When would be the appropriate time to use code 93640? Codes 93641 and 93642 are clear in their descriptions, but code 93640 leads me to believe that if a physician evaluates just the leads of ICD and not the whole system you may charge for it. For example, if a patient gets an ICD generator replacement due to end of life, and testing of the leads itself is done with EP catheters through an external EP system then can you charge 93640. What are your thoughts?
For the case that follows, I don't think code 61055 is correct (puncture not at the cervical level). I don't think this qualifies as a myelogram (62884). Is it correct to use code 62311 or lumbar puncture 62272? Radiology code 70015. Could you please clarify? "Patient has CSF leak from nose. Procedure: Fluoroscopically-guided lumbar puncture for cisternography. Under fluoroscopic guidance a spinal needle was advanced into the thecal sac at level L3-4; clear CSF return was noted. Omnipaque was instilled under fluoroscopic guidance."
Is there a code for FFR performed in a non-coronary vessel - in this case the subclavian artery?
Is it enough to dictate that 6 minutes of fluoroscopy was used to support the use of the code 77001 or 49440? If not, what would be the appropriate documentation? For example, if the dictation stated that the wire was advanced under fluoroscopic guidance, is that enough? Or should the use of the fluoroscopic guidance be matched up with the final placement of the catheter?
"Procedure performed: Through an Aegilis deflectable sheath system a Freezor Xtra 3 6 mm cryoablation catheter was introduced into this location. Cryoablation was performed under 3-D electrode anatomic mapping and intracardiac echo guidance with temperatures down to -80°C with continuous monitoring of the AH and HV interval. Pre-excitation and premature atrial contractions were ablated within 10 seconds of the first lesion with prolongation of the HV interval to 58 ms. Three continuous lesions in a freeze thaw freeze cycle were placed each of 240 to 300 seconds duration. Patient was then observed for 30 minutes post ablation with isuprel infusion up to 10 mcg/min. Antegrade and retrograde pacing protocols were performed during this time including Wenkebach cycle lengths. HV interval was 58 ms." Question: Can code 93623 be reported in addition to 93653? Or is code 93623 reserved for pre-ablation drug infusion? Your feedback is greatly appreciated.
Why is the current MUE edit for 92973 equal to 2? That number doesn't seem to fit with coding logic for either reporting that code once for all vessels intervened on, nor does it fit for coding once per coronary territory. I have a case where AngioJet or coronary thrombectomy was utilized during an AMI on the left anterior descending and ramus, so I'm thinking of billing it twice. Thoughts on this MUE?
When placing a CVC line from the subclavian with an occluded SVC into the azygos system, would this be considered a central line placement?
Patient has a previous fem-anterior tib bypass with vein. He is taken back to the OR for stenosis of bypass at outflow. Physician did an interposition jump graft from distal bypass to new location of distal anterior tib. Would this be a revision of bypass or a new bypass code like 35571?
We have had several cases (CCLV or EP) lately that have been cancelled or rescheduled due to labs being off. They made it as far in the department as the lab and then our pre-procedure area, where the nurse continues the process in prepping the patient (IV, consent, fluids, shaving etc.). Once the labs come back, we've had to reschedule or cancel the procedure. I was told that I should be coding the procedure with a -73 modifier. Is this correct? What would the appropriate situations be where this would apply, and does that cover any procedure under those circumstances?
During the creation of an AV fistula my provider ligated two veins off the cephalic vein to aide in maturation of the fistula. He used two separate incisions to do so; is this billable? Here is an excerpt from the operative note: "The cephalic vein appeared to split into two veins in the proximal forearm with one coursing laterally and not being fairly superficial of excellent size. There were two branches connected to this vein. In order to allow maturity of this branch as well, I proceeded to make a very small stab just proximal to the entry of this branches to the cephalic vein, and these veins were clipped. Each small stab was closed with 1 interrupted 4-0 Monocryl suture."
If a patient has endarterectomies performed in the common femoral, profunda femoral, and superficial femoral, can all three be coded? Do the territory rules apply for the PTA/stent/atherectomy rules to the endarterectomy procedures (35301-35372), which only allow one intervention in the fem/pop region?
