Knowledge Base

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Code 92921

In our procedure (non-Medicare payer), a stent was placed in the OM2, and an angioplasty was performed in the left posterolateral branch.  We were reporting code 92928 for the drug eluting stent in the OM2 (branch codes can be base if they are the more intensive procedure).  Can we also report code 92921 for the angioplasty in the left posterolateral branch?  (It's a major artery, not a branch.)  Thanks.

Code 36221 with Code 37215

The physician performs cervical carotid stent (37215) and performs arch study as well.  Can we report code 37215 and ONE of the new codes from series 36221-36224? 

Code 36223 with Imaging of Other Carotid via Arch

I have a question regarding a cerebral case.  LCCA is selected and cervical and intracranial imaging obtained.  Unable to access the right, so imaging of the right cervical and intracranial circulation is performed from the arch.  Would the correct coding be just code 36223 for the left?

Code 36227

I have a question about the new external carotid artery code. We performed a bilateral nasal embolization for epistaxis. On the left side, we did a common carotid injection, followed by superselective ECA injections and embolization. On the right side, an ECA injection was done, followed by superselective ECA injections and further embolization. I know on the left we charge codes 36222 and 36227, but what about the right side? Since code 36227 is an add-on code I know we can't charge it by itself, but I don't know what else to do. Your help with this is very appreciated!!!

Coronary Intervention, Codes C9600 and 92921

How would you code for a drug eluting stent to the obtuse marginal and an angioplasy to the left circumflex? Would you report codes 92920 and C9601 since the angioplasty was in the major coronary artery and the stent is in a branch? Or, would you report codes C9600 and 92921 based on the higher intervention per coronary vessel distribution regardless of whether it is a major vessel or branch?

Code 37210

Original Question: How would you code a uterine artery embolization for dysfunctional uterine bleeding where the end of the report states: "Right uterine artery injection outlines large round mass consistent with leiomyomata. This was succesfully embolized." This patient had congenital absence of the left uterine artery (determined after doing angiography.) Would you use code 37210 or 37204, etc.? Follow-Up Question:  The issue is that the IR doc says "consistent with leiomyomata", so it is not definitive and this is for professional fee billing.  I coded the dysfunctional uterine bleeding instead, and it was denied. However, I felt using the selective catheter placement, angiography, and regular embolization codes would be over-coding.  Any thoughts on this?

Codes 93621 and 93623 with Codes 93653-93656

Can codes 93621 and 93623 be billed with the new ablation codes?  I did check the NCCI Policy Manual but was still a little confused.  Thanks.

Modifier -76, Repeat Procedure

We had a STEMI come through the ER. The patient recieved a left heart cath, and a drug eluting stent was placed in the OM2. The procedure ended and the patient was taken off the table and moved to his room. About two hours later, the performing physician was reviewing the study and realized he had unknownly recanalized a lesion in OM1 that he now felt was the true culprit lesion. This vessel did not have good flow, so the patient was at risk for another cardiac event. So, the patient was brought back into the lab and a drug eluting stent placed in this vessel. As both of these interventions were done in the left circumflex distribution, will we be able to charge for the second stent placement with a -76 modifier? Or can we only charge for the initial procedure? 

Bridging Coronary Single Stent

Could you please clarify, would this be considered a bridging lesion? And would just one intervention be coded? "DESCRIPTION OF PROCEDURE: 5 French EBU 4.0 was engaged to the left coronary and Runthrough wire was passed distally in the left circumflex OMB 3. Heparin and Integrilin were given for anticoagulation. ACT checked and therapeutic during procedure. A 3.0 x 10-mm AngioSculpt was taken at 8 atmospheres twice and exchanged for a 3.5 x 18-mm Integrity at 12 atmospheres. There was TIMI-2 flow before procedure, TIMI-3 flow after, no dissection or residual stenosis within the stented area. FINDINGS: PERCUTANEOUS CORONARY INTERVENTION TO THE LEFT CIRCUMFLEX AND OBTUSE MARGINAL BRANCH 3: EBU 4.0, 3.5 x 18-mm Integrity at 12 atmospheres. TIMI-2 flow pre and TIMI-3 flow post, no dissection, no residual stenosis within the stented area, 10-mm lesion length."

Code 61624

Procedure was a dorsal spinal dural arteriovenous fistula (DAVF). Embolization of right lateral sacral branch accessed via lateral sacral trunk off right internal iliac artery. Performed as an outpatient procedure. Should this be reported with code 61624 (spinal) or code 37204? 

Aspiration Thrombectomy

Is non-mechanical aspiration thrombectomy chargeable, or is it included in the intervention procedure? If it is chargeable, which code should we use now that code 92973 is for mechanical thrombectomy only?  If it is included in the intervention, and it is done without any intervention procedure, is there a code that we can use?

61624

Procedure was a dorsal spinal dural arteriovenous fistula (DAVF). Embolization of Right lateral Sacral branch accessed via lateral sacral trunk Off right internal iliac artery. Performed as an outpatient procedure. Should this be reported as 61624 (spinal) or 37204 ? Thanks!

Code 33215

The patient had an infected device, and all the device components were removed.  Then a temporary pacemaker was placed using a pacemaker lead and a grey device (outside the body) and not a pacing catheter, so when that lead had to be repositioned would that be reported with code 33215? Or an unlisted code?

Washout Wound

What code should we use for washout wound when it is performed in the operating room?

33215

The patient had an infected device and all the device components were removed, then a temp pacemaker was placed using a pacemaker lead and a grey device (outside the body) and not a pacing catheter so when that lead had to be repositioned would that be the 33215 code? or an unlisted code? Thanks for your help with this.

