Q & A with Dr. David Zielske

Question: WADA Testing

I need help coding a portion of a case, super-selective WADA testing of anterior spinal artery using sodium Amytal and lidocaine with SSEP and neuralphysiological monitoring. Microcath was passed into the anterior spinal artery to a point just proximal to the AV fistula. First testing was performed with the infusion of 25 mg of sodium Amytal from this site. Monitoring did not show any evidence of changes in the lower extremity or anal sphincter monitoring.

Proceeded with testing the white fibers with injection of 20 mg of lidocaine from this site. After injection of lidocaine, monitoring showed a loss of signal intensities in the right lower extremity. Microcatheter was advanced to a more distal site. Repeat testing with 20 mg of lidocaine from this site again showed a loss of signal in the right lower extremity. Microcatheter advanced to a more distal site outside of the fistula. Repeat testing with 20 mg of lidocaine showed same results. After recovery to baseline microcatheter advanced distally to fistula site. Repeat testing from site did not show any changes. How would you code for the WADA with 4 separate injections?


Answer

WADA testing with sodium Amytal and lidocaine is described by a single code, 95958. The catheter placements and imaging are separately coded, depending on where the anterior spinal artery is imaged from. If a vertebral artery injection is made first, then the anterior spinal artery in the high cervical region is the area tested - use 36226. If it is being tested from the artery of Adamkowicz, use the 75705, 75774 and 36216/7/8 or 36246/7/8 catheter placement codes as appropriate.