The CPT Codebook seems to have conflicting verbiage; new 2014 instructions at the heading "Vascular Embolization and Occlusion" state that the embolization codes include "imaging necessary to document completion of the procedure". My physician also submitted code 75898 (angiography for follow-up study) for embolization, which sounds right. I just want to be sure that I'm not removing a billable service.
What code(s) would you use for endo-anchors to treat a Type 1 aortic endoleak at a later date than the initial endograft? This ultimately failed, so a transcatheter embolization was done, but had the anchors resolved the leak. Access was left common femoral.
What documentation is required to bill for a post biopsy diagnostic mammogram, providing that biopsy guidance was of different modality? Is a statement documenting only a clip placement enough?
Can RNs perform the initial stick for an EVLA and do sclerotherapy themselves under general supervision? Also, is there an NCD to cover EVLA for coumadin patients? NGS is our Medicare Part B administrator for Illinois and does not allow this per LCD25519.
"Patient presented for TEVAR for thoracic aortic ulcer. Bilateral femoral cutdowns were done (34812-50). On the right, pigtail was passed for diagnostic angio (36200). Device sheath could not be advanced due to iliac disease. Common and external iliac stents were placed (37221/37223). Still could not advance device sheath. Right side was abandoned. Device sheath couldn't advance on the left either, so an iliac conduit was placed (34833). Catheter was advanced into arch through conduit (36200-50). TEVAR not covering subclavian was placed (33881/75957). Conduit was then converted to a ilio-common femoral bypass (35665)." Since the right side was abandoned and the stents were placed to facilitate passage of device, can I still code the stents? Can I code the conversion of the conduit as a bypass and as a conduit? Can I report code 36200-50 since the catheter was for the TEVAR, not the stents? Your expertise is greatly appreciated.
I have a follow-up to question #5129. My surgeon is treating an endoleak for an AAA. The original surgery was done at an outside hospital, and now my surgeon is placing the Heli-FX to resolve the Type 1A endoleak. Any suggestions on what code should be used for this?
My doctor reported thrombectomy from beginning and throughout the report, but I think a couple of words at the very end of the report may have changed the coding from a thrombectomy to an endarterectomy. Does this limited documentation support reporting code 35371? "Incision overlying the femoral vessels... dissected out the common, superficial, and profunda vessels. Controlled vessels... arteriotomy extensively on the CFA and extended to the SFA. Fogarty catheter was placed, retrieving thrombus from the distal SFA out of the arteriotomy… thrombectomized the profunda vessel - flushed all the thrombus and clot out of the proximal CFA and actually endarterectomy of the CFA was also done with some degree of endovascular plaque disease, typical of atherosclerosis as well."
Our doctor performed an AV fistulogram in an ESRD patient and documented his finding as subclavian stenosis. How should I code his diagnosis? Should I code it as an AV fistula complication (996.73 and 459.2)? According to CPT P216, AV shunt is defined as beginning with the arterial anastomosis and extending to the right atrium. Would the definition apply to ICD-9 coding too?
I was taught that if an intervention was done after venography and access I should code only the intervention. I seem to have come across some confusion with this. I think I understand that if intervention was done on one leg, and just venography done on the other leg, I can bill the venography for the other leg separately, and just the intervention on the other extremity. Can you please give me some guidance as to how these are to be billed?
Can we bill code 92941 if patients are diagnosed with NSTEMIs but are stable and not taken to the cath lab until the next day and an intervention is performed?
The physician performed SFA atherectomy and placed the drug-eluting stent. I'm billing for the physician's services in a hospital setting. Does code 37227 include this stent, or is there another code for this type of stent?
What CPT code should we use to report the new Nellix Endovascular Aneurysm Sealing System (EVAS)?
Procedure: femoral AV fistula, fistulogram, stents outside fistula, upper extremity venogram, and IVUS (several vessels including fistula). Can IVUS inside the fistula be billed?
I would appreciate your assistance on an issue we are having with the correct codes to use in the following situation: Access was from the right common femoral. The catheter was placed in left internal iliac, superior gluteal, and two separate branches of the superior gluteal (36247, 36248). The left external iliac was then catheterized. I feel that the left external iliac should be reported with code 36248 since these vessels are in the same vascular family (contralateral common iliac family per vessel ordering table from the SIR manual). The other opinion is that the left external iliac should be reported with code 36246 based on your pelvic arterial anatomy chart. Can you clear this up for us?