Code 75898, Predetachment of Coil

I need your help again. One of our physicians would like to code 75898 when he performs a predetachment angiography during cerebral embolizations. When asked for further detail he stated that he releases contrast while the coil is still attached to the catheter to see if the coil looks good then if it does he releases the coil. Then he will put the next coil in and repeat the process. Can code 75898 be applied to predetachment angiography? 

Aneurysm Aspiration after Stent Graft Treatment

I need your expertise. I have an AVF intervention: 36147, 35476, 75978, 37205, 75960 - then I'm unsure about this part.  The doctor places a stent graft in a large mid arm pseudoaneurysm out flow vein. It is completely excluded (got that part).  He then makes a puncture of the same pseudoaneurysm and aspirates blood (thrombus was documented in the findings).  Is this a thrombectomy or an aspiration?

Nephroureteral Stent Placement

How would you code a nephrourteral stent replacement when the stent fell out at home? The tract is already in place, so a new stent would be overcoding, wouldn't it? Please see below. INDICATION: Nephroureteral stent accidental dislodgment and removal. PROCEDURES: 1. Percutaneous nephroureteral stent placement using fluoroscopic guidance. 2. Nephrostogram. Patient's existing skin defect at previous nephroureteral stent slight was probed with a KMP catheter and Glidewire. Tract was identified and Glidewire and came P. were advanced into the renal pelvis and down into the bladder. Wire was changed for a Amplatz wire. A 10 French nephroureteral stent was placed. This is confirmed by contrast injection which showed moderate hydroureteronephrosis. Catheter was secured to the skin with stitches Catheter was secured to skin with suture. The patient tolerated the procedure without complication.

Code 34201

My physician performed open cutdown of left common femoral artery and left over the wire popliteal thrombectomy. How do I code the over wire thrombectomy. Should I use code 34812 for cutdown and code 34203-22 for over wire thrombectomy? Please advise.

34201

Hi, My Dr. performed open cutdown of left common femoral artery and left over the wire popliteal thrombectomy. How do I code the over wire thrombectomy. Should I use 34812 for cut down and 34203-22 for over wire thrombectoy? Please advise. Thanks, Renata

Replacement of nephroureteral stent that fell out at home

Hi Dr. Z- how would you code a nephrourteral stent replacement when the stent fell out at home? The tract is already in place, so a new stent would be overcoding, wouldn't it? Please see below. Thank you INDICATION: Nephroureteral stent accidental dislodgment and removal. PROCEDURES: 1. Percutaneous nephroureteral stent placement using fluoroscopic guidance. 2. Nephrostogram. Patient's existing skin defect at previous nephroureteral stent slight was probed with a KMP catheter and Glidewire. Tract was identified and Glidewire and came P. were advanced into the renal pelvis and down into the bladder. Wire was changed for a Amplatz wire. A 10 French nephroureteral stent was placed. This is confirmed by contrast injection which showed moderate hydroureteronephrosis. Catheter was secured to the skin with stitches Catheter was secured to skin with suture. The patient tolerated the procedure without complication.

Fenestrated EVAR

Our practice just performed their first fenestrated EVAR. They used a fenestrated aortic cuff with a bifurcated stent graft. They also stented both renal arteries with iCAST stents and used an extension on the right iliac and used an iCAST stent on the left iliac. From what I have researched, I believe the codes would be 0078T, 0079T, 0080T, 0081T for the fenestrated cuff with bifurcated EVAR graft, and codes and 34825, 75953-26 for the extension on the right iliac. Are the renal stents included in the fenestrated graft codes, or can they be coded additionally? And can the iCAST stent for the left iliac be coded with 37221? A stent was done because 'there was only 4-5 mm of available iliac artery to extend the graft and there was noted to be poor apposition of the stent wall due to tortuosity of the proximal iliac artery'.

Balloon Maceration Thrombectomy

It is my understanding that you cannot bill a stent or angioplasty when done for maceration of a thrombus unless there is an underlying stenosis. Would this apply to ANY stent or angioplasty regardless of where it's done (i.e., pulmonary artery)? Thank you for your help.

Carotid Imaging Codes

1. First question: The physician refers to a 'follow-up' of intracranial cerebral without advancing catheter into additional selective but increasing rate of imaging to better capture AVF draining into a venous varix. The physician contends this is a separate charge.  However, I say that is NOT CORRECT. Please help.  2. Second question: The physician performs selective external carotid angiogram followed by advancement of catheter from trunk of LECA to position just proximal to left internal maxillary artery and superficial temporal artery with additional imaging. Since these are not INTRACRANIAL CIRCULATION BRANCH arteries I am hesitant to add code 36228 to the bill. Thanks.

Codes 93975 and 93976

We would like any clarification you could give us for codes 93975 and 93976.  AMA code 93975 reads "duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study". For a complete study, 93975, is this per organ studied or per area (abdomen, pelvis, scrotal, and/or retroperitoneal)? To also be considered a complete study, does the arterial inflow and the venous outflow have to be imaged? The techs are saying that imaging the arteries of one organ is a complete study, (i.e., mesenteric artery only or renal artery only). The Society of Vascular Ultrasound website imaging guidelines do not mention imaging of the veins in the mesenteric study and even have it named mesenteric artery duplex imaging. Their renal imaging guidelines do mention venous imaging on one line only. I understand these are imaging guidelines. We would like clarification on what is needed for a complete study. The "arterial inflow and venous outflow" says 'and', not 'or', so do both need imaged? Or is it okay to just do the artery and call this a complete study? I have looked in several locations for material addressing these certain issues and can not find anything. Any help would be appreciated.

Items 276 to 300 of 1889 total

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