Ask Dr. Z

For the case below, the coder reported codes 64493-50 and 64494-50. However, the provider wants codes 64493-50, 64494-50, and 64494-59 to be reported. Which, if either, is correct?

"Procedure: Lumbar medial branch blocks, BILATERAL L3, L4, L5. The lumbosacral area was prepped with Chlorhexidine and draped in sterile fashion. The skin over the target medial branch nerves was anesthetized with 0.5% lidocaine. A 22 gauge 3.5-inch needle was inserted into the target medial branch nerve under fluoroscopic guidance at each level and location. No paresthesia was elicited with needle placement, and aspiration was negative for blood and CSF. Next a mixture of 40 mg of Triamcinolone mixed with 5 cc of Bupivicaine, 0.25% was evenly divided and injected at each level. An additional 0.5 ml of lidocaine was injected in the needle tract as the needle was withdrawn. The identical procedure was performed at the remaining levels. The skin was cleansed and a sterile bandage applied. Following the procedure the patient's vital signs were stable. Patient tolerated procedure well, and no complications were encountered."

Would placement of the FRED (Flow Re-Direction Endoluminal Device) be coded as an embolization or a stent? It looks like a stent, but it is used to occlude an aneurysm.

I have a situation where there is a question about what CPT codes can be billed together with a PICC line insertion. I have a charge for the insertion of the PICC (no pump > 5) and ultrasound charges for US-guided vascular access (76937) and duplex UE/LE unilateral (93971). Can codes 76937 and 93971 be billed together for PICC line insertion? There is documentation by the radiologist that "US evaluation was performed of the left UE to evaluate vessel patentcy and the basilic vessel was deemed patent. During real time sonographic imaging, access was gained into the basilic vein utilizing micropuncture technique. Sonographic imaging obtained for confirmation." The documentation for the duplex states to "please correlate with the PICC line placement." If both ultrasound codes cannot be billed, which is the appropriate one to use?

"Patient has aneurysmal development of the distal SFA in above- and below-knee popliteal arteries. Doctor performed left distal superficial femoral artery to below-knee popliteal artery bypass using non-reversed transposed greater saphenous vein, ligation of below-knee popliteal artery, and ligation of above-knee popliteal artery with plication of popliteal aneurysm." Would code 35556 be more appropriate than 35151 due to involvement of SFA and popliteal? The physician also advised ligation would not normally be included. Do we need to report code 37618 x 2?

We are reviewing documentation for echocardiograms and are debating what needs to be dictated to prove spectral Doppler and what is needed to prove color flow Doppler. We are confused on how to prove/differentiate the two forms of Doppler spectral and color flow.

Does using a "micropuncture" needle/sheath mean that a procedure was done percutaneously, or can it sometimes mean open? Examples: 1) Dissected out the fistula and then accessed the aneurysm with a micropuncture 6 French sheath. 2) A right upper arm incision was made distal to the axilla. The brachial artery and vein were identified. The brachial artery was circumferentially dissected and encircled with Vesseloops. Needle access to the brachial vein was obtained with a micropuncture needle, allowing placement of a micropuncture sheath. Right upper extremity and central venograms performed, showing occlusion of a previously placed right innominate vein stent. A 6 French sheath was inserted. A guidewire was advanced across the right subclavian and innominate vein occlusion. Balloon angioplasty of the stent performed. The 6 French sheath was exchanged for 12 French peel-away sheath. Gore hybrid stent graft was inserted using the introducer sheath. It was placed into the right brachial vein and deployed after removing the peel-away sheath. The graft was tunneled in a loop fashion.

Patient with duplicated right kidney has a bilateral nephrostogram and nephrostomy tube change in addition to a nephrostogram and nephrostomy tube change on the right duplicated kidney (two on right, one on left) because of poor drainage from the catheters. Initially we reported codes 50394-50, 50394-59RT, 50398-50, 50398-59RT, 75984-50, and 74425, but we got an MUE of 1 on 50394-59RT, 50398-59RT. What's the correct way to code this?

