February 2015 Q & A

Question: Heart Transplant - Congenital Versus Non-congenital

There has been much back and forth over the years as to whether or not congenital heart transplant patients should continue to be reported as congenital for heart catheterization coding purposes. Physicians state that “once congenital always congenital”, but I've understood from consultant recommendations that unless the new heart has a congenital defect or complex rerouting of vessels due to congenital cardiac anatomy, then all heart caths for transplant patients are coded as non-congenital. Can you please clarify?

January 2015 Q & A

Question: 37186 - Secondary Mechanical Thrombolysis

What is your opinion of coding 37186 as add-on with 37225 when thrombus is identified and documented in the primary atherectomy site, not in distal anatomy? Single rotational/aspiration device is used.

December 2014 Q & A

Question: Preoperative Tumor Embolization

The preoperative embolizations are sometimes confusing because they are done for varying reasons. When embolization is arteries supplying tumor, would this be considered Tumor Embolization? Patient has metastatic renal cell carcinoma to femur.

November 2014 Q & A

Question: IVUS Without A Base Code

I thought I read something about a change regarding IVUS without a base code. The patient has known CAD, and the only procedure done was an IVUS of the Left Main and LAD. Patient's groin prepped, 5 French sheath was placed and the guide was advanced. Wire was placed down to the LAD & IVUS of Left Main and LAD was done. I have documentation of the IVUS findings. Catheter as well as sheath were removed. IVUS would be coded as 92978 &92979, but current edits indicate a base code is needed. We don't have a base code. Was there a change so this can be coded, or is there another code that we should add, or is our claim going to be denied?

October 2014 Q & A

Question: Venous Stent Placement During Thrombolytic Therapy

In the 2014 Interventional Radiology Coding Reference, page 196 example #2, there is a thrombolytic therapy procedure that ends with a venous stent placement. The venous stenting codes do not include the catheter placement, and according to the CPT manual, you should report those in addition to the stents (37238-37229). The example only has the 37238 and does not list a catheter placement CPT code. The thrombolytic catheter is removed and a new catheter for the stent placement is inserted. Other coding references have stated that if a new catheter is placed even from the same access, you would report the catheter placement for the intervention. Wouldn’t you report the venous catheter placement in this example? And if so, what code would you use?