Knowledge Base

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SAFARI Procedure

How is a SAFARI procedure coded ("subintimal and arterial flossing with antegrade-retrograde intervention")?

Biopsy of Mediastinal Mass After Pneumonectomy

I would appreciate uour input on this report. I was thinking this should be reported with codes 32405 and 77012. "History: Patient is status post left pneumonectomy due to lung cancer. Procedure: CT-guided biopsy performed of soft tissue mass in left hemothorax along the left heart border. Patient was supine with the left side elevated. Local ansthesia administered and skin nick made. A Cook 18-150-20 coaxial biopsy system used and trocar advanced to the lesion. CT images confirm proper localization. Several samples were obtained. Needle was removed, and hemostasis was obtained. Impression: CT-guided biopsy of mass long the left heart border in the pneumonectomy site."

Roadmapping a Vertebral

Could you please let me know if I need to report code 36226 if the physician states, "Right vertebral artery, roadmap images. Roadmap images of the right vertebral artery were obtained, showing normal caliber and contour of the right vertebral artery." The right vertebral was listed as one of the vessels selected during cerebral angiogram. Please let me know if you need additional information.

Code 93662

In reference to question IDs 5422 and 5442... You mentioned coding a right heart catheterization if done with ICE (93451 and 93662). We get an edit indicating that code 93451 isn't a valid base code for 93662. Is this correct?

Aptus Endoanchors

Is code 34845 the only code needed for extensions done? Do we bill unlisted for the anchors or include? From the report: "I placed an 8 x 5 Viabahn covered stent. This was placed into the SMA, making sure not to cover the bypass or any proximal main branches, and from the left side over the Lunderquist wire we placed a 31 x 14 x 13 Gore excluder C3. We continued deployment of the main body. Over the Lunderquist wire we placed a 23 x 14 limb on the right and placed a 20 x12 extension piece and the left iliac. We post-dilated using a q. 50 balloon. We performed a lateral angiogram, which unfortunately revealed a small type I endoleak seen along the posterior margin, which was not evident on the AP view. Given this finding and the large proximal neck with quick reversed tapering, we decided to place, and this tapers for better fixation particularly in the setting of the patient has had previous slippage of the graft. Two Aptus Endoanchors were placed posterolaterally, each 45 degrees off midline, but in the opposite direction of the snorkel."

Cisternogram Injection Code

What CPT code do you suggest for the injection portion of the cisternogram, 62311? "DESCRIPTION OF PROCEDURE: Lower back was localized with intermittent fluoroscopy at the L3-4 level. The L3-4 level was marked, prepped, and draped in the usual sterile fashion. 5 mL of 1% Xylocaine was infiltrated into the skin and subcutaneous soft tissues of the lower back at the L3-4 level. Under fluoroscopic guidance, a 3.5 inch, 20 gauge spinal needle was slowly guided into the dural sac at the L3-4 level, yielding spontaneous return of clear cerebrospinal fluid. A shielded syringe continuing 1.5 mCi indium 111 DTPA was attached to the hub of the needle and injected intrathecally. The stylet was replaced, and the needle was removed."

Catheter Placement for Venous Thrombolysis

We are new to coding thrombolysis cases, and we are questioning what catheter placement codes we can bill. Our report states, "Venous access was obtained via the left popliteal vein. Next, the catheter was placed into the left common iliac vein. Contrast injection was then performed in the iliac vein and IVC to perform venogram at this location to make sure there is no thrombus there. We then performed popliteal and femoral vein angiography to the side port of the 6 French sheath placed in the popliteal vein." We have come up with codes 37212, 76937-26, 75825-26, and 75820-26 for the ultrasound guidance for the thrombolysis and for the venograms. We are questioning what catheter codes we can use. We currently have 36005, 36010, and 36011.

50395 and 74485

The radiologist and urologist are working together on nephrolithotomy cases. Is it appropriate to report code 74485 for the radiologist when they work together in the OR? For example: 1) The radiologist creates the tract (50395). The radiologist joins the urologist in the OR and dilates the tract for the stone removal and dictates a procedure report. Can the radiologist bill code 74485 for dilating the tract, or is it included with stone removal? 2) The urologist creates the tract, the radiologist and urologist work together in the OR, and the radiologist dilates the tract for the nephrolithotomy and dictates a procedure report. Can the radiologist bill code 74485 for dilating the tract in this situation?