I have a doctor who is an interventional cardiologist, and he has recently asked me about his specialty being considered a separate specialty/sub-specialty of cardiology, which has been the case for EP. He states that he heard CMS has now officially recognized "Interventional Cardiology" as a separate specialty. He wants to know if this is true, and if so did it start in January 2014 or is it to begin in January 2015?

I thought I read something about a change. The patient has known CAD, and the only procedure done is an IVUS of the left main and LAD. "Patient's groin was prepped, and a 5 French sheath was placed and guide advanced. Wire was placed down to the LAD, and IVUS of the left main and LAD was done." I have documentation of the IVUS findings. Catheter as well as sheath were removed. IVUS would be reported with codes 92978 and 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 are to add? Or is the claim going to be denied?

"A 5 French micropuncture sheath was advanced into the cephalic vein, followed by an exchange to a 7 French Pinnacle sheath. Next a 5 French puncture sheath was placed into the reverse saphenous vein graft and the patient’s DRIL bypass. Initially the arterial anatomy was scrutinized: widely patent anastomoses of DRIL graft. Axillary and brachial arteries were moderately calcific but patent. Then a venogram of the cephalic vein was performed: critical stenosis of the LT subclavian vein just distal to its subclavian and innominate confluence. This finding is consistent with venous TOS. Through the sheath, a glidewire with a 5 French Kumpe catheter traversed the tandem venous stenoses. A superior venacavagram was performed. Next, serial venoplasty with Armada 8 x 40 cm balloon, followed by ConQuest 10 x 40 cm balloon, was performed. Post venogram revealed widely patent venous segments." Here are our coding thoughts: DRIL access (36120, 75710-26), venacavagram with venous access (36005, 75820-26), venoplasty (35476, 75978-26). Provider is asking for fistulogram. Is the DRIL part of AV fistula?

Can you help me code this (selective renal transplant arteriogram with embolization). Report excerpt: "Micropuncture was performed of the right common femoral. A 0.018 wire was inserted, followed by placement of 5 French micropuncture set and subsequently a 5 French sheath. A 5 French Kumpe catheter was then advanced into the iliac artery, and injection was performed in the right external iliac artery, opacifying the feeding vessel to the transplant kidney. This was then superselected with a Kumpe catheter and formal arteriogram performed, showing evidence of renal cortical thinning. There is normal arterial blood flow. A 3 French microcatheter was then advanced selectively into the distal vascular bed of the transplant kidney. n-Butyl Cyanoacrylate (1 mL mixed with 4 mL of ethiodol) was then subsequently injected under fluoroscopic control, withdrawing the catheter and filling the entire vascular bed of the transplant kidney. The microcatheter was then subsequently removed. A follow-up injection was then performed with a Kumpe catheter in the right external iliac artery, showing complete occlusion of the transplant renal artery and no evidence of residual arterial flow."

How would you code aspiration and embolization of facial macrocystic lymphatic malformation? "US 20 gauge needle into neck/facial lymph malformation. Aspiration of fluid sent to pathology. Injection of contrast for lymphangiogram under fluoroscopic guidance was performed, confirming isolated cystic structure. Contrast was aspirated, and we performed infusion of doxyclcline with sterile water and contrast under fluoroscopy. No evidence of non-target embolization. Catheter tract was plugged with collogen matrix."

Is it appropriate to charge the cerebral diagnostic angio (no prior study) when a planned thrombectomy is done that resulted in the need for a stent by applying modifier -59, as the ipsilateral study is bundled with the stent? But in the case where the stent is not a planned event, can modifier -59 be used?

