Ask Dr. Z

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

Coding FFR, IVUS and OCT in 2013

Regarding 2013 cardiac coding: FFR, IVUS and OCT - do you code initial and additional vessels per major branch? Do these modalities follow the same rationale as coronary intervention? Our thoughts are that nothing changed for those CPTs, so it will not follow the rationale. You would get one initial charge per heart and all other vessels are additional branches and are still considered part of the major branch for these modalities.  Thank you very much.

Cardiac ablation

Regarding the new EP ablation codes - CPT says it includes comprehensive diagnostic EP. If you don't do diagnostic part - do you need a modifier 52 for decreased service? Thank you!

92937

DR. Z., Patient had PTCA with bare metal stent inserted in the PDA via the SVG. He also had a PTCA of the LD via the LIMA. We coded with 92937 and 92921. Is this correct? 92938 indicates that it has to be a combination of procedures and since only a PTCA was done did not think this code was appropriate. Thank you for your assistance. JD

75710

The physician's at our facility routinely perform a l/e angio this way, and I am wondering if you would code this 75630 and 75774 or just 75710? The symptoms involve just the left leg, and not sure there is justification to charge for the aorta and bilateral iliac everytime or is this more incidental? The cath was reformed in the distal infrarenal aorta. An AP aortogram was performed, confirming the patency in the infrarenal aorta and both common iliac and external iliac arteries. The catheter was used to direct an 0.035 Glidewire up and over the aortic bifurcation, down the left iliac system. The catheter was seated over the aortic bifurcation. The Glidewire was advanced to the level of the left inguinal ligament, and the catheter was advanced into the left common and external iliac artery. The catheter was parked in the proximalmost portion of the left common femoral artery. Selective angiography of the left lower extremity was performed. Thank you!

93650, 93653

DR. Z, I our cath lab doctor recently did an AV nodal modification. His report reflects he did not ablate the AV node. I am unfamiliar with this procedure and hope you can assist me in explaining what the difference is between AV nodal modification and AV ablation. Is there a CPT code for the AV nodal modification.

C9606

Hello Dr. Z. I have a question for you regarding the new CPT Code 92941. I believe there is much confusion regarding the use of this code. While I though I understood the concept of CPT 92941 (patient with MI and having a combination of BMS/DES Stenting, Angioplasty or Atherectomy), I'm not sure I do. If I have a patient who presents with an MI but we only insert a BMS or DES stent, am I to charge CPT Code 92928 or C9600 since CPT 92941 requires a combination of stenting, angioplasty or atherectomy? If this is the case, why have CPT 92941 when CPT Code 92928 & C9600 includes angioplasty. This seems to me to be the most common procedure performed as a combination. Thank you in advance for your help. Candy

93623

We are getting conflicting information regarding the correct usage of 93623 with the 2013 ablation code changes. Can it be billed prior to the ablation to assist with arrhythmia induction? We understand it cannot be billed following the ablation to verify adequacy of the outcome. Thanks.

92921 with C9600

Hi Dr Z I am hoping you can help me with the new codes for the stenting and PTCA of the coronary artery if the pt has a drug eluting stent to LAD and then a PTCA to the diagonal branch would that just be C9600 or can I add the 92921 also to show the PTCA to the diagonal. Thank You for your help Brenda Dominski

75658 Retrograde Brachial

Hi DR. Z. I bet you are having fun like us with all of the new cervicocerbral artery codes! We have a case where the MD punctures the right radial artery and brings the catheter to the level of the right mid subclavian artery. He injects from here (there is nothing to support that he moved the cath any farther than the subclavian). He describes findings of the origins of the rt vertebral and common carotid, but mostly describes the subclavian. (the patient was experiencing dysarthria and arm pain). Would this just be 36222-RT or 36140 and 75710-RT (retrograde brachial angio)? It seems that code 36222 was written for an "Aortic arch" approach, and not a radial or brachial approach. My understanding is that approach no longer matters. However in our case the physician is only describing the vertebral origin and not really the vertebral circulation. Thanks for your help.

Aspiration thrombectomy

Hi, In going through my notes from the Z conference in Vegas, it was my understanding that the only time you can ever charge 92973 is with a mechanical thrombectomy cath (Angiojet), all other aspiration thrombectomy is included in all the cardiac interventional codes? Did I hear that correctly? Thanks for your help!

FFR and IVUS

Dr Z ~ Now that we can charge for individual vessels for PCI (LAD, diagonal) can we also charge separately for Radi wire diagnostic, per vessel (93571 and 93572)?

Defibrillator device edits

Dr Z, our facility upgraded a patient that had a single chamber defib to a dual chamber defib. The single ICD was removed and then implantation of new dual ICD and new RA lead. The old RV lead was fine and retained. The model for the new atrial lead corresponds with C1898. However, this is not a valid device code for Medicare. The doctor states that leads can be compatible with both pacer and defib. Does this happen often and is there a way to get this covered under the device to procedure or procedure to device edit? Also, if you can help me understand why we have different devices for pacer and defibs if some of the devices are compatible with both generators, I would appreciate any help!

93623 and cardiac ablation

Dr. Z. We have a patient that had an EP study, pulmonary vein foci ablation for atrial fib and isuprel was used to induce an arrythmia and it was determined that a portion of the right lower seemed to be reconnected and ablation of the posterior wall was ablated. There was no inducible atrial flutter after the additional ablation. We are currently coding 93656 and 93657. Per your handout for your webinar you stated that coding/billing 93623 with an ablation was a gray zone. Can you clarify whether or not you recommend coding/billing for this or not? Does the NCCI supercede CPT? Thanks! JD

36224, 36226

Please do NOT include any actual patient medical records with your question. if we do a cerebral bilateral and a vertebral bilateral, Should we charge 36224RT, 36224LT, 36226RT AND 36226LT? Accoding to changes for 2013.

