Ask Dr. Z

Bridging Coronary Single Stent

Could you please clarify, would this be considered a bridging lesion? And would just one intervention be coded?

"DESCRIPTION OF PROCEDURE: 5 French EBU 4.0 was engaged to the left coronary and Runthrough wire was passed distally in the left circumflex OMB 3. Heparin and Integrilin were given for anticoagulation. ACT checked and therapeutic during procedure. A 3.0 x 10-mm AngioSculpt was taken at 8 atmospheres twice and exchanged for a 3.5 x 18-mm Integrity at 12 atmospheres. There was TIMI-2 flow before procedure, TIMI-3 flow after, no dissection or residual stenosis within the stented area. FINDINGS: PERCUTANEOUS CORONARY INTERVENTION TO THE LEFT CIRCUMFLEX AND OBTUSE MARGINAL BRANCH 3: EBU 4.0, 3.5 x 18-mm Integrity at 12 atmospheres. TIMI-2 flow pre and TIMI-3 flow post, no dissection, no residual stenosis within the stented area, 10-mm lesion length."

Code 36010

"Percutaneous access was gained to the left basilic vein near the elbow joint. Left upper extremity venography was then performed. A 5 French catheter was introduced and was advanced up to the point of subclavian vein occlusion. Then catheters were manipulated across the occlusion and down into superior vena cava. An angiopolasty was then performed of the left subclavian vein." My question is, what is the cathether placement code? Code 36010 or higher?

Code 76937

Can we code for US guidance (for arterial access) when performing arterial embolizations (not uterine fibroid embolizations) and diagnostic arteriograms without an intervention? Thank you.

Code 49424

I have an IR case here where the MD brings the patient in for evaluation of an existing tunneled Pleurx drain (tunneled chest tube). The patient has chronic malignant pleural effusion, and complains of leaking around the tube. The MD injects the tube with contrast and reports that the tube is normal, and nothing else was done. I cannot find a code for a pleural cath injection. What codes would you suggest?

ICD NIPS

What are the appropriate codes for a NIPS study (EP study performed through a patient's exisiting device) and termination of an arrhythmia through a patient's pre-exisiting device? Is it code 93724 (pacer) and code 93642 (ICD)?

Fluoroscopy with Tunneled Catheter Removal

Original Question: Will you please address the issue of tunneled catheter removal since it now has its own code (32552)? Is it appropriate to code a fluoro guidance code, 76000 or 77002? I don't get an edit, but the your IR book states S&I is N/A. In this particular case, fluoro was utilized to make sure there were no retained fragments of catheter. The catheter could have been compromised because of infection. Why is this?  Thank you!

Additional Information: In this particular case, fluoro was utilized to make sure there were no retained fragments of catheter.  The catheter could have been compromised because of infection.

 

Code 33249

Need your help with the following scenarios: (1) Patient had a biventricular pacer/defib that had reached end-of-life and admitted for generator replacement. The RV lead was also replaced and new generator attached to new RV lead and Chronic RA/LV leads. Would this be reported with code 33249? (2) Same scenario except the RV lead was a recall lead. Would this be reported with codes 33264/33216 or code 33249? Thanks.

Charging for Contrast

Is charging for contrast dependent upon type or route? I have been told we could not charge for oral, rectal, or intrathecal contrast of any type.

Removal of an Infected Graft

Greetings, I have a physician coding both 36832 and 35903 for the following procedure procedure. I do not think I can bill these two codes together in the same area. Here is what the physician surgically completes: He opens at the site of the graft and drains the sinus tract. He transects the graft on the venous side. Then he make add'l incision and places a new peice of graft tunneled well away from the infected area and anastomosed to the remenent of the venous side of the graft then he transects the arterial side of the original graft and attaches the new graft to the remenent of the old graft. At the end of this the physicuan goes back to the original incision and removed the piece of infected graft. My thought is I can only code this as a revision using code 36832. Am I correct, or is the physician correct? 

Thrombectomy and Atherectomy in the Same Vessel

Dr. Z, I have a doctor who used a Navitus 2.1 catheter for both a thrombectomy and athrectomy in the same vessels.  Can we bill both? 

Codes 36251 and G0275

A patient with exercise induced angina and hypertension that has been unresponsive to medication has a diagnostic cardiac cath from a radial approach. At the conclusion, the cardiologist selects the right renal artery and does and angiogram. In the interim, the patient develops a vasospasm that prevents placement of the catheter in the left renal artery. He places the catheter in the abdominal aorta close the the left renal origin and does another angiogram. Would it be appropriate to bill codes 36251 and G0275 for the angios?

