The proposed changes to Medicare policies and payment in 2020 were released today. They can be accessed at the following sites:
Physician Payment: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16041.pdf
OPPS Payment: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16107.pdf

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Posted in News Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - March 2018

Mar 24, 2018 11:18:00 AM

March 2018 Q & A

Question: 36904

How would you bill for crisscross infusion catheters placed in a AV dialysis fistula? Fistulogram showed thrombus within AV fistula with total occlusion. Successful crisscross placement of 5 F sheath and 10 cm infusion catheter within the venous limb directed peripherally and 6 French with 10 cm infusion catheter within the arterial limb directed centrally.

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Posted in Free Newsletters By Sondra Dunn

February 2018 Q & A

Question: Single Lead Pacemaker Generator Change

1. Pacemaker generator change 2. Placement of a new lead in the right ventricle 3. Capping and abandonment of old lead. When the existing right ventricular lead has been capped and abandoned and new lead is advanced into the right ventricular apex using a combination of straight and custom-formed stylettes onto new pacemaker generator, (pulse generator was also changed), should this procedure be coded as 33212, 33216, 33233? Or 33227 with 33212 and 33216, and is fluoroscopy always included in a pacemaker procedure?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - January 2018

Jan 29, 2018 11:18:00 AM

January 2018 Q & A

Question: Peripheral Angiography with a Cardiac Cath

Left heart catheterization is ordered for a patient with unstable angina. The Op report states that the patient also has a small ulcer on the foot, a history of atherectomy of the SFA, and reassuring ABI. Catheterization is performed via a right radial artery access. Subsequently, the catheter is moved down to right common femoral artery where runoff of the right leg with digital subtraction at 2 levels is performed. CFA is normal and arthrectomy site is patent. Would this be coded 93458, 36247, 75710?

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Posted in Free Newsletters By Sondra Dunn

Retroactive Billing Medicare for Drug Coated Angioplasty Balloon Code C2623 with AV Dialysis Intervention Codes

Medicare is allowing pass-through payment for code C2623 with AV dialysis interventions for claims filed retroactively for dates of service from August 25, 2017, through December 31, 2017. Pass-through payment wasn’t made with this combination in 2017 due to Medicare not changing its limited coverage for the catheter’s use only in the femoral popliteal arteries. Effective January 1, 2018, pass-through payment for code C2623 ended.

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Posted in Free Newsletters By Sondra Dunn

December 2017 Q & A

Question: Drug Eluting Balloon C2623 with CPT 36902

Our facility is performing the AV angiography of the dialysis circuit as described in CPT code 36902. The surgery department is using the device code C2623 for the drug eluting balloon that is documented as being used by the surgeon. We are receiving denials that the drug eluting balloon code does not have a matching CPT code. From what I can find, it appears that drug eluting balloon code C2623 can only be used with fem/pop procedures; is this correct?

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Posted in Free Newsletters By Sondra Dunn

November 2017 Q & A

Question: Infrarenal AAA

My provider did infrarenal AAA, using US guidance, he accessed both femoral arteries. He deployed a Gore endovascular stent with careful attention not to encroach the left renal artery. Then, the Gore limb was placed into the right common iliac artery. An extender device was placed from the main body limb, just above the left hypogastric. My question: is it appropriate to code 34825 since he used another limb extension?

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Posted in Free Newsletters By Sondra Dunn

2018 Change to Bone Marrow Biopsy Coding

Oct 31, 2017 12:05:48 AM

On January 1, 2018, long-utilized HCPCS code G0364, Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date aof service, will be retired. 

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Posted in Free Newsletters By Sondra Dunn

October 2017 Q & A

Question: Can you bill 61635 and 61624 for the stent assisted coiling?

Diagnostic cerebral angiogram and stent-assisted coiling. Subsequently the stent was placed and unsheathed through the supraclinoid and ophthalmic segment of the ICA. DSA in AP and lateral views demonstrated optimal wall apposition. At that time the coil was introduced completely into the aneurysmal dome. Under new roadmapping a 5 x 15 hydroframe coil was introduced into the dome.

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Posted in Free Newsletters By Sondra Dunn

September 2017 Q & A

Question: Limbs AV Fistula Declot & Stenting Failure; TPA and Repeat Stent for Extravasation

AV left forearm graft fistulogram showed extensive thrombus in main draining vein up to the level of the distal third of the humerus. Crossing sheaths placed. Angiojet catheter used to treat arterial and venous anastamosis. It worked for arterial but not venous. Angioplasty of arterial anastomosis, with arterial flow re-established. Stent was placed across venous anastamosis to improve outflow. Patient continued to clot despite administration of 10,000 units of heparin during the procedure. Multiple passes again made with the angiojet. Flow was not re-established.

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Posted in Free Newsletters By Sondra Dunn

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