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. ...

August 2014 Q & A

Question: Liver biopsy with tornado coil placement

Physician performed a percutaneous needle core biopsy of the liver using ultrasound guidance (47000 &76942). At the end of his dictation for the biopsy, he said "An introducing needle was then placed into the lesion. An 8x4 tornado coil was placed through the introducing needle." Can I code for this coil placement, and if so, what code(s) would I use?

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: 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.