Code 37210

Original Question: How would you code a uterine artery embolization for dysfunctional uterine bleeding where the end of the report states: "Right uterine artery injection outlines large round mass consistent with leiomyomata. This was succesfully embolized." This patient had congenital absence of the left uterine artery (determined after doing angiography.) Would you use code 37210 or 37204, etc.?

Follow-Up Question:  The issue is that the IR doc says "consistent with leiomyomata", so it is not definitive and this is for professional fee billing.  I coded the dysfunctional uterine bleeding instead, and it was denied. However, I felt using the selective catheter placement, angiography, and regular embolization codes would be over-coding.  Any thoughts on this?

37220 via Two Punctures

I have a right common iliac angioplasty. I want to use code 37720 for the angioplasty. But the physician used two different access point. One in the right common femoral and the other in the right brachial, both access sites were used to insert ballons for what looks like a kissing technique. Would I code the brachial catheterization separately, or is that included in code 37720?

Aortic Angioplasty in Prior Stent, Code 35472

When a physican goes in to dilate a previously placed stent, do you bill an unlisted code or do you code the angioplasty code for that vessel? For example, patient has an area of stenosis within a previously placed stent within the aorta and the physician does balloon dilation of the stent within the aorta, do you use code 93799 or 35472? Thanks so much for your help!

Bilateral Iliac Artery Aneurysm Stent Graft with Endurant with 34900 x 2

Patient has bilateral common illiac aneurysms repair with Endurant stent graft with two extensions and embolization of the internal illiac with Amplater plug. Do I report this with codes 34802/75952-26 for the primary device or codes 34900/75954-26?  And do I report the embolization with codes 37204/75894-26 or 34808 all the other codes I have? I could not see any guide on the site already. I'm leaning as coding this the same way I would code the AAA repair. 

Doxorubicin Beads

I have a question about how to report the Doxorubicin beads 100-300 micron in size used for chemoembolization of a liver tumor? In the ZHealth online Q&A 2215 a similiar scenario is listed. You state the hospital should also report the J code for the drug. I have researched this and am only coming up with codes J9000 and J9001. My understanding is that these codes are to be used when the drug is administered via IV. What J code do you recommend to use for chemoembolization with Doxorubicin beads? Thank you.

Code 36832

Hoping you might provide assistance in regards the following: Specifically it concerns an AV graft, in which percutaneous thrombectomy (36870) is performed. After intervention, collateral vein in mid-fistula is determined to be stealing 50% of flow from AV graft and ligation is performed. Based on 2012 SVS recommendation, code 36832 would be appropriate for the ligation of collateral, as we are revising the flow of graft. However, the physician performed percutaneous thrombectomy during the same session. Codes 36870 and 36832 represent an NCCI coding conflict with no modifier override. Would you recommend reporting code 36833 despite having not performed open thrombectomy? Or report the ligation with unlisted code 37799? 

Carotid and Vertebrals

I have a question regarding code 36226: In scenario A the patient was brought in for an angio due to SAH. The physician catheterized the left ascending cervical artery, the findings read: "Left vertebral artery origin is occluded. The ascending cervical artery reconstitutes the distal left vertebral artery which supplies the PICA. No aneurysm is seen. No AVM."  Code 36225 doesn't capture the catheterization, but code 36226 states it should be the vertebral artery. What is appropriate to code?

In scenario B the patient was also brought in for an angio due to SAH. However, the physician bilaterally catheterized the subclavian, costocervical & thyrocervical arteries to rule out cervicalmedullary AVM. Findings for all arteries read: "No evidence of AV shunting." (The vertebrals, ICAs, and ECAs were all imaged as well.) Would the evaluation of the subclavians, costocervicals, and thyrocervicals be seen as inherent within codes 36224, 36226, and 36227? Can code 36228 be used to capture this additional work?

Codes 93621 and 93623 with Codes 93653-93656

Can codes 93621 and 93623 be billed with the new ablation codes?  I did check the NCCI Policy Manual but was still a little confused.  Thanks.

Modifier -76, Repeat Procedure

We had a STEMI come through the ER. The patient recieved a left heart cath, and a drug eluting stent was placed in the OM2. The procedure ended and the patient was taken off the table and moved to his room. About two hours later, the performing physician was reviewing the study and realized he had unknownly recanalized a lesion in OM1 that he now felt was the true culprit lesion. This vessel did not have good flow, so the patient was at risk for another cardiac event. So, the patient was brought back into the lab and a drug eluting stent placed in this vessel. As both of these interventions were done in the left circumflex distribution, will we be able to charge for the second stent placement with a -76 modifier? Or can we only charge for the initial procedure? 