TAVR

I have a question regarding an open (33362) vs. percutaneous (33361) TAVR procedure. If the valve is delivered via percutaneous approach (i.e., modified Seldinger technique), but then the closure device fails at the end of the procedure, requiring an open femoral artery cutdown and repair, would you code the open procedure or percutaneous TAVR procedure? If you would still code as percutaneous TAVR, would you code separately for the cutdown (34812) and repair (35226)?

Surefire Filter to Prevent Non-Target Vessel Embolization during Y-90

I have a patient whom we are mapping for a Y-90 embolization. The physician comes back on the same date of service and places a Surefire Filter for infusion of Technetium 99m MAA. Is there a separate code for this? I was just going to code for the catheter placements on this particular exam and not the S&I since we had already done a diagnostic exam earlier in the day.

Transtelephonic Monitoring

Per the CMS NCD, frequency guidelines for TTM are divided into two categories: Guideline I and Guideline II. Can you clarify these two categories? Are they divided by specific devices?

Pacemaker Upgrade with LVL Placed

Patient has single chamber pacemaker with right ventricular lead who came in and was upgraded to a biventricular pacemaker with only left ventricular lead added. So no right atrium lead was added. How would you code this? I would code as a multi-lead change-out (33229) and left ventricular lead add-on (33225). Would this be correct?

Aortic Valve and Aorta Procedure

I need help with coding this case. The patient underwent a three-vessel bypass a couple of years ago. Now, he/she has returned because of ascending and arch aneurysm and needs aortic valve replacement. The physician performed the following procedures: 1. Redo sternotomy (33530), 2. Ascending and total-arch replacement with a 32 mm Gelweave graft under circulatory arrest and with proximal anastomosis at the sinotubular junction (33860, 33870), 3. Aortic valve replacement with a 27 mm Magna pericardial tissue valve (33405), 4. Saphenous vein interposition graft placed from the neoaorta to the right coronary graft (I don't have a clue), 5. Reimplantation of the right internal mammary artery free graft with aortic patch into the neoaorta (I don't have a clue), 6. Placement of atrial and ventricular temporary pacing wires (bundled no code), 7. Endoscopic vein harvest (33508). These are the only codes I could figure out: 33860, 33870, 33405, 33508, and 33530. I'm having trouble with procedures 4 and 5.

Brachial Vein Transposition

What code should we use for upper arm brachial vein transposition AV fistula? Code 36819 is for basilic, and code 36818 is for cephalic. Would you consider code 37799 or 36825?

Bypass Using Cryopreserved Artery

Procedures: 1) Redo left axillo-bi-femoral bypass graft using three pieces of cryopreserved superficial femoral artery. 2) Right common femoral to upper superficial femoral artery bypass using cryopreserved femoral artery. Physician used an unlisted code, and Medicare has continually denied for description issues. What would the proper codes be for these?

36247-50 for UFE Procedure

I'm hoping you might clarify something for me. With the new UFE procedure code, code 36247-50 is being recommended when performed bilaterally. I can understand the contralateral uterine artery being a third order, but the ipsilateral uterine artery appears to be second order (common femoral puncture - 36140, internal iliac - 36245, uterine artery - 36246). Am I thinking completely wrong?

Renal Hilar Mass 50200 vs. 10022

Can you tell me what code you would use for an FNA of a mass in the hilum of the right kidney? When I look at code 50390, it states it is used for cysts or urine in renal pelvis. Here is a portion of the report to help clarify. "Indications: An 81 year old female with history of infiltrating mass in the right kidney suspicious for malignancy probably transitional cell carcinoma, however, could also represent lymphoma. Under CT guidance, a 19 gauge guiding needle was advanced into the periphery of the right kidney. Through this access, a 22 gauge Chiba needle was utilized to fine needle aspirate the hilar mass. Three separate fine needle aspirations were performed, and the samples were sent to pathology. The needle was removed, and a sterile dressing was applied. Path report: Bloody material containing discohesive atypical cells and a few cytologically bland glandular appearing cells."

Exchange of Tunnelled Pleurx Chest Catheter

There is no CPT code for the exchange of a Tunnelled Pleurx Chest Catheter. What is your coding recommendation for the case example below: a) unlisted CPT code or b) 49424/76080?? "Chest and abdomen were prepped and draped in usual sterile fashion. The right-sided chest tube was removed over a stiff Glidewire, which allowed for placement of an 11 French peel-away sheath. After successful creation of a subcutaneous tunnel, the 11 French Pleurx catheter was advanced through the tunnel and through the peel-away sheath into the right-sided thoracic cavity. The incision was closed with 4-0 Prolene. Catheter was secured to the skin at the exit site from the tunnel with 2-0 Monosoft suture."

