Knowledge Base

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Breast Localization Brachytherapy Sources

Would you please guide us with the following question? We’re going to start a new service where we inject radioactive seeds under mammographic guidance or ultrasound guidance for women who will have subsequent breast tumor removal. The seeds will be removed with the tumor during the operative exam. We need the localization and supply codes for the seeds.

Procedures on the Vessels of the Foot

What code(s) should be used when angioplasty, atherectomy, or stenting is done to the arteries or veins of the feet?

Venous Duplex with Vein Mapping

Patient presents for bilateral evaluation of lower extremity varicose veins and venous insufficiency. We perform a venous duplex Doppler examination that includes vein mapping. Are we able to charge anything in addition to code 93970 for the vein mapping?

Unsucceesful Stent vs. Successful PTCA

The physician made several attempts to cross the lesion in order to place a stent. It was unsuccessful. He ended up doing a plain old balloon angioplasty. The stent will be replaced by rep. What should we bill for hospital, code 92928-74FD or 92920? And what codes for physician billing, code 92928-53 or 92920 (with location modifier added also)?

Drainage Catheters

Our doctors were delighted to clear up the catheter drainage issue based on your respected publication regarding leave in or take out after drainage. The AMA/CPC and research I have done all agree with your original definition. The doctors said the extra work of catheter for drainage is the same whether it is left in or removed. And with the only publication I found that stated the catheter had to be left in when researched, upon further communication, the author stated it was her interpretation since 2005 that it should be left in and that it was not a direct quote from the AMA/CPC. So my question is, I am curious why the errata regarding catheter must stay in after procedure?

Repair Catheter, 36575

Can this code be used for re-stitching the catheter place? Or is it only for replacing the hubs? Are there other uses for this code?

Hydrocele Aspiration

Would aspiration of hydrocele be reported with code 55000? I noticed this is not listed in the ZHealth IR book and just want to be sure this is the code you would recommend. "Title of Procedure: Ultrasound-guided aspiration of hydrocele. Under sonographic guidance one step needle advanced into the left scrotum and a total of 470 mL of straw/amber fluid was removed. Catheter was removed at the termination of the procedure. A 22 gauge needle was advanced into the right scrotum where a total of 80 mL of straw-amber fluid was removed."

Right and Left Heart Catheterization and 36822

The cardiologist coded this as atrial septostomy (92992), which can't be right. Except for transseptal puncture nothing else is the same. The report reads more like percutaneous LVAD, but not quite. The patient was on ECMO from the day before. According to this report, transseptal puncture was to place a venous cannula and connect it to the ECMO circuit. So would this be reported with codes 36822, 93453, and 93462 if the report says only right heart catheterization was done? Dx 425.4  "The RFV was accessed percutaneously. A 10 French sheath was placed in the vein. Right heart catheterization was performed without incident. Cardiac output was determined using FICK method. A 7 French adult transseptal sheath was advanced to the SVC. A transseptal needle was introduced, and the sheath was brought down along the atrial septum. The needle was used to puncture the septum, and the sheath was advanced across the septum. An Amplatz superstiff wire was positioned in the left atrium. The long sheath was exchanged for a 17 French ECMO cannula with the tip and drainage holes in the left atrium. The ECMO cannula was sutured into place."

Single Chamber Pacemaker Upgrade to Dual Chamber

"Patient came in for elective subcutaneous pacemaker generator change. This was performed and seemed successful. But, prior to extubation, pacemaker lost capture. It was decided to replace the whole system. Patient was re-prepped and draped. A sternotomy was performed. Bipolar epicardial lead placement, with suboptimal parameters; a unipolar screw-in lead was then placed in the right ventricle at base of heart. Process was repeated, with same leads then placed in the right atrium free wall. Unipolar leads showed good threshold. The pacemaker pocket had been opened and subcutaneous pacemaker removed. All four new leads were tunneled to the pocket. Pocket was revised to hold new hardware. Bipolar leads were capped; original V-lead was also capped. New unipolar leads were connected to new dual chamber pacemaker." I know I need to report code 33202 for the epicardial lead placement. My dilemma is that the CPT Codebook says to use code 33202 with 33213 for pacemaker insertion with existing dual leads, but isn't code 33213 for when a previous generator is not being removed during same session? Would it be appropriate to bill either codes 33202/33228 or 33202/33214 for this scenario?

Code 76536

We receive orders for patients with a history of thyroid cancer and enlarged lymph nodes. We are asked to perform an ultrasound evaluation of the thyroid postsurgical bed and to map the neck lymph nodes levels I - VI, bilaterally. Are we able to charge more than once for CPT code 76536 because of the amount of work involved and the different anatomical body parts?

Stress Echos for Physicians

I recently started billing graphics again after many years. Since I last coded them I see they have added the option of a -26 modifier on code 93351. I would like to know if code 93351-26 includes the tracing (93017). My physicians do not do the tracing, so I thought I should be using codes 93350-26, 93016, and 93018. However, in a past question here, the answer stated that code 93351-26 includes codes 93350, 93016, and 93018 with no mention of 93017. In the CPT Codebook it says when all professional services of a stress test are not performed by the same physician to use code 93350 with the appropriate codes (93016-93018) for the components that are provided. Since my physicians do not perform the tracing, this sounds to me like I should be using codes 93350, 93016, and 93018 instead of 93351-26. Thoughts?