Aspiration Thrombectomy

Is non-mechanical aspiration thrombectomy chargeable, or is it included in the intervention procedure? If it is chargeable, which code should we use now that code 92973 is for mechanical thrombectomy only?  If it is included in the intervention, and it is done without any intervention procedure, is there a code that we can use?

Code 61624

Procedure was a dorsal spinal dural arteriovenous fistula (DAVF). Embolization of right lateral sacral branch accessed via lateral sacral trunk off right internal iliac artery. Performed as an outpatient procedure. Should this be reported with code 61624 (spinal) or code 37204? 

Code 33215

The patient had an infected device, and all the device components were removed.  Then a temporary pacemaker was placed using a pacemaker lead and a grey device (outside the body) and not a pacing catheter, so when that lead had to be repositioned would that be reported with code 33215? Or an unlisted code?

Washout Wound

What code should we use for washout wound when it is performed in the operating room?

Aneurysm Aspiration after Stent Graft Treatment

I need your expertise. I have an AVF intervention: 36147, 35476, 75978, 37205, 75960 - then I'm unsure about this part.  The doctor places a stent graft in a large mid arm pseudoaneurysm out flow vein. It is completely excluded (got that part).  He then makes a puncture of the same pseudoaneurysm and aspirates blood (thrombus was documented in the findings).  Is this a thrombectomy or an aspiration?

Code 75898, Predetachment of Coil

I need your help again. One of our physicians would like to code 75898 when he performs a predetachment angiography during cerebral embolizations. When asked for further detail he stated that he releases contrast while the coil is still attached to the catheter to see if the coil looks good then if it does he releases the coil. Then he will put the next coil in and repeat the process. Can code 75898 be applied to predetachment angiography? 

Code 34201

My physician performed open cutdown of left common femoral artery and left over the wire popliteal thrombectomy. How do I code the over wire thrombectomy. Should I use code 34812 for cutdown and code 34203-22 for over wire thrombectomy? Please advise.

Nephroureteral Stent Placement

How would you code a nephrourteral stent replacement when the stent fell out at home? The tract is already in place, so a new stent would be overcoding, wouldn't it? Please see below.

INDICATION: Nephroureteral stent accidental dislodgment and removal. PROCEDURES: 1. Percutaneous nephroureteral stent placement using fluoroscopic guidance. 2. Nephrostogram. Patient's existing skin defect at previous nephroureteral stent slight was probed with a KMP catheter and Glidewire. Tract was identified and Glidewire and came P. were advanced into the renal pelvis and down into the bladder. Wire was changed for a Amplatz wire. A 10 French nephroureteral stent was placed. This is confirmed by contrast injection which showed moderate hydroureteronephrosis. Catheter was secured to the skin with stitches Catheter was secured to skin with suture. The patient tolerated the procedure without complication.

Codes 93975 and 93976

We would like any clarification you could give us for codes 93975 and 93976.  AMA code 93975 reads "duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study". For a complete study, 93975, is this per organ studied or per area (abdomen, pelvis, scrotal, and/or retroperitoneal)? To also be considered a complete study, does the arterial inflow and the venous outflow have to be imaged? The techs are saying that imaging the arteries of one organ is a complete study, (i.e., mesenteric artery only or renal artery only). The Society of Vascular Ultrasound website imaging guidelines do not mention imaging of the veins in the mesenteric study and even have it named mesenteric artery duplex imaging. Their renal imaging guidelines do mention venous imaging on one line only. I understand these are imaging guidelines. We would like clarification on what is needed for a complete study. The "arterial inflow and venous outflow" says 'and', not 'or', so do both need imaged? Or is it okay to just do the artery and call this a complete study? I have looked in several locations for material addressing these certain issues and can not find anything. Any help would be appreciated.

Carotid Imaging Codes

1. First question: The physician refers to a 'follow-up' of intracranial cerebral without advancing catheter into additional selective but increasing rate of imaging to better capture AVF draining into a venous varix. The physician contends this is a separate charge.  However, I say that is NOT CORRECT. Please help. 

