Knowledge Base

Items 276 to 300 of 2220 total

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Disruption of left femoral-popliteal bypass graft and left femoral artery pseudoaneurysm

Propaten bypass graft placed from external iliac artery to fem-pop bypass graft at midthigh. All incisions closed. New incision to expose common femoral artery pseudoaneurysm. Lumen opened 1 liter of blood lost. Ligation ofcommon femoral, profunda femoris, superficial femoral. Proximal end of fem-pop bypass graft separated from previous patch graft. Patch graft resesected and sent for culture and suture ligated. The proximal portion of the fem-pop bypass graft avulsed from leg and proximal portion removed intact and sent for culture. 35665? 37618? ?????

CardioMEMS Heart Failure System

Our institution will start implanting the CardioMEMS HF System. What codes do we use for implanting the device and remote monitoring?

Resection of Vagus Nerve

Need assistance with coding an excision of paranganglioma of the vagus nerve. I'm thinking 64771, but possibly needs to be an unlisted procedure. Procedure: A transverse incision was made from the midline laterally approximately 2 fingerbreadths above the clavicle. Dissection was deepened. The platysma was divided and platysmal flaps were raised. Dissection was deepened and jugular vein was dissected along it's medial edge and retracted laterally. The paranganglioma was identified and it was clearly not only adjacent to, but part of the vagus nerve. We carefully dissected this trying to ascertain whether or not the paranganglioma could be resected and the vagus nerve preserved, however, it was apparent that the lesion was actually part of the nerve itself. For this reason, we resected the paranganglioma with a section of vagus nerve proximally and distally. Pathology was obtained and sent for exam. Careful inspection for any other areas of neoplasm was carried out and none were seen. Closing began.

Repeated Angioplasties

I'm looking for the appropriate cpt code(s) for repeated angioplasties in the left dorsalis pedis artery and distal anterior tibial along with repeated angioplasties proximal and origin of left anterior tibial artery for severe ischemia of the left lower extremities.

Venogram, Venacavogram

RT groin, under ultrasound guidance, RT common femoral vein accessed. a vascular sheath was advanced over a guidewire. then advanced in the rt external iliac vein with venogram. next, using a catheter the confluence of the bilateral iliac veins were catheterized w/subsequent inferior venacavogram. next cath was advnced beyond the area of narrowing along the infrarenal IVC and a ssuperior venacavogram was done. At this point all cathes and wires were removed. The codes I think should be 36011, 75825-26, 75827-26 and 75822-26

Co-surgery for FEVAR

Since the co-surgery surgical indicator is "0" for the new FEVAR codes, how do you suggest coding a procedure when two vascular surgeons (partners) work together equally on a case?

Ligation with bypass

Here is the procedure: 1. Right common iliac artery (end-to-side) to right renal artery (end-to-end) bypass with 7-mm PROPATEN graft. Right renal artery proximal ligation. 2. Left external iliac artery (end-to-side) to left renal artery (end-to-end) bypass with 7-mm PROPATEN graft. Left renal artery proximal ligation. Question: Are these ligations part of establishing flow and included in the bypasses?

Aortic Repair

For this case, is it possible to bill 33853 with 33854?  The physician actually extended the graft to the distal arch because it was hypoplastic, so I wanted to know if I could bill both codes under these circumstances. Procedure performed open repair of coarctation PROCEDURE NOTE: A left-sided posterolateral thoracotomy was made. The distal aortic arch and proximal descending thoracic aorta were mobilized. The Control of the distal aortic arch and subclavian artery was obtained. CPB was utilized. The coarctation was then resected and sent to pathology. In order to sew a larger graft to the distal arch, the arch was opened up into the left Subclavian and a 22 mm graft was then sewn to the distal aortic arch and subclavian. The graft was then trimmed to size and sewn to the descending thoracic aorta distal to the aortic coarctation Interposition graft was approximately an 4 cm long. FINDINGS: His distal aortic arch was hypoplastic measuring approximately 18 mm between the carotid and the left subclavian. The aortic coarctation was distal to the left subclavian in the isthmus area. We resected the coarctation area and performed an end-to-end anastomosis with interposition graft and 22 mm Dacron graft.

