Knowledge Base

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CardioMems

We are wondering what documentation is sufficient enough to bill for outpatient interrogations for CardioMems. Can the nurse make a note that the MD reviewed the downloads and bill for that? Also, what CPT codes are used? Can they program the device?

Spectranetics Laser for PPM/ICD Lead Removal

I have a physician who wants to start using the Spectranetics laser for removal of PPM/ICD leads. I have checked the CPT Codebook along with your web site and have not found any information about how you would go about coding for this procedure. Would the only codes you could use be 33234, 33235, or 33244?

Ultrasound Chest and Thoracentesis

If a patient has an order for a thoracentesis, in the hospital setting, can the radiologist request that ultrasound be used to assess for pleural fluid, dictate a diagnostic chest (76604), and then proceed to perform an ultrasound-guided thoracentesis (32555) and dictate this separately? Does it matter if there has been any previous imaging that the ordering physician is using as a basis for ordering the thoracentesis?

PICC Line with Dual Chamber Pacemaker

Patient was getting a dual chamber pacemaker inserted, but a vein was collapsed, so a PICC line had to be inserted as well. Can I bill for the PICC line with the pacemaker (33208, 36569)?

Thrombin Injection for Ruptured Vein

"Balloon angioplasty of an AV fistula resulted in the rupture of the vein at the second of the two strictures. Attempts at sealing the rupture were unsuccessful. Therefore, thrombin was injected directly into the hematoma under direct ultrasound guidance, resulting in closure of the rupture." How would this be coded? Or is this included in the procedure?

Endoleak Repair with a Stent after AAA Repair

Not sure what 30000 series and S&I codes to code here. "The right common femoral artery was accessed percutaneously. A catheter was advanced into the aorta, and abdominal aortogram confirmed a type 2 endoleak. The hypogastric was selectively engaged, and selective angiogram of the hypogastric artery was performed. An attempt was made to engage the descending branch from the hypogastric, but because of the sharp takeoff just a few millimeters from the origin of the hypogastric artery, this was not successful. Therefore, prior to proceeding any further, using the Omni Flush catheter, the superior mesenteric artery was engaged, and a contrast injection into the SMA was performed with delayed views to see if there was a communication between actually the mesenteric vessels and the lumbar artery, and obviously not appeared to be the case. After the hypogastric artery again was engaged, the area of the takeoff of the feeding branch for the lumbar was treated by placing a 6 mm Viabahn x 2.5 mm covered stent with complete obliteration of the origin of the feeding vessel."

Venous Embolizations

What do you code when an arteriovenous fistula is treated on the venous side only? My IR surgeon believes that code 37242 is appropriate, as the condition treated (AV fistula) is critical in code selection, not the portion of the cardiovascular system treated (venous vs. arterial). I have an additional question as a result. A number of sources (CPT, CMS, etc.) state that non-selective catheterization and non-diagnostic angiography are inclusive to code 37242, yet there are no NCCI edits for diagnostic extremity venography (36005, 75820) for code 37242 (arterial malformation). Would codes 37242, 36005, and 75820 be correct in this scenario?

Use of 52 vs. 74 Modifier, Graft Angiography

Coding advice from another vendor is to append modifier -52 to 93455 when only selecting and injecting coronary bypass grafts instead of modifier -74. See their rationale below: "The appropriate modifier for hospital use would depend on the circumstances. If the planned procedure was to do bypass grafts only, modifier -52 is appropriate even for the hospital. If the planned procedure was a coronary angiogram to include both native arteries and grafts, but for some reason only the grafts were imaged, then modifier -74 would be the appropriate modifier for the hospital. The rationale for the above is that -74 is a “discontinued” service, and the description says 'due to extenuating circumstances or those that threaten the well being of the patient', while modifier -52 is for services that are 'partially reduced or eliminated at the discretion of the physician or other qualified health care professional'.” We are now uncertain of the correct modifier to use in this coding scenario, as we have been advised by your company to use -74 if anesthesia was used. Please advise.

CT Change of Drain Catheter

Would it be appropriate to use code 75984 when using CT guidance? I was under the impression it is understood to be via fluoroscopy guidance. I'm seeking your validation for the appropriate use of this code, fluoroscopy or CT. Thank you.

Eversion Endarterectomy

The physician performed endarterectomy of common femoral artery (35371), and an eversion endarterectomy of external iliac was also performed proximally. What code should I use for eversion endarterectomy of the external iliac?

Tunneled Peritoneal Catheter

What is the correct code for insertion of Pleurex catheter for drainage of ascites under ultrasound when the catheter is left in place and secured? Can code 49083 be used if the catheter is left in place?

Thoracic Outlet

Patient underwent rib resection with scalenectomy (21705) as well as excision of the pectoralis minor. Is there a code for the additional work involved in excising the pectoralis minor, or should this be billed with a -22 modifier?

Incompleted Staged Stent Procedure

Patient came in and had left heart catheterization and drug-eluting stent to RCA. Noted severe lesions in LAD, but due to stress test results felt RCA should be stented first, as it was a more critical blockage. Two weeks later for elective stent LAD, and after angiogram and FFR the physician noted lesions to be less than originally noted and chose medical therapy. Should we code 93455 with FFR? Or abort drug-eluting stent?

Coronary Stent with Angioplasty through Stent Struts

If a provider deploys a stent in the left main, which extends into the left circumflex (92928-LC), and then "inserts a balloon through the stent and performs an angioplasty of the LAD through the stent", would the angioplasty be separately reportable? My concern is the documentation mentions in the conclusion that he is "dilating the struts of the stent" into the ostia of the LAD with no residual stenosis in the left circumflex or the LAD. There is "no significant stenosis" in the LAD per the diagnostic cath and "minimal plaquing", so I'm not sure this is a medically necessary angioplasty or just facilitating the final stent placement and more of a "bridging lesion" scenario. Any help you can provide is appreciated!