2. Second question: The physician performs selective external carotid angiogram followed by advancement of catheter from trunk of LECA to position just proximal to left internal maxillary artery and superficial temporal artery with additional imaging. Since these are not INTRACRANIAL CIRCULATION BRANCH arteries I am hesitant to add code 36228 to the bill. Thanks.

Fenestrated EVAR

Our practice just performed their first fenestrated EVAR. They used a fenestrated aortic cuff with a bifurcated stent graft. They also stented both renal arteries with iCAST stents and used an extension on the right iliac and used an iCAST stent on the left iliac. From what I have researched, I believe the codes would be 0078T, 0079T, 0080T, 0081T for the fenestrated cuff with bifurcated EVAR graft, and codes and 34825, 75953-26 for the extension on the right iliac. Are the renal stents included in the fenestrated graft codes, or can they be coded additionally? And can the iCAST stent for the left iliac be coded with 37221? A stent was done because 'there was only 4-5 mm of available iliac artery to extend the graft and there was noted to be poor apposition of the stent wall due to tortuosity of the proximal iliac artery'.

-50 modifier with cervicocerebral codes

We purchased and watched the 2013 CPT code update webinar. Since then, we received the update from ZHealth below regarding cervicocerebral angio bilat coding. We're not sure if this something that we should take action on or not.

Based on the 2013 CPT book and the information from the webinar, our health system created unique charge codes for the new cervicalcerebral angio CPTs when performed bilaterally (to the same order of cath plcmt).

Given the information provided below, would you have any guidance on if we continue to use the unique charge codes for the bilateral variation - as the CPT book seems to advise? Or do we charge the same CPT twice when both sides are imaged to the same level of cath placement?

I understand that Medicare reimbursement generally doesn't hinge on the charge codes assigned; but apparently, if coded wrong, reimbursement might be denied. So... any help on this?

Thank you!

IVUS with DES

Dr. Z, When the physician documents IVUS and then inserts a drug eluting stent we get an edit stating that 92978 needs to be billed with another CPT code. It is not recognizing the C9600- C9607 codes. You do not mention the use of these the C codes with 92978 in your chapter on IVUS. Is this not acceptable? Please advise. Thanks!! JD

93657

Hi Dr. Z, one more EP coding question: After an A-fib ablation by pulmonary vein isolation is completed, (93656) then a different A-fib is ablated by a line across the LA roof, then at the CFE at CS inputs, can we then add the 93657 twice? Or would this be considered all part of only one 93657? …Can the 93657 as well as the 93655 be used in multiples? Thanks!

36221 with 75710 and 36215

Good morning Dr. Z. My question concerns how to code for the aortic arch imaging done with upper extremity angio now that CPT 75650 has been deleted and 36221 doesn't appear to be correct. Extremity angio done for suspected steal in diabetic patient with RUE AV fistula. Patient presents with numbness/tingling of RT hand with non healing sore of hand. Access via groin with final catheter placement in the RT subclavian. Findings: Cervical cerebral arch-Bovine type arch anatomy. Origins of the great vessels all patent. Antegrade flow noted in all of the great vessels noted. RUE areteriogram--Widely patent high origin radial artery to cephalic vein fistula above the level of the right elbow with significant AV steal. Only significant flow to hand is via collaterals that fill radial artery at the level of the proximal forearm with sluggish antegrade flow down to hand. Ulnar artery occludes above the level of the wrist. We have 75710 with 36215. Thank you, Theresa KC, MO

Carotids and vertebrals

Hello Dr. Z! I have a question regarding code 36226: In scenario A the patient was brought in for an angio due to SAH. The physician catheterized the left ascending cervical artery, the findings read: "Left vertebral artery origin is occluded. The ascending cervical artery reconstitutes the distal left vertebral artery which supplies the PICA. No aneurysm is seen. No AVM." 36225 doesn't capture the catheterization but 36226 states it should be the vertebral artery. What is appropriate to code? In scenario B the patient was also brought in for an angio due to SAH. However, the physician bilaterally catheterized the subclavian, costocervical & thyrocervical arteries to rule out cervicalmedullary AVM. Findings for all arteries read: "No evidence of AV shunting." (The vertebrals, ICA's & ECA's were all imaged as well.) Would the evaluation of the subclavians, costocervicals & thyrocervicals be seen as inherent within codes 36224, 36226 and 36227? Can code 36228 be used to capture this additional work? Thanks for the help Dr. Z, it's much appreciated!

