We had a patient come in and the order was for CT abdomen with contrast. The tech did both the abdomen and pelvis, so of course our dictation reads for both and we charged code 74177. A pre-authorization was done for code 74160 and now the facility is wanting us to change the code to 74160 due to tech error. My question is, can we do that since the documentation states both, or could we separate the charges to 74160 and 72193 and not charge the pelvis and rebill code 74160? What would be the best way to handle this?
We have performed left iliac artery aneursym decompression and ligation of hypogastric artery and right iliac artery aneursmorrhaphy using Dacron graft. Can I bill this procedure with code 35131 x 2?
Is it enough to say the C-arm was used to confirm to support using code 77001? Or does the physician have to say fluoroscopy guidance was used?
What is the correct CPT code for right brachial artery angiogram and PTA of the right radial artery? And what books can help me to get more understanding of selective catheter placement (choosing first and second order, etc.). I am confused. I am a new coder for vascular surgeries.
This is an image-guided sclerotherapy of a right knee low flow vascular malformation. "Under direct ultrasound guidance, a 22 gauge needle was advanced through the anesthetized tissues and into the vascular malformation. An ultrasound image was recorded. Under fluoroscopy, hand injection of contrast confirmed position. The angiographic study of the malformation revealed filling of the dysmorphic irregular veins/venous lakes within the malformation in the lateral aspect of the femoral condyle. The malformation has two small draining veins at its proximal aspect emptying into the right popliteal vein, likely the genicular veins. Next the foam was injected into the low flow vascular malformation until filling of the draining veins was identified. There was good distribution of the sclerosing agent within the malformation..." With the new codes for 2014, we are pretty sure we would report this sclerotherapy with code 37241. But what, if anything, should we use for the needle access and angiographic study?
This seems like a simple code issue, but I continue to debate with myself over it. "(AVF) Forearm native radial artery cannulated retrograde beyond arterial anastomosis. Retrograde brachial angiogram done, which shows patent brachial ulnar, interosseous, and radial artery. Native radial proximal and distal forearm stenosed. Sheath repositioned and fistulogram done." What is the proper use of code 36120? I research code 36120 and it states retrograde brachial access, but the physician is accessing the radial artery retrograde. Is code 36120 only for retrobrachial, or can it be used for retroradial access as well? And would I code for retrobrachial angio 75658, as well as 75710 and 75791? Thank you in advance for your time and expertise.
How would you code the following? "Contrast was injected through the new catheter opacifying the collecting system. Given persistent leakage of contrast from the catheter skin exit site and possible compression of the catheter by adjacent internal plastic biliary stents, I elected to remove the biliary stents and further upsize the biliary drainage catheter. The catheter was removed over a guidewire common, and over the wire a vascular sheath was advanced into the small bowel. The distal end of one of the indwelling stents was snared and withdrawn into the sheath and removed. The second stent that had become withdrawn into the biliary tree was snared within the biliary tree and removed as well. Then, over a guidewire, a 14 French biliary drainage catheter with additional sideholes cut in the tube was advanced, and the distal pigtail coiled within the small bowel the most proximal sidehole was positioned peripherally in the biliary tree. Contrast was injected through the new catheter. The catheter was flushed with saline, secured to the skin using 2-0 Prolene suture, and pl..."
What is your code recommendation of this case? "Upper abdomen was prepped and draped in usual sterile fashion. Contrast was injected into patient's indwelling percutaneous pigtail type gastrostomy tube, confirming intragastric location. Catheter hub was cut, and the catheter was removed over Amplatz superstiff wire. A 12 French sheath was advanced into the stomach in order to facilitate fistula brushing, which was performed with 3 mm bristle Cellebrity Cytology Brush over Amplatz wire as sheath was retracted from fistula. Next, Cook enterocutaneous fistula plug was deployed through 24 French sheath within the fistula. Inner disc was in appropriate position along gastric staple line, as confirmed with fluoroscopy and radiography in multiple obliquities. External portion of the plug was secured to abdominal wall with Molnar disc and trimmed. There were no immediate complications."