Closure Device Angiography vs. True Diagnostic Leg Angiography for Medical Necessity

"Retrograde access was achieved in the left common femoral artery with a micropuncture set, and a 6 French sheath was placed. Arteriography of the left femoral bifurcation was performed using carbon dioxide and contrast. A 5 French Omniflush catheter was positioned in the distal abdominal aorta and bilateral iliac arteriography performed using carbon dioxide. Catheter was positioned across the aortic bifurcation into the distal right external iliac artery and right lower extremity arteriography performed using carbon dioxide and contrast." While arteriography of left femoral bifurcation only is being performed, and a complete run-off on the right side, should it be considered unilateral or bilateral angiography of lower extremity?

Repair of Ruptured Retrovisceral Aorta

I am confused about how to code for the 4-vessel debranching of the visceral aorta through a midline laparotomy. "The patient was opened, and four of the visceral vessels were debranched, and a Coselli graft was sewn in to revascularize the renal, mesenteric, splenic, and superior mesenteric. A wire was placed through the Coselli graft, and a Gore tube graft was deployed to cover the descending thoracic aorta and visceral abdominal aorta. This is the end of the procedure." Would I go with unlisted?

Arterial Line and Monitoring 36620

Can we report code 36620 for placement of an arterial line during a diagnostic/interventional cath procedure if placed in a different access than what was used to perform the primary procedure? "A 7 French sheath was placed in the right femoral vein, and a 4 French sheath was placed in the right femoral artery for pressure monitoring purposes. A complete right heart catheterization was performed using a 7 French balloon wedge catheter, and RV and pulmonary artery angiograms were performed using the 7 French cardio marker catheter."

37184 vs. 37186

We have started doing complex lower extremity interventions in our lab. A question has been raised about the proper use of codes 37184, 37185, and 37186. Would you still use code 37186 (secondary thormbectomy) if, after stent deployment in the SFA, there's a need to perform thrombectomy in the AT, PT, and peroneal vessels using a mechanical thrombectomy device? This doesn't seem to fit the limited or short segments of thrombus, which is used to describe secondary thrombectomy (37186).

Two Catheters in One Lower Extremity

"The patient has a left femoral to below knee popliteal artery bypass graft and a left abandoned bypass graft. A micropuncture needle was advanced in a midline retrograde fashion and a sheath placed. A pelvic angiogram showed occlusion of the bypass graft, and a 10 cm infusion Cragg-McNamara infusion catheter was placed and positioned across the proximal arterial anastomosis. Then under direct ultrasound guidance a micropuncture needle was advanced into the proximal graft and in antegrade fashion, then sheath was placed followed by lower extremity angiogram. Next a 10 cm infusion length Cragg-McNamara catheter was advanced across the distal anastomosis. 1 mg tPA per hour split between the two infusion catheters with 300 units per hour." Since there are two separate access sites, can I report codes 36140 x 2, 37211 x 2, and 75716? Please advise because I am not sure if I can code both since it's the same leg (although there are two separate access sites and two infusions catheters placed).

Catheterization of MCA M1 and M2 (Embolization or Mechical Thrombectomy)

I see middle cerebral branch M1 and M2 or unnamed feeding branches selected without imaging for an intervention. May we now report code 36228-52? And are M1 and M2 reported with 36228 x 2, or do you consider the entire MCA one vessel?

FFR Done Alone

One of our physicians would like to charge FFR (93571-26) and states “that not all FFR needs PCI and in fact most don't”. The doctor did not do anything else with the patient. "Procedure: Approach into right radial artery, lesion site dCIRC, pre-stenosis 60%, post stenosis 60%. FFR Finding: FFR resting result: 1.08, FFR result:1.09, FFR result: 1.07. PCI Equipment: Verrata pressure wire 180 cm (non-consigment)." Would you report this with an unlisted code? Any information is greatly appreciated!

75898

The physician did a transjugular liver biopsy. After the biopsy was taken he dictated: "Hand-injection digital subtraction venography was performed through the sheath demonstrating no extravasation of contrast material following the biopsy.” Another coder wants to add code 75898 for this injection. Is this an appropriate use of 75898 in this situation?

Bending Views with Myelograms

There seems to be a discrepancy as to whether we can bill for bending views (72114) during the same session as a myelogram. The facility I work for does bending views with all their myelograms. I do not hit any NCCI edits, but one person is telling me it is inclusive.

Thoracoabdominal Aneurysm Repair with Endarterectomies

Without going into too much detail, the vascular surgeon I code for performed a type 4 thoracoabdominal aneurysm repair along with endarterectomy of the renal arteries bilaterally and endarterectomy of the celiac and superior mesenteric arteries. I was wondering if I should report code 33877 with 35341-51, 35341-59, and 35341-59. It's the endarterectomies that have me confused.

Multi Level Kyphoplasty and Ablation

I hope you can clarify something. One of our radiologists performed kyphoplasties on L1, L2, and L3 with RF ablations done at each level for bone mets. Our radiologist feels that the ablation should be charged per level. I feel the CPT code describes the full ablation theray. So if one or more tumors are ablated in a session, regardless of how many spinal levels this involves, you only charge the ablation code 20982 once. Can you please provide some clarity for the correct charging of this?

Items 276 to 300 of 2280 total

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