36227 external carotid superselections

Good morning from KC. Have a question concerning additional catheter selections of the ECA. Brief scenario-- ER admit, no previous exams. Bil CCA, Bil ICA, Bil ECA, RT subcl, Lt Vert. The doctor also did a sub-selection of LT internal maxillary that shows a fistulous communication between superfical temporal artery & superficial temporal vein. No treatment at this time. My question is how do we code for the sub selection for the ECA. 36228 is only suppose to be applied with 36224 or 36226 correct?? Appreciate your help. Thanks, Theresa

36222 arch with innominate to look at carotid

Hi Dr. Z. Can you help us code the one below? Not sure with the new Cervicocerebral angio codes. Thank you Aortic arch and the selective left innominate artery injection Pigtail catheter and a Bentson guidewire were advanced into the descending aorta. A right-sided aortic arch was again noted. Contrast injection with AP imaging of the arch and lateral imaging of the head performed. Multiple catheters were then utilized in attempts to catheterize the aberrant innominate artery including DAV catheter, Headhunter catheter, JB2 catheter, angled pigtail catheter, and a Newton 5 catheter. Successful placement and imaging was performed with a Vert catheter placed over a Bentson wire. J-wire, Bentson wire, and a glide wires were utilized. Following demonstration of stenosis of the origin of left common carotid artery from the aberrant innominate artery, the procedure was ended and sheath was withdrawn with closure device placement. Findings: Right-sided arch with aberrant innominate artery. Selective catheterization included the innominate artery. The examination shows a high-grade stenosis at the origin of the left common carotid artery from the aberrant innominate artery best demonstrated with Vert catheter placed into the distal innominate artery. Subclavian artery on the left was open as well as the left vertebral artery. Since there was a diagnostic CT angiogram, further catheter manipulation in the arch was thought unneeded arch injection showed open right common carotid artery and right subclavian artery without origin stenosis. Right vertebral artery was open and large.

Subclavian angiography with carotid angiography

Our question is how to code the subclavian angiography on the following case: 36225-52-50 or 36216, 36215, and 75716-52? The Radiologist selectively catheterized the RT and LT Common Carotid arteries, the LT External Carotid artery, and the RT and LT Subclavian arteries. From the RT CCA, he did angiography of the cervical and cerebral carotid circulation and we're coding 36223 for that. From the LT CCA, he only did the cervical and we're coding 36222 for that. For the LT ECA, we're coding 36227. From the Subclavian arteries, angiography demonstrates brisk filling of the distal branches with normal arterial runoff. No significant stenosis at the origin of the vertebral artery was noted. This is done as part of a Carotid and Cerebral study, and the origins of the vertebrals are all that was checked for that anatomy. How would you code them?

37214, 37213, 37184

Good afternoon to all, Dr Z, Dr Dunn, Regarding the new thrombolysis codes 37211, 37212, 37213 and 37214; edits are in place with 37184, I'm going to assume mechanical lysis is included and the edit would be for a separate site i.e. opposite leg. Would this be a correct assumption? Also same procedure sequence 37213 and 37214 same DOS, would you only code the 37213 as opposed to 37214? Thanks for all your help. jb

Carotid vertebral coding 36223 36225

I recently sat in on a webinar with a co-worker. It was thru a different company but I like to use Dr. Z for my references. I am now confused on one thing, when doing a bilateral carotid or cerebral angiogram do I code it twice with a -59 modifier? or just once? Also, if a Vertebral is selected do you code the cerebral and the vertebral? Thank you!

92937

I come across a case where they stented the anastomosis and this how it was documented as ‘where graft meets the native artery’, can we still code 92937 or it is only native so 92928? He kind of saying both like graft is patent but there is a lesion distal to the patent graft. Please advice.

Thanks

92920

I have a case in which a patient has a subtotally occluded RCA in the mid segment then proceeds to chronic total occlusion in the mid segment. PCI was performed as follows. "A 0.014 inch Asahi Prowater wire was used to attempt to cross the totally occluded segment of the right coronary artery although we were unsuccessful. After this, a 1.5 x 8 mm over the wire Emerge balloon was then used in attempts to exchange the Prowater wire for a hydrophilic wire. We had difficulty passing the Emerge balloon through the stenosed segment in the proximal right coronary artery. PTCA was then performed to the proximal right coronary artery with the 1.5 x 8 mm Emerge balloon at 8 to 10 atmospheres. This was repeated x2. We were still unable to advance the balloon any further. We exchanged the 0.014 inch Asahi Prowater wire for a 0.014 inch Whisper wire; however, we were still unsuccessful in being able to cross the occluded right coronary artery segment. At this point, we decided to abandon the procedure." I am not sure whether to use the 92943 for the CTO or the 92920. Since it appears he treated the subtotal segment I lean toward 92920 even though he was trying to treat the CTO. Thank you for your help.