Vein Aneurysm Excision 37799

What CPT code is appropriate for ligation and excision of venous aneurysm? The left upper extremity was prepped and draped in the usual sterile fashion. He received intravenous antibiotics preoperatively, and an appropriate time-out was performed. There was a dilated mass overlying the forearm distally in the mid forearm basilic vein. Local anesthetic was infiltrated in this area. A small longitudinal incision was made. The venous aneurysm was exposed, and it was quite dilated, but the more proximal and distal veins were completely normal. The forearm basilic vein was then ligated proximal and distal to the venous aneurysm which was then excised and handed off the field as a specimen. Hemostasis was ensured, and the wound was closed in layers.

Deep Lymph Node biopsy

We have 49180 for deep lymph node biopsy for all peritoneal/retroperitoneal lymph nodes. What about deep axillary or intramammary lymph nodes? If unlisted, would you use 38999 even if a clip was placed at the biopsy site?

Aberrant Right Subclavian Artery for Cardiac Cath

The physician initially attempts a right radial approach and documents that he has difficulty and brings the catheter up to the aortic arch and into the ostia right subclavian and documents that the patient has an anomolous takeoff of the right subclavian off the aortic arch. The doctor then takes a femoral approach and performs a standard left heart cath. No vertebrals were mentioned. I'm thinking 36215-59 (separate takeoff of the right would make this a 1st order, correct?) and a 75710-RT-59 as well as the 93458 for the garden variety LHC and a 93567 as he does discuss the aortic arch but that was after with the LHC approach. I considered 36225 but no vertebrals were mentioned and it didn't seem like this was really the intent of the angiography. I'd really appreciate your thoughts on this. Thank you.

Bilateral S&I

When using bilateral procedure codes and separate S&I codes, ie. 50394/74425, 50398/75984 or 50390/74470 etc, how would you report the S&I? Would it be: 1)50394-50 and 74425 and 74425-59 2)50394-50 and 74425 x2 3)50394-50 and 74425 x1 ??? I seem to remember reading somewhere that you would code the 2nd one with a 59 but I can’t find it now...

50398 vs 50387

50398 vs 50387? And why. Contrast material was then instilled through the bilateral nephroureteral tubes, and the images obtained show appropriate positioning and bilateral hydronephrosis/hydroureter. A Bentson wire was inserted through both of the existing 8 French nephrostomy tubes. While maintaining the guidewires in place, on each side the previously placed nephroureteral tubes were removed, and new nephroureteral tubes were advanced over the wire. New 8 French 26 cm tubes were introduced over the wire under fluoroscopic observation. The proximal loops were formed in the renal pelvis and the distal loops formed within the bladder. Contrast material instilled through these new tubes, and films obtained show adequate contrast opacification of the collecting systems. The nephroureteral tubes were then secured to the skin with revolution devices and sterile dressings were applied.

Peripheral

I coded 36247 Rt & 75716-26, is this right? What am I missing? REASON: Nonhealing rt leg wound. PROCEDURE: 1. Distal aortic angiography w/nonselective bilateral iliac angiography. 2. Rt femoral angiography w/runoff (via third order). 3. Lt femoral angiography w/runoff. 4. Successful atherectomy of mid right SFA using TurboHawk. 5. PTA of femoral popliteal artery.

Y-90 Preliminary Workup

Is it appropriate to add an extra cpt code of 36248 for the proper hepatic when a diagnostic arteriogram if performed? The celiac was selected,type 1 celiac anatomy, selected common hepatic, , The G.D. was selected. To prevent reflux and nontarget embolization in the GDA. The cath was positioned in the proper hepatic artery, an arteriogram was performed. The r. gastric artery was identified arising from the r. hepatic artery. This was selected microcath, arteriogram done. To prevent reflux & nontarget embolization into the RGA, the RGA was occluded with coils. The cath was directed deeper in the r. hepatic artery, arteriogram was performed. 1.5 mCi of tech 99 MAA was infused into the r. lobe. The cath was then directed into the l. hepatic artery. 2.5 mCi of tech 99 MAA was infused in the l. lobe. Codes used: 37242,36247(G.D.),36248X4(proper hepatic, r. gastric, r. hepatic, l. hepatic) & 79445. My understanding is we can add a 36248 for the proper hepatic, because they stopped at this level to do a diagnostic arteriogram. If the cath was going from the proper to the hepatic, not stopping to do an arteriogram of the proper hepatic, then we would pick the highest cath placement?

3D Reconstructions, 76377

Can these two codes be billed with the diagnostic codes for 36221-36228? What kind of information should be documented? Are the words as described above enough or should there be more? I have searched everywhere for documentation guidelines and have been unable to find. I was under the impression these codes were only to be billed with just the other 70,000 code series(e.g CT or MRI).