Our surgeon performed a cephalic vein thrombectomy and later performed an internal jugular vein end-to-end venous anastomosis ot the cephalic vein. How would I code the venous throbectomy and anastomosis? See operative: "The microscope was brought into the field, and after the placing vascular loops to stop the blood flow through the internal jugular vein, a venotomy was created. Then, utilizing of Synovis 2.5 mm venous coupler ring, an end-to-side venous anastomosis was created from the cephalic vein into the internal jugular vein. There was excellent blood flow, and we placed a little bit of Gelfoam to bolster the vein to prevent kinking."

The cath lab would like to charge codes 11983, C1781, and 33263 when a dual chamber AICD is replaced and an antimicrobial envelope is used. Is code 11983 appropriate in this case?

"Left arm fistula was accessed and diagnostic fistulogram performed. Venous outflow stenosis was identified and angioplasty performed. The result was a focal rupture of the fistula requiring placement of a bare metal stent. Attention was then turned to the arterial anastomosis where a web-like stenosis was identified. Arterial anastomosis angioplasty was performed." I believe codes 37238 and 36147 would be correct, but I wondered about the PTA of the arterial anastomosis (35475, 75962). Is that considered inclusive to venous stent code 37238, or is it separately reported?

Our physician replaced a pacemaker generator. He removed a single chamber device and replaced it with a dual chamber device; however, there is still only one lead in the ventricle. He pinned the atrial lead port. Would this be reported with code 33227 or 33228?

Our physicians state they are performing a facet joint injection and a nerve root block. If both of these procedures were performed at the same session, are we allowed to report both codes 64483 and 64493-50? "Utilizing sterile technique, fluoroscopic guidance, and local anesthetic, 22 gauge spinal needles were advanced into the bilateralL4-L5 facet joints. After injection of dilute contrast into the joints, confirming the needle position, 1 ml mixture of 0.25% bupivacaine and 20 mg of Kenalog were injected into each joint space. Utilizing sterile technique, fluoroscopic guidance, and local anesthesia, a 22 gauge spinal needle was advanced into the perineural space of the left L4 nerve root. After injection of dilute contrast into the perineural space, confirming needle position, 1 ml mixture of 0.25 bupivacaine and 20 mg of Kenalog was injected."

Our hospital started doing CardioMems HF system in 2014. We see that there is a new HCPCS code for OP coding as of October 1, 2014: C9741 (RHC with implantation of wireless pressure sensor in the PA including any type of measurement, angio, imaging supervision and interpretation report; includes provision of patient home electronics unit).

Would it be appropriate to code a diagnostic right heart cath when pressures are taken in the RA and RV if it is done for diagnostic purposes since the CardioMems itself includes a RHC? Can you touch on IP vs. OP vs. physicoan coding (CPT and ICD-9 px)? We know what the vendor is suggesting as far as coding, but we are lacking official coding guidance. Also, do you know of any medical necessity ICD-9 diagnosis requirements?

If a lumbar puncture (62270), myelogram injection (62284), and blood patch treatment (62273) are all done at the same level (i.e., L3-L4), is the blood patch billable? Current NCCI edits allow the -59 modifier if appropriate. Does that mean only if done on a different level?

Pediatric cardiologists bill codes 76825, 76827, and 93325 for fetal echos. They also look at the umbilical artery. They want to bill code 76820 in addition to the three above codes. Looks like there is a bundling issue with codes 76820 and 93325, but 76820 pays more. I can't seem to find anything about billing these codes together. I'm assuming code 76820 cannot be billed in addition to these codes, but I would like to confirm.

I'm not sure how to code this. Would it be unlisted, urinary, or intestinal section? "PE: Abdomen/Flank: Soft, non-tender, non-distended. Positive for bowel sounds. No palpable masses or flank tenderness. Well-healing incisional wound. Ileal conduit with clear urine. Stoma somewhat retracted but reddish mucosa visible. The skin may have pulled away from the bowel mucosa. She was experiencing continuous urinary leakage due to a large vesicovaginal fistula at the trigone of her bladder. Patient is now s/p an ileal conduit urinary diversion and closure of VVF defect with democusalized detrussor flaps and concomitant ventral hernia repair. She had revision of her stoma for stenosis, and the stoma unfortunately re-stenosed. Has been staying relatively open - dilated to 28 French today without issues. Patient instructed on how to use self-dilator and will continue to do this several times per week."