93653

Hello! We are encountering the following dilemma, and would like guidance on the correct coding. Patient had a previous Afib ablation (Jan 2012) which was mapped to the pulmonary veins, patient returns (Jan 2013) for an Afib ablation of an additional area, on this patient the afib was mapped to the left atrium roof, mitral ridge ligament of marshal and the LA anterior line. Per report "12. PV's already isolated". Since the CPT code 93656 indicates that Afib ablation is performed via pulmonary vein isolation, as the ablation was not performed via pulmonary vein isolation (the second time), can this code be used? Thank you in advance

C9606

I have a question that involves the new cardiology intervention codes for 2013. We had a STEMI come in that was intervened on. There were lesions treated with drug eluting stents in two different vessels. The first lesion was the middle 1/3 of the SVG graft from the aorta to 2nd left posterolateral artery and the second lesion was in the natvie 2nd left posterolateral artery. Can we charge for both stent placements? I think we can. But, would we charge C9606 twice or would we charge C9606 once and charge C9601 too? Any and all help with this is very appreciated!!!!!

92941

Dr Z. Per documentation pt presents with a non-stemi acute MI. SCA shows total occlusion of the proximal RC. PTCA done. Procedure ended. We are questioning how to bill this as 92941 states ANY combination of stent, atherectomy and angioplasty. Does this mean that more that one intervention must be done on the lesion in order to bill with 92941? Would 92920 be the correct code to use? Thanks for your assistance. JD

36227 and 36228

I hope this doesn't sound like a really dumb question, but I have a carotid case where the left common, external, and then the superior thyroid artery were selected. i'm looking at 36222 and 36227 for that. I was looking at 36228 for the superior thyroid but noticed that the description for that code mentions "each intracranial branch of the internal carotid or vertebral arteries" Would that also include additonal brances of the external? or is 36227 as far as that goes? thanks!

37211

For the new TPA infusion codes, 37211-37214. If a patient is brought in and the TPA is initiated and then brought back later the same day for a re-check, is that re-check now included in the initial 37211 since it was done on the same day? Thanks!

Direct Puncture Therapy

Here is a procedure that was performed that I need some assistance in correctly coding. These unusual procedures can get very confusing. 

DEVICES UTILIZED: Two separate 21 gauge micropuncture needles were utilized. PROCEDURES: 1. Ultrasound and fluoroscopically guided percutaneous access into the venous malformation in two separate areas. 2. Percutaneous venography of the venous malformation, times two. 3. Injection of Sotradecol into the lesion, three separate times, ten minutes apart. Using sterile technique, local anesthesia, general anesthesia, ultrasound and fluoroscopic guidance, two separate 21 gauge needles were placed within the lesion. Injection of contrast material was performed, demonstrating the extent of the filling of the lesion. The contrast material was then allowed to drain and the volume was replaced with Sotradecol. The Sotradecol was allowed to stand for ten minutes before attempting to remove it and reinjecting the same space with Sotradecol. This was performed twice from the first needle position and once from the second needle position. At the termination of the procedure the needles were removed, and band-aids were placed over the skin puncture site(s). The patient tolerated the procedure well, and no complications were encountered during or immediately following the procedure. FINDINGS: The first injection from the first needle placement demonstrated excellent filling of the lesion, representing the majority of the lesion, with a multi-lobulated appearance. The venous drainage was into an external jugular branch draining inferiorly. The second injection was in the most superior part of the lesion, filling the superior third. Venous drainage was as outlined above. IMPRESSION: Good filling of the lesion was achieved with Sotradecol, for purposes of sclerotherapy of the venous malformation within the substance of the left masseter, as described above.

Carotid and vertebral CPT codes

Hi, I have been reading the increasing number of questions regarding some of the new codes pertaining to the carotids. I have a doctor that frequently performs selective bilateral common and external carotids and these codes are just not clear to me. Could you help. I see add on codes 36227 to be used with 32666,36223 or 36224 and add on code 32668 to be use with 36224 or 36226. When would these apply I also have a question of how to bill bilaterl selective subclavian angio. There does not seem to be an add on code for 36225. Do we or do we not append the 50 modifier to these codes? Any suggestions would be greatly appreciated. Thanks J Anderson