37217 vs. 37799

Should we use code 37217 or 37799 if the doctor directly exposes the carotid and inserts a stent that extends from the ICA into the carotid bifurcation? The stenosis is in the ICA. Code 37217 is intrathoracic, and ICA is not intrathoracic.

Carotid Angioplasty 35475

For PTA of an in-stent re-stenosis of the right common carotid near its origin, would I use codes 35475, 75962, and 36223 (findings were given on common, anterior, and middle cerebral arteries)? Or, would I use the unlisted px code 37799 with a -GZ modifier and 36223 for my catheter placement?

Mechanical Removal Explanation

What specifically would be considered mechanical removal for coding? For example, what types of procedures would need to be performed for reporting code 49460?

E&M

We are wondering if it is proper to charge an E&M code when we are performing a cardiac test on the same day in an outpatient setting. We would be the attending.

Rhythym Strip Before, During, and After Adenosine

The physician wants to perform this in the office during patient office visit. I do not think there is a code for this if done in the physician's office, but of course I can't find anything on it so maybe I'm wrong. Is there a CPT code for a rhythm strip before, during, and after adenosine is given? And is it supported when done in the office?

Color Flow Documentation on Echo

I am being told that if the doctor dictates findings such as "left to right atrial shunt" or a "valve insufficiency" that this supports reporting code 93325 and that they do not need to dictate the technique used. My understanding is that color flow is a visual assessment, so you would need to note those findings were by color flow.

Aorta Graft Procedures

I'm trying to determine how to code this case correctly. "A midline sternotomy was performed. The physician replaced the ascending aorta graft (33860), total arch replacement with hybrid debranching graft to 10 mm branch to innominate artery, 8 mm branch to left common carotid, and 8 mm branch to left subclavian (33870, 35626 x 3). Then he performed a stent graft repair of descending thoracic aortic aneurysm with coverage of the subclavian with TAG graft (33880). A Dacon graft was sewn end-to-side to the innominate artery for the purposes of cerebral perfusion. Epiaortic ultrasound of ascending aorta (76998-26)."

FEVAR

When choosing the code for repair of an AAA with a fenestrated device, is the code determined by the number of fenestrations or the number of stents placed in visceral arteries? The CPT code description says "including 1, 2, 3, or 4 visceral artery endoprostheses", which leads me to think the code is determined by the stents... but then how would I code a graft with four fenestrations and zero stents? My physician has done several cases where there are four fenestrations, and he only places stents in one, two, or three arteries.

New to Interventional Coding

I am also new to vascular coding. Which of your products (webinar, reference book, anatomical illustrations)would help to clarify catheter placement by order? Interventional cardiology is what I will be coding.

35907

In my research for excising an aorto-bifemoral graft, the only case I came across was one that was done on separate days of service. My question is, do I use code 35907 for the abdominal graft (they do incise the abdomen) and 35903-50 for the femoral grafts? Or do either of the codes include all of the graft? I am new to these vascular procedures.

Percutaneous Angioplasty Lumbar Artery

Our physician is doing a right hypogastric artery percutaneous transluminal angioplasy (37220), but he is also doing a right lumbar artery percutaneous angioplasty. Should this be reported with unlisted code 37799 with the selective catheter placement and 75962-26? I didn't think the lumbar was a visceral artery, which is why I only see an unlisted code here (the S&I states other peripheral artery).

Externalization of Generator

We have a patient with an infected pocket. The doctor removed the generator, taped it to the patient's body, and cleaned out the pocket. The patient returns to the EP lab five days later for new leads and a new generator. When the doctor removed and externalized the generator, can we bill code 33241?

Maceration of Clot during Thrombolysis

For codes 37211-37214 (infusion therapy), if they are using a Mustang balloon to macerate the clot during infusion therapy, is this included in the codes above? Is there anything we can bill for the maceration procedure?

Cystic Lymphocele Ablation with Alcohol

I seem to have a hard time grasping these sclerotherapies. I get the 37241, but I dont know what else I can code with this case. "Using ultrasound, a Chiba needle was introduced through the skin and in between the pancreas and the kidney. Small amount of hydrodissection was employed to make a space between the kidney and the pancreas. After getting past the kidney and the pancreas, the lymphatic malformation was entered. Wire was then placed since the needle into the cyst, and a 3 French portion of the 3-4 dilator was placed into the lymphatic malformation over the wire. Contrast was injected through Touey, which showed filling of the lymphatic malformation. A Rosen wire was then placed into the lymphatic malformation, and a 5 French Yueh centesis pigtail was placed over the wire into the lymphatic malformation. 24 cc of 70% ethanol was injected through the catheter, filling the cyst. Unfortunately at the very end of the injection, the back end of the malformation ruptured. We waited five minutes for the alcohol to react with the lymphatic malformation wall."

Items 276 to 300 of 2087 total

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