We are hoping for guidance on a CPT code for when a stent is placed through the ileal conduit. I have a case where the patient presents with a stricture in his ileal conduit at the ureteral anastomosis causing hydronephrosis. "Through the Berenstein catheter, a Super Stiff Amplatz wire was advanced until it passed through the urostomy orifice. The wire was partially pulled through, and the catheter was removed. A pigtail catheter was then advanced in a retrograde fashion such that the pigtail loop was located in the renal pelvis. The wire was removed, and the catheter was locked into position. Final imaging shows the pigtail loop appropriately positioned within the renal pelvis."

My surgeon approaches this like an endovascular AAA repair; however, it is for severe atherosclerotic disease (not aneurysm), so I know we need to use lower extremity stent codes. My problem is deciding what is bundled due to inflow/outflow. HELP! "Bilateral fem exposures were made, and embolectomy was performed on one side just to get to aorta to take grams, which revealed patency of renal arteries and abdominal aorta to just inferior IMA, then occluded. Right external iliac is occluded. Large amount of thrombus both chronic and subacute from aorta and right iliac arteries retrieved. Flow was established and majority of clot burden removed. Good flow down the right iliac with multiple areas of stenosis and dissection. Neither internal iliacs filled, nor did the left common or left external iliacs. Angioplastied aorta, bilateral common iliacs, and bilateral external iliacs. Bilateral femoral embolectomy performed with severe residual stenosis. Bilateral stents from IMA into origin each common iliac. Two more bilateral common iliac stents. Two bilateral external iliac stents. On the right, common iliac residual disease beyond the stent at site of initial femoral incision required full endarterectomy with large core removed."

If a patient has a congential heart defect such as a PFO and they are coded as congenital 745.05 and we perform a congenital Echo 93303. Then the patient comes back a year later and the PFO has closed and the Echo is now showing normal would you still code them as congenital?

Below is an operative report from one of my providers. The provider is indicating we bill as indicated below; however, I think there may be more catheter placements or angiographies. What are your thoughts?

• Digital subtraction cerebral venography. • Introduction of needle catheter into the right femoral vein under continuous ultrasound guidance (76937). • Selective catheterization/venography right jugular bulb. • Selective catheterization/venography anterior third of the superior sagittal sinus (36012/75870). • Selective venography torcula second order vessel venous system, AP and lateral views centered over the skull. • Selective catheterization/venography left jugular bulb across the bilateral transverse sinuses (36012/75860 only billing once, not bilateral). • Selective venography left transverse sinus second order vessel venous system, AP and lateral views centered over the skull (36012/75860). • Venous sinus pressure measurements through catheter of the anterior middle and posterior superior sagittal sinus torcula, left jugular bulb, + 9 other vessels (75898 x 1).

For this case, is it possible to bill 33853 with 33854?  The physician actually extended the graft to the distal arch because it was hypoplastic, so I wanted to know if I could bill both codes under these circumstances.

Procedure performed open repair of coarctation PROCEDURE NOTE: A left-sided posterolateral thoracotomy was made. The distal aortic arch and proximal descending thoracic aorta were mobilized. The Control of the distal aortic arch and subclavian artery was obtained. CPB was utilized. The coarctation was then resected and sent to pathology. In order to sew a larger graft to the distal arch, the arch was opened up into the left Subclavian and a 22 mm graft was then sewn to the distal aortic arch and subclavian. The graft was then trimmed to size and sewn to the descending thoracic aorta distal to the aortic coarctation Interposition graft was approximately an 4 cm long. FINDINGS: His distal aortic arch was hypoplastic measuring approximately 18 mm between the carotid and the left subclavian. The aortic coarctation was distal to the left subclavian in the isthmus area. We resected the coarctation area and performed an end-to-end anastomosis with interposition graft and 22 mm Dacron graft.

