May 2015 Q & A

Question: Coding Both Bone Marrow Aspiration and Bone Marrow Core Biopsy

According to the AMA’s CPT Assistant March 2015, when both bone marrow aspiration and bone marrow biopsy of the same site are performed, we can code both 38221 and 38220. Since there is a NCCI edit between the two codes, can we use modifier -59 to override this edit? Please clarify. Thanks.

September 2014 Q & A

Question: Vertebral Artery Stenting

Rt. vertebral artery origin has severe flow-limiting stenosis at level of C-6 and intracranially 50% and 40%. Procedure codes used are 0075T, 76937 x2, G0269, 36140. Impression: Rt. vertebral artery origin severe stenosis reduced to minimal residual after balloon mounted stent placement. Basilar artery flow is improved with lower blood pressure after the intra-arterial administration of vasodilator and rt. vertebral artery origin stent placement. Lt. superficial femoral artery arterial monitoring catheter placement.

Medicare is denying 0075T for modifier incompatibility. ...

Effective January 1, 2015, CMS is implementing four new HCPCS code modifiers to replace modifier -59, a modifier used to define a “Distinct Procedural Service.”

May 2014 Q & A

Question: Yttrium-90 intrahepatic embolization, catheter placements bundled by NCCI

Under ultrasound guidance for right common femoral artery access, a catheter was advanced to abdominal aorta and on to superior mesenteric artery where an arteriogram was performed (36245-59 for catheter placement). The catheter was redirected into the celiac artery and the proper hepatic artery was selected (36247-59) where an angiogram was performed.

The catheter was then advanced into ...

Q & A with Dr. David Zielske

Question: Permatemp Pacemaker Placed Post TAVR

Recently our cardiologists have started prophylactically inserting a "permatemp pacemaker" at the end of all TAVR procedures as part of a new guideline (I'm not sure whether this is an internal policy or a new guideline for standard of care on all TAVR procedures). If no significant heart block develops, they are removed later.

I feel that we should not bill for prophylactic care and that codes 33216 and 33234 should only be billed when the patient is documented as having heart block necessitating the continued pacing after removal of the pacing wire/balloon used during the TAVR. What are your thoughts?