disappeared completely on ultrasound. Follow-up mammogram showed also that the lesion has disappeared. Lesion is felt to represent a cyst, which was completely drained. IMPRESSION: Cyst drained on its own after being punctured with the lidocaine needle."
If the physician documents "we would have to partially cover the subclavian artery" and in the summary states "all head vessels were patent", and there is no documentation of a carotid-subclavian bypass, would you report code 33880 or 33881?
“Do not code for angioplasty and separate stent in the same site or same vessel in 2014. Angioplasty is bundled in ALL stent placement.” Is this true for ureteroplasty and insertion of stent in the same site? "Contrast was injected through the previously placed right-sided tube. The tube was removed under fluoroscopy over a coons wire. The catheter and wire were manipulated across the distal ureteral stricture into the neobladder. Intraluminal position was confirmed. Exchange was made for an Amplatz stiff exchange wire. The catheter was removed. Angioplasty of the lesion was performed with 6 mm/4 cm balloon catheter (53899, 74485) and inflated to 15 ATM for 60 seconds. The balloon catheter was removed. A 20 cm/8 French Cook double pigtail ureteral stent was deployed (50393, 74480) from the renal pelvis through the ureter into the neobladder. Impression: Right pyelography confirmed persistent previously documented obstructive distal ureteral stricture. Imaging documents catheterization across the lesion,dilation of the lesion and stenting of the ureter."
Is there any information regarding reporting code 76499 for a 3D breast mammogram? From a recent Medicare newsletter it stated that only a 2D should be charged since the 3D is part of the 2D; therefore, code 76499 is no longer valid to be used for this procedure. In other words, use G-codes for Medicare and codes 77055-77058 for managed care. Please advise.
Patient has colorectal liver metastases. Yttrium 90 mapping arteriogram performed. Documentation indicates that left gastric artery microcoil embolization performed with post coil embolization arteriogram, right gastric artery embolization with post embolization imaging, medial branch gastroduodenal artery embolization with post embolization imaging, and lateral branch gastoduodenal artery embolization with post imaging are all performed. I am thinking this is one surgical field and would be reported with codes 37204 x 1 and 75898 x 1 (2013 case). The facility wants to report the embolization x 3 for the three separate vessels. Would this be considered one surgical field or more?
The patient had an alcohol ablation with temporary pacemaker. The 2014 code (93583) includes the temporary pacemaker. But what if the temporary pacemaker is in place for 48 hours post procedure? Can we report code 33210-59 then?
I seem to be getting more confused on when it is appropriate to assign code 93623. I thought code 93623 should only be assigned if done prior an ablation. Per question number 5091, it states that code 93623 may be billed if done prior to the ablation or after. I also have another reference that has the following example: "EP performed, catheters in RA, RV for pacing and recording, etc. SVT is induced; ablation for SVT performed. Isoproterinol is administered to determine efficacy of ablation (93653 and 93623)." So, can code 93623 be reported regardless of when it is given, and can it be coded when only to check for efficacy? Does an arrhythmia need to be induced after the initial ablation? Also, if the isuprel infusion further induced an arrhythmia, does an ablation need to be done in order to report code 93623?
Bilateral uterine fibroid embolization with catheter placements in both uterine arteries and selective right/left internal iliac artery angiograms. We should now be able to report codes 36247 and 75736 with 37243, correct? No longer inclusive like code 37210?
I just found out that codes J0152/G0275 were deleted 12/31/2013. What are the replacement codes?
With the new 2014 embolization codes, is code 76377 reported separately from codes 37241-37244 since it is inclusive of all S&I done in the procedure?
When the physician selects the right hepatic artery for a tumor embolization we would no longer report code 36247, correct? Because new embolization code 37243 includes the selection codes now?
Reading through your 2014 Interventional Radiology Coding Reference, you state to use code 37241 for treatment of a true venous malformation (via direct puncture or leg vein access). We are wondering if we can use code 37242 for direct puncture embolization of an AVM or aneurysm, or is it still an unlisted code in 2014?
Based on the report below, my question is as follows: Is an additional angioplasty code used for the "profundus" since it branches off the common femoral? If so, which code? I used codes 37221 (EIA stent), 37224 (fem/pop PTA), 75710-2659 (iliac imaging), and 75774-2659 (SFA imaging). Access from right. Cross-over to left iliac via omniflush and glide wire. Angiography showed occluded external iliac artery just after internal takeoff. Glide wire passed into SFA. Catheter advanced to SFA, and angio showed patent SFA. Then 0.018 wire placed in SFA and another wire in profunda. Angioplasty was done in SFA, profunda, and left iliac with thrombectomy through the 7 French sheath. This restored flow. A stent was placed in iliac to cover left iliac dissection with slight extravasation at end of procedure treated with reversal of anticoagulation.
I understand that embolization is based on surgical site, so all embolizations done in AVF would only be billed one time. However for pulmonary AVMs, what is considered the surgical field when multiple lobes are treated? Are the entire lungs considered one surgical field? Per embolization? Any guidance is greatly appreciated.
We have been reporting code 79445 for the MAA injection for Y-90 planning and code 77778 for the actual Y-90 injection, according to an SIR article written by Dr. Siskin back in 2007. For the CY 2014, the CPT Codebook suggests that code 79445 now be reported for the Y-90 injection. What code would you suggest for the MAA injection performed weeks prior to the Y-90 injection? We are also reporting for the planning, handling, and dosimetry, when applicable.
Patient arrives to EP lab for comprehensive SVT ablation (93653). During mapping, the physician decides to do a retrograde Ao root angiogram at level of aortic valve to map coronary arteries in order to possibly ablate a focus. No primary heart catheterization is done. On occasion a coronary angio may be performed, but not always. How would I code the aortogram?
I am seeing a lot of denials for when we bill the OCT (0291T/0292T) concurrent with the heart catheterization codes. Currently there is not an LCD for this procedure other than the "L31832" for Category III codes. The denials are basically stating that "the effectiveness of this service has not been established and is considered to be investigational". I was curious if you had any tips on how to get these paid? Or are they going to continue to deny because the procedure still does not have an LCD specific to these codes?
To use the new drainage codes (e.g., 10030), does the catheter need to be left in? I am trying to understand when code 10160 would be appropriate to use. I have been told that code 10160 is only used when the catheter is removed after the procedure and not left in.
Alcohol embolization of a true venous malformation of lower extremity. Direct needle puncture used to access venous sites. In 2014, code 37241 is used for the embolization of the venous malformation. What about the needle placement? Should we use code 36299? Or is direct puncture included in code 37241?