To code a left heart catheterization there must be documentation that hemodynamic measurements were performed. If the doctor documents: HEMODYNAMIC DATA: The hemodynamic data obtained from the left heart was normal Is that sufficient to code the catheterization or does the doctor have to give the actual measurements?

Patient admitted with an acute myocardial infarction. Procedure note documents that a stent was placed in the diagonal vessel of the left main which was presumed to be the culprit vasculature. They then redirected the wire down the left anterior descending artery and in the proximal left anterior descending artery, stented an eccentric lesion that was 85% stenosed. The wire was redirected down the circumflex system and a stent was deployed across the circumflex marginal vessel. The physician is billing 92941, 92938 and 92944. I don't agree with this code selection.

I need your help coding this procedure. "Serial CT images of the left upper neck and chest demonstrate a large soft tissue mass corresponding to area of suspected metastasis noted on outside MRI imaging. This area was targeted for ablation. The overlying skin was prepped and draped in normal sterile fashion. After local anesthetic was given intended needle tract, 4 x Ice Rod Plus probes were advanced with serial CT guidance. Confirmation was performed utilizing CT scan in multiple planes. After confirmation of appropriate positioning, ablation was commenced. Ablation commenced with two cycles of 10-minute freeze and 6-minute active thaw. At the conclusion of this, the Ice Rod Plus probes were removed. At the conclusion of the procedure, post-procedure CT of this region was obtained, which failed to demonstrate evidence of hematoma and appropriate coverage of the lesion with the ice-ball formation. Sterile dressings were applied."

Right arm fistula procedure. Normal access of the fistula and imaging (36147). There was a stenosis present in the innominate branch. Multiple attempts were made to cross this lesion from the inital access site. This was unsuccessful. The decision was made to obtain groin access and address the lesion from below. This attempt was successful. Now comes the question you've been waiting for... What on earth do I charge for the groin access and the venoplasty of the brachiocephalic? I did give a good ole college try...this is what I billed: 36147,36011, 35476 and 75978. i'm hoping that I wasn't too far off.

Here is the procedure: 1. Right common iliac artery (end-to-side) to right renal artery (end-to-end) bypass with 7-mm PROPATEN graft. Right renal artery proximal ligation. 2. Left external iliac artery (end-to-side) to left renal artery (end-to-end) bypass with 7-mm PROPATEN graft. Left renal artery proximal ligation. Question: Are these ligations part of establishing flow and included in the bypasses?

Can these two codes be billed with the diagnostic codes for 36221-36228? What kind of information should be documented? Are the words as described above enough or should there be more? I have searched everywhere for documentation guidelines and have been unable to find. I was under the impression these codes were only to be billed with just the other 70,000 code series(e.g CT or MRI).

Pt. came in as a stemi. Pt. had previous grafts and the physician stented the native circumflex,not going through svg.In the final impression he stated that the svg to the om was the culprit lesion. I'm assuming, due to years working in the cath lab, and not what the physician stated in his dictation that he opened the native circumflex to get flow to the om. If the pt. comes in infarcting but he doesn't do the culprit lesion, can we still charge AMI-92941?

Since the co-surgery surgical indicator is "0" for the new FEVAR codes, how do you suggest coding a procedure when two vascular surgeons (partners) work together equally on a case?

Is it appropriate to add an extra cpt code of 36248 for the proper hepatic when a diagnostic arteriogram if performed?