Venous Malformation Occlusion

If a patient is having a sclerosis as seen below, would I be able to use code 37241, or would I have to have an unspecified code 37799? "Multiple vascular malformation of left leg and left arm. Percutaneous track puncture sclerosis of vascular malformation. History: Multifocal venous vascular malformation. The patient presents for staged embolus embolization therapy of multiple focal low subcutaneous and superficial venous vascular malformations. Sedation: The patient received intravenous sedation with Versed and Fentanyl. Utilizing a combination of fluoroscopic and ultrasound guidance, access is gained to the multifocal malformation of the left leg and separately to the multifocal malformation of the left arm. With each puncture, embolization is performed utilizing Sotradecol mixed with contrast. Total procedure fluoroscopy time: 0.5 minutes."

Arterial Thrombectomy

I have a physician who wants to charge for three arterial thrombectomies. Here is his documentation: "We then attempted AngioJet with a thrombectomy catheter, which did resolve about 30% of the clot. We then pulse sprayed 50 of the 100 ml, so approximately 10 mg of tPA, and let this dwell for approximately 15 minutes. Angiography demonstrated resolution of clot within the left popliteal. There was flow into the left anterior tibial, but again, no flow into the left posterior tibial or peroneal. CONCLUSION: 1. Severe thrombotic occlusion of the left popliteal, which was 100% occluded. There was no visualization of any of the three infrapopliteal vessels. 2. There is suboptimal mechanical thrombectomy of the left popliteal and tibioperoneal clot. An AngioJet thrombectomy with thrombolysis with pulse spray was performed of the left popliteal, left tibioperoneal trunk, and left anterior tibial arteries." So the question is, do we charge for codes 37184 and 37185 x 2? Or just report code 37184?

Epigastric Vein Embolization

How would I code the following case? "Inferior epigastric vein catheterization from a right femoral vein approach with injection and imaging. Subsequently, the anterior abdominal wall in the distribution of the right lower quadrant parastomal region was interrogated. Just along the caudal margin of the stoma there was a small vein that appeared to emanate to the surface. This was slightly ectatic. With ultrasound and dressing maneuvering, brisk bleeding was initiated. This was immediately treated with compression. Subsequently the bleeding site was intubated with a 4 French dilator. 3 mL of 3 percent sodium tetradecyl sulphate was instilled. 5000 units thrombin were placed at the superficial surface of the bleeding site. Compression was performed. Subsequently the site was further treated with three 2-0 Vicryl sutures. Sterile dressing was applied. Osteoma stoma reapplied. Bleeding cessation was encountered."

Venogram

We have a physician who has us take a venogram via the existing sheath (36005). What I'm wondering is if we should also be charging code 75820 for the S&I of the venogram. Do we charge the same thing if he gains access to the vein with a micro needle and sheath?

Diagnostic Venography at Time of Venoplasty

My question is regarding the S&I codes for venography (75820) with venoplasty when both venography (75820, 76011) and venoplasty (35476, 75978) are performed in an outpatient acute care facility. We are coding for the facility. I have an edit for venography code 75820 being included in 35476. Is it appropriate to report code 75820 with a -59 modifier if no prior venography has been done?

Transseptal Codes

When performing atrial fibrillation ablation, can I code two transseptal punctures if one is for ablation catheter and one is for mapping catheter? I know code 93656 includes transseptal, but I'm not sure if I can code an additional.

Endovascular Aneurysm Repair with Aortic Cuffs

"Patient has history of end-to-side aorto-bi-femoral bypass and has developed a large AAA anastomotic aneurysm at proximal aorto-bi-fem bypass anastomosis. Aorto-bi-fem limbs are patent. After right fem incision, sheath was advanced up right iliac system. Surgeon placed aortic cuffs starting distally from old aorto-bi-fem bypass and building proximally up to infrarenal aorta utilizing 5 aortic cuffs overlapping. Proximal, distal, and junctions were ballooned. Angiogram revealed junctional leak. Reballooned. Persistent junctional leak. Two more cuffs were placed overlapping in midportion of previously placed cuffs and then ballooned. Leak improved, but was still faintly present. Patient not candidate for open repair. Surgeon feels that with heparin reversal and time this faint leak will seal." Is aneurysm repair with tube prosthesis 34800 and one cuff 34825? Or is the initial code 34825 since he used cuffs and it is for aneursym repair? I see the cuff code descriptions are for inital vessel and each additional vessel. This was all done in the aorta, so only one vessel had intervention. Seven aortic cuffs in all.

Items 276 to 300 of 2139 total

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  9. 86

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