"Patient had surgery two weeks prior with left ureteral stent and right nephrostomy with known hydronephrosis with obstruction. Here now for right ureteral stent. Under fluoroscopy, needle was passed into right kidney. Injection of contrast showed hydronephrosis and hydroureter to approximately 4 cm from UVJ where there is total occlusion, markedly redundant ureter. A 4 French catheter was placed, followed by an 8 French sheath. A 4 French angled catheter was used to gain access into bladder. A stiff guidewire was placed. Then, an 8 French by 26 cm ureteral stent was deployed with distal pigtail in bladder, proximal pigtail in right renal pelvis, and was noted to function." Codes 50393-RT and 74480 were assigned. Would you consider it appropriate to also report codes 50390-59RT and 74425?
I was just wondering what the coding protocol would be when we angioplasty the arterial anastomosis and place a stent in the graft venous outflow. Would one procedure override the other, as arterial angioplasty would be coded instead of venous angioplasty, but since stenting now includes any angioplasty does it matter that it's arterial anastomosis angioplasty?
Please advise on how you would code the following procedure. "Given the large size of the IVC it was not felt safe to deploy the Option filter in an infrarenal location, as there is significant risk for filter migration. Unfortunately, the Birds Nest filter, which is approved for IVC >28 mm, was not available in our department or in the operating room. Subsequently it was decided to place bilateral iliac vein filters. The Option filter sheath was exchanged over a wire for an MPA catheter. The external iliac veins were then selected with the MPA catheter over a Benson wire. Left and right pelvic venogram was then performed. Subsequently, the Option filter was then replaced over a wire to the common iliac veins respectively. The filters were deployed. Post-filter venography demonstrates appropriate location of the filters with their apices at the most distal aspects of the common iliac veins."
2014 codes, balloon angioplasty and stent placement left proximal and mid subclavian, also with left subclavian angiogram. Also for angiogram the vertebral was viewed and noted to have stenosis. Diagnosis for subclavian is PVD with claudication.
Patient has a large pelvic tumor through the left gonadal vein, the left renal vein, and the suprarenal IVC, and a retrohepatic IVC forming a large mass filling her right atrium and causing severe R heart failure. My surgeon performed the abdominal and caval component, and the CT surgeon performed the cadiac portion. A transverse venotomy from the left renal vein and into the IVC was made, and the tumor thrombus was removed. Along with the CT surgeon the tumor was removed. The cavotomy was repaired. The tumor thrombus extending from the ovarian vein into the left renal vein was then retrieved through a separate venotomy ofn the left ovarian vein. The only code I can come up with is 34401-22, but this doesn't seem adequate for all the work that was done. Do you have any suggestions on the correct way to bill this? Would you suggest an unlisted code? And, if so, what comparable code would you use?
What code should we use when a doctor creates a thigh AV fistula using the saphenous vein (femoral-saphenous fistula)? When they state they "harvested the entire saphenous vein through the knee... tunneled and anastomosed to femoral artery", is this reported with code 36821 (possibly with -22 modifier), or is it reported with code 36825 (possibly with -52 modifier)? Or would it be unlisted?
For your answer to Q&A ID# 5393 regarding coding for bilateral pulmonary thrombolysis, did you mean code 37212? Is the code for pulmonary thrombolysis venous rather than arterial?
Our EP physician brought the patient in for what he thought was a dislodged or malfunctioning pacemaker lead. Once the pocket was opened and the leads were detached from the pacemaker and examined, it was determined that they were fine. There was a set screw that was loose, and this was tightened down. Leads were attached to the same pacemaker and pocket closed. Our EP lab manager has only seen this a few times. What can I code for this, if anything? If fluoroscopy was used, can this be charged? Any suggestions would be most beneficial.