The celiac was selected,type 1 celiac anatomy, selected common hepatic, , The G.D. was selected. To prevent reflux and nontarget embolization in the GDA. The cath was positioned in the proper hepatic artery, an arteriogram was performed. The r. gastric artery was identified arising from the r. hepatic artery. This was selected microcath, arteriogram done. To prevent reflux & nontarget embolization into the RGA, the RGA was occluded with coils. The cath was directed deeper in the r. hepatic artery, arteriogram was performed. 1.5 mCi of tech 99 MAA was infused into the r. lobe. The cath was then directed into the l. hepatic artery. 2.5 mCi of tech 99 MAA was infused in the l. lobe. Codes used: 37242,36247(G.D.),36248X4(proper hepatic, r. gastric, r. hepatic, l. hepatic) & 79445. My understanding is we can add a 36248 for the proper hepatic, because they stopped at this level to do a diagnostic arteriogram. If the cath was going from the proper to the hepatic, not stopping to do an arteriogram of the proper hepatic, then we would pick the highest cath placement?

I coded 36247 Rt & 75716-26, is this right? What am I missing? REASON: Nonhealing rt leg wound. PROCEDURE: 1. Distal aortic angiography w/nonselective bilateral iliac angiography. 2. Rt femoral angiography w/runoff (via third order). 3. Lt femoral angiography w/runoff. 4. Successful atherectomy of mid right SFA using TurboHawk. 5. PTA of femoral popliteal artery.

Propaten bypass graft placed from external iliac artery to fem-pop bypass graft at midthigh. All incisions closed. New incision to expose common femoral artery pseudoaneurysm. Lumen opened 1 liter of blood lost. Ligation ofcommon femoral, profunda femoris, superficial femoral. Proximal end of fem-pop bypass graft separated from previous patch graft. Patch graft resesected and sent for culture and suture ligated. The proximal portion of the fem-pop bypass graft avulsed from leg and proximal portion removed intact and sent for culture. 35665? 37618? ?????

Our institution will start implanting the CardioMEMS HF System. What codes do we use for implanting the device and remote monitoring?

Need assistance with coding an excision of paranganglioma of the vagus nerve. I'm thinking 64771, but possibly needs to be an unlisted procedure. Procedure: A transverse incision was made from the midline laterally approximately 2 fingerbreadths above the clavicle. Dissection was deepened. The platysma was divided and platysmal flaps were raised. Dissection was deepened and jugular vein was dissected along it's medial edge and retracted laterally. The paranganglioma was identified and it was clearly not only adjacent to, but part of the vagus nerve. We carefully dissected this trying to ascertain whether or not the paranganglioma could be resected and the vagus nerve preserved, however, it was apparent that the lesion was actually part of the nerve itself. For this reason, we resected the paranganglioma with a section of vagus nerve proximally and distally. Pathology was obtained and sent for exam. Careful inspection for any other areas of neoplasm was carried out and none were seen. Closing began.

Thank you for the information on this drug test and the information included in my cardiology book. I have been working on getting this procedure code added to our system for our EP physicians to use in ordering and performing the tests. Code 93799 (unspecified code) would be used for this study. I need to provide the closest code to this unspecified code. I felt the ergonovine provocation test (93024) would be closest. I also see in the guidelines for the ergonovine test that it would include the drug used. Would this be the same case for the procainamide drug challenge? Any and all information regarding this is appreciated.

I'm looking for the appropriate cpt code(s) for repeated angioplasties in the left dorsalis pedis artery and distal anterior tibial along with repeated angioplasties proximal and origin of left anterior tibial artery for severe ischemia of the left lower extremities.

RT groin, under ultrasound guidance, RT common femoral vein accessed. a vascular sheath was advanced over a guidewire. then advanced in the rt external iliac vein with venogram. next, using a catheter the confluence of the bilateral iliac veins were catheterized w/subsequent inferior venacavogram. next cath was advnced beyond the area of narrowing along the infrarenal IVC and a ssuperior venacavogram was done. At this point all cathes and wires were removed. The codes I think should be 36011, 75825-26, 75827-26 and 75822-26

We are uncertain of the appopriate code to use when the provider describes the use of a bifurcated graft placed at the aorta with one leg of the graft anastomosed to the right common iliac artery and the other leg anastomosed to the left common femoral artery. There are three anastomoses (Aorta, RT CIA, LT CFA) thus we are unsure if two separate bypass codes would be appropriate in this case or if this may necessitate an unlisted code (which comp code would be appropriate?) Your guidance would be greatly appreciated. Thank you .