Acute MI 92941

Pt. came in as a stemi. Pt. had previous grafts and the physician stented the native circumflex,not going through svg.In the final impression he stated that the svg to the om was the culprit lesion. I'm assuming, due to years working in the cath lab, and not what the physician stated in his dictation that he opened the native circumflex to get flow to the om. If the pt. comes in infarcting but he doesn't do the culprit lesion, can we still charge AMI-92941?

Documentation for a LHC

To code a left heart catheterization there must be documentation that hemodynamic measurements were performed. If the doctor documents: HEMODYNAMIC DATA: The hemodynamic data obtained from the left heart was normal Is that sufficient to code the catheterization or does the doctor have to give the actual measurements?

92941 with Other Vessel Interventions

Patient admitted with an acute myocardial infarction. Procedure note documents that a stent was placed in the diagonal vessel of the left main which was presumed to be the culprit vasculature. They then redirected the wire down the left anterior descending artery and in the proximal left anterior descending artery, stented an eccentric lesion that was 85% stenosed. The wire was redirected down the circumflex system and a stent was deployed across the circumflex marginal vessel. The physician is billing 92941, 92938 and 92944. I don't agree with this code selection.

AV Shunt Intervention

Right arm fistula procedure. Normal access of the fistula and imaging (36147). There was a stenosis present in the innominate branch. Multiple attempts were made to cross this lesion from the inital access site. This was unsuccessful. The decision was made to obtain groin access and address the lesion from below. This attempt was successful. Now comes the question you've been waiting for... What on earth do I charge for the groin access and the venoplasty of the brachiocephalic? I did give a good ole college try...this is what I billed: 36147,36011, 35476 and 75978. i'm hoping that I wasn't too far off.

ICD-9 for Congenital Issues

If a patient has a congential heart defect such as a PFO and they are coded as congenital 745.05 and we perform a congenital Echo 93303. Then the patient comes back a year later and the PFO has closed and the Echo is now showing normal would you still code them as congenital?

TAVR

Coding Clinic states that a diagnostic left heart cath may be reported with the TAVR (ICD-9), but states that sampling or monitoring of heart pressures is included in the TAVR procedure. What would indicate that a left cardiac cath is done for a diagnostic purpose? Is the physician's statement that it is a "diagnostic left heart cath" enough? He gave indications (acute on chronic dias heart failure from aortic stenosis) and only provided the LEDVP. It seems to me that all patients who require a TAVR probably have some degree of acute or chronic heart failure. Would this scenario be sufficient to code the CPT for the diagnostic left heart cath in addition to the TAVR? I am hoping this will provide some insight into my ICD-9 coding.

Labs with Interventions

My doctor is checking the activated clotting time and post stent placement, and sometimes does this two or three times. Is this something that would be included with the stent placement procedure, or is it something that we should be billing for? I am confused as to what code to use, if indeed we can bill.

Lateral Branch Blocks in the Sacrum

What are the correct surgical CPT codes for lateral branch blocks in the sacrum? The orthropaedic physician says he is injecting bilaterally the lateral branches S1-S4. The radiology guidance reports seeing four needles into the SI joints; however, the physician says he is not injecting the joints, rather he is performing lateral branch blocks. The physician also confirms he used four needles for the injections, and he advises the codes for this are 64493-50, 64494-50, and 64495-50. My question is, if he is using four needles, would three levels be injected bilaterally? Also, I am seeing on some pain management websites recommendations to use code 64450 for lateral branch blocks, as they are considered peripheral nerves in the sacral area. Please advise.

TGA Status Post Transplant with Continued Vascular Anomalies

If a CHD patient receives a heart transplant, are heart cath and echos coded as congenital or non-congenital? Physicians insist on congenital, but problem then is what congenital diagnosis can we use if it no longer exists? Also, see the following example of patient with post transplant complex anatomy. Should this patient be coded as congenital? Patient's native IVC and SVC were left-sided; complex re-routing of the systemic veins was performed at the time of his transplant. A flap of atrial tissue was used to redirect the IVC to the right atrium, while the donor innominate vein was anastomosed to the recipient left-sided SVC to the right atrium. Instead of using a congenital code, should we be adding a modifier -22 for this patient?

Items 276 to 300 of 2220 total

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