September 2015 Q & A

Question: 36228 with Pipeline Embolization

Following diagnostic cerebral angiogram with bilateral internal carotid artery catheter and 3D angiogram requiring separate work station, angle projections for treatment of the cavernous segment of the right internal carotid artery aneurysm were obtained. Navien catheter was positioned within the intracranial segment of the right internal carotid artery, and Marksman catheter was navigated into the right middle cerebral artery. Then pipeline embolization was done on the right cavernous carotid segment. At the completion of the coiling procedure, cerebral angiogram was performed via the right internal carotid artery. Besides 36224-50, can I add 36228 in this case even though the embolization was at cavernous carotid? I also coded 61624, 75894, 75898, and 76377. Are these the right codes for this case?

July 2015 Q & A

Question: 2 Infusion Catheters, 2 Graft Punctures for Access of the Same Leg

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 shows occlusion of the bypass graft and a 10 cm infusion Cragg-McNamara infusion catheter is placed and positioned across the proximal arterial anastomosis. Then under direct ultrasound guidance, a micropuncture needle was advanced into the proximal graft in an antegrade fashion, then a sheath was placed, followed by lower extremity angiography.

New HCPCS code C2623, Catheter, transluminal angioplasty, drug-coated, non-laser, will be effective April 1, 2015.

Code C2623 is a “pass-through” code and will receive additional payment from Medicare when billed. Hospital charge description masters should be updated with this code on April 1, 2015. These catheters can cost over $2,000, so it is important for the facility to receive the additional reimbursement when these specialty catheters are used.

March 2015 Q & A

Question: Atherectomy of Left Arm

Could you please clarify the uses of code 0234T? The CPT description says, "transluminal peripheral atherectomy." Since there is a separate code for the brachiocephalic trunk and branches (0237T) on the right side of the body, does this mean that 0234T may be used for atherectomies in the left arm, as well as renal atherectomies?

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?