50398 vs 50387? And why. Contrast material was then instilled through the bilateral nephroureteral tubes, and the images obtained show appropriate positioning and bilateral hydronephrosis/hydroureter. A Bentson wire was inserted through both of the existing 8 French nephrostomy tubes. While maintaining the guidewires in place, on each side the previously placed nephroureteral tubes were removed, and new nephroureteral tubes were advanced over the wire. New 8 French 26 cm tubes were introduced over the wire under fluoroscopic observation. The proximal loops were formed in the renal pelvis and the distal loops formed within the bladder. Contrast material instilled through these new tubes, and films obtained show adequate contrast opacification of the collecting systems. The nephroureteral tubes were then secured to the skin with revolution devices and sterile dressings were applied.

Our surgeon performed a cephalic vein thrombectomy and later performed a internal jugular vein end-to-end venous anastomosis ot the cephalic vein. How would I code the venous throbectomy and anastomosis? see below op note The microscope was brought into the field, and after the placing vascular loops to stop the blood flow through the internal jugular vein, a venotomy was created. Then, utilizing of Synovis 2.5 mm venous coupler ring, an end-to-side venous anastomosis was created from the cephalic vein into the internal jugular vein. There was excellent blood flow, and we placed a little bit of Gelfoam to bolster the vein to prevent kinking.

ESRD pt w/hx of coiling of a branch vein originating from immature AV fistula w/coil migration to the RT heart. RT CFV was punctured w/ placement of 7 French sheath, pigtail cath advanced over Bentson guidewire into descending branch of LT pulmonary artery (36014), contrast injected & imaged showing coil lodged at bifurcation of descending pulmonary artery branch. A 9-15 mm EN-snare was used to capture end of coil & retracted into RT iliac vein & as it was pulled into the sheath began to unravel. Sheath removed, unraveled wire clamped w/hemostat. Maln coil mass was still in iliac vein. CFV was punctured a 2nd time, slightly higher than initial puncture. 7 French sheath was placed & coil mass then easily captured with snare & removed. (36000-59) The other guidewire fragment was cut at the skin & removed through the 2nd venotomy. Imaging confirmed complete removal of the coil. (37197) Will codes 37197, 36014, and 36000-59 accurately represent this procedure? Clinic says 36005 should be charged, not 36000-59. Which do you advise?

When access is made in LCFA to REIA 36246 with 75710 of the Rt lower extremity. A second access is made in RCFA and angioplasty is done of the RATA 37228 from the second access site. Do we bill for the catheter placement from the first access (LCFA)? Since the procedure was done on same extremtiy as catheter placement but (sep access) I wasn't sure if billing catheter would be correct.

I have a scenario where one cardiologist did a lhc and then during the same operative setting, another cardiologist stepped in and did a rhc. Would I bill these out separately as they were performed? Or bill as 93460-26 for both? If 93460, what modifier would I use? They have both dictated their own portion but modifier 80 doesnt seem to fit and modifier 62 isn't allowed for this px.

I was hoping you could shed some light on a case for me. A patient is brought in for an ICD battery replacement due to end of life. Prior to ICD replacement, the physician performs DFT testing with the old device to check the lead integrity. The results are normal and the physician proceeds with ICD replacement. Once the new device has been placed, the physician performs DFT with the new device. I know that CPT 93641 would be used for DFT after the replacement, but what can we use for the testing prior to the replacement? Is it appropriate to use CPT 93642 or is it possible to use CPT 93641 and 93641-59 or 93641-76?