I have a question about the EP study with the ablation. Your cardiology coding book said the physicians don’t have to do a complete study when it is not necessary. Do you have to document a reason the complete study wasn’t done in the report? If not, do you bill with the reduce service modifier? The reason for my question is I was told by an EP consultant that I must have the reason the complete study was not done in the report to bill the ablation without a reduce service modifier for the incomplete EP study. I would like to know your opinion on this as to what a good documentation policy should be regarding this.
Patient has a history of ELG with a type 2 endoleak (not global). During an open embolization of the aortic sac and ligation of IMA, the physician inserted a sheath into the aortic sac and obtained intra-arterial pressures. Is that a separate billable service? If yes, what code(s) would I be able to use? We currently have code 37244 for the embolization and code 35221 for the ligation of the IMA.
When we are coding for biventricular pacemakers, we are having a conflict with the NCD for Single and Dual Chamber Pacemakers. The claims are being held if they do not have diagnosis acceptable for this NCD. Is there a separate NCD for biventricular pacemakers? We can only find NCD for biventricular defibrillators. This seems to be a recent development.
I need help on coding the attached two-day procedure. "PROCEDURE DETAIL: Nephroureteral stent was injected outlining the renal pelvis. Scout films demonstrated calcification in the proximal ureter. An exchange length Amplatz wire was passed down along the tube and into the bladder. The nephroureteral stent was removed over the wire. The wire was then secured to the skin. FINDINGS: Renal stone in the left ureter. Removal of the ureteral stent with wire placed into the bladder. IMPRESSION: Successful removal of left nephroureteral stent over a wire, with the wire left down into the bladder for laser lithotripsy. The following day after patient had laser lithotripsy and insertion of double-J ureteral stent by surgeon. PROCEDURE DETAIL: Using fluoroscopic guidance the Amplatz wire was removed using continuous visualization of the double-J tube to ensure no movement. FINDINGS: No significant movement of the double-J stent upon removal of the Amplatz wire. IMPRESSION: Successful removal of Amplatz wire without disruption of the double-J stent."
Day 1: Patient comes to IR for the radiologist to percutaneously place a nephrostomy tube with ultrasound, fluoroscopy, and contrast guidance. Day 2: Radiologist assists urologist by removing the previous placed nephrostomy catheter. Serial dilations to a 28 French sheath. The urologist removes the stone through the sheath, and a nephrostomy catheter is placed by the radiologist. Day 3: The radiologist injects contrast (does a full nephrostogram dictation) and then removes the nephrostomy catheter. Can I only bill codes 50395 and 74485?
Could you please help with correct coding of following case? "Patient has sternoclavicular lesion. Under ultrasound guidance, a needle was advanced to the right sternoclavicular joint, and a core biopsy was obtained. In addition, fine needle aspirates were obtained."
I have an abscess catheter check. A decision was made to place TPA through the catheter. A total of 2 mg of TPA mixed in 15 cc of saline and infused to the catheter with the catheter capped for one hour. What code, if any, can be used for the TPA infusion? The doctor is asking for code 37212, which I believe is incorrect. Some places it states not billable. Could you please clarify if this is billable and what code would be used?
One of our providers is wanting to bill for left heart catheterization (93452) with VT ablation (93654). It's my understanding that VT ablation includes a comprehensive diagnostic study of the right heart and left ventricle. I've noticed we can bypass the NCCI edit by adding modifier -59, but I am wondering when it would be appropriate to bill separately when performed with the VT ablation.
"Procedures Performed: 1) Left groin access under ultrasound guidance. 2) Bilateral lower extremity angiography with distal aortogram. 3) PTA and atherectomy of right CFA and proximal SFA. 5) Intra-arterial nitroglycerin and Mynx device closure for left groin. 6) Selective catheter placement in the right CFA and angiography." I reported this with codes 76937, 75716-59, 37225, 36247-59, 37202, and 75896. I am not sure about distal aortogram. What code should I use for it?