Bridging lesions treated with a single stent

With the new PCI codes would you consider this two billable procedures or just one? The same balloon was used, but it was moved from the marginal to the left main. Starting in the marginal branch and working back into the left main multiple dilatations were performed with a 2.5 Trek balloon. The whole length of the stenotic area was then stented with a single 2.5 x 33 Xience stent deployed to 12 atmospheres. Thank you!

37214

Dr. Z, It was bound to happen and I am sure we are not the only ones to experience this. The patient came in to the hospital and thrombolytic therapy was begun on 12/31/12. The patient was returned to the angio suite on 1/1/13 for follow-up angio and the infusion was terminated. This is, of course, an IP account, but like most hospitals, our chargemasters are hard coded for IR procedures. So, for the thrombolysis would these codes be correct? For 12/31/12--75896 and 37201 For 1/1/13--37214 Thanks for your help, Chris M.

36222 and 36223

Please clarify the difference between CPT codes 36222 & 36223. I am confused with the verbage of "extar-" and "intra-" cranial circulation. Is this referring to external & internal circulation without vessel selection? thanks

CCI Guidelines Part 1 Dr. Z, I cannot find the excerpt from the Introduction of the CCI Manual you included as the 3rd paragraph or your update. Is it further defined in the IOM? Please advise as the CCI Manual reads, "Providers reporting services under Medicare's hospital outpatient prospective payment system (OPPS) should report all services in accordance with appropriate Medicare Internet Only Manual (IOM) instructions."

92941

Dr.Z For CPT code 92941, would that cover all AMI's even if the %blockage was say 80% and not a total/subtotal occlusion. Thanks

34201

Hi, My Dr. 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 34812 for cut down and 34203-22 for over wire thrombectoy? Please advise. Thanks, Renata

Replacement of nephroureteral stent that fell out at home

Hi Dr. Z- 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. Thank you 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.

Acute MI and coronary intervention

What guidelines do we use to determine if AMI Revascularization is applicable? Our call teams are activated all the time for Non STEMI's and unstable angina that are called "AMI's". Any suggestions? Thanks!

Acute MI and coronary intervention

With the 2013 PCI codes... I have been told that you can only report the AMI (92928 for example) a single time per episode. I do not think this is correct. If the pt has a AMI and 2 or more major arteries are involved need stenting would you not code the AMI CPT 92928-LD, 92928-RC-59 ..... To me the wording in CPT "Single major artery or branch" is that in can only be coded a single time in that Vessel but could be used multiple times if AMI involve seperate Vessels? Thank you for quidence in this, Misty

Number of time EP add-on code may be used

For 2013, how many times can you use the EP add-on code for additional atrial ablations? We are trying to train staff and don't want to mislead them from the beginning. Thanks!

33215

The patient had an infected device and all the device components were removed, then a temp 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 the 33215 code? or an unlisted code? Thanks for your help with this.

EP codes

Dr. Z, I have a couple of questions on 2013 codes. For 93656 I have heard that HRS is trying to get clarification or re-wording on the code so it does not read like all components must be done and if this is not accomplished a 52 modifier will be needed for professional billing. What are your views on this? And have you heard if there is to be any clarification of the code? Second question, there is no reimbursement on the SICD T codes is there? Thank you, Debbie Grant

Follow-up Question:

Dr. Z,
 
Thank you for your answers.  I know that you are recommending not charging for 93623 now and was wondering about 93621.  It is still an add on code to 93620 and causing an edit with 93653 and 93654 due to no primary procedure code.  What are your recommendations for this?
 
Thank you,
 
Debbie
 

93620 and ablations

In looking over the new combined EP/ablation codes for 2013. I'm wondering if any of the add-on codes for 93620 can be used with the new codes. The CPT book still says "use ..... in conjunction with 93620" on the add-on codes. If the EP study is included with the ablation, then we won't be billing 93620. Just wondering if there will be an NCCI edit not allowing.

What do you think about coding for the new ICD system with a single subcutaneous lead?

Are you advising your clients to report an unlisted code for this?  We'll be doing our first one really soon, and I would love to know your opinion.

Hope you are doing well.

Thanks,

37225, 37229, 75630

Dear Dr.Z Good afternoon I am your student through webinars. I was able to code most of charts confidently after listening to your webinars. But, following is the case where I am feeling little chalenge. Please help. Patient doesnâ?Tt have any prior catheter based angiogram of Lower Extremities. Now, the patient with Peripheral vascular disease. Planned angiogram to evaluate Lower extremity PVD and Intervention as necessary for Limb salvage procedure. Right femoral arterial sheath placement and Right common femoral angiography done. Then, Aortobiiliac angiography was performed. Followed this Left common femoral and popliteal angiography with runoff done. Then the wire was in the dissection plane. Then, an ultrasound re-entry device was used to re-enter into the distal SFA. Then, TurboHawk Atherectomy and angioplasty done in superficial femoral artery. Following this Atherectomy of Tibioperoneal Trunk was done. My coding 36247-59, 75625-59, 75716-59, 76937-59, 37225 & 37229 Q) 1) As patient doesnâ?Tt have the prior catheter based Angiogram, I coded 36247-59 for Angiogram (based on this angiogram only physician decided to do intervention). Am I Correct? Q) 2) Is it appropriate coding 76937 (ultrasound guidance for re-entry) here? I appreciate your help