Ask Dr. Z

TAVR, 34812, 0256T

Dr.Z, I code for a vascular surgeon and the procdure is an exposure of LCFA and LCFV for the purposes of transcatheter aortic valve placement (TAVR) by Cardiac surgeons. Vascular surgeon exposed the artery and then turns the procedure over to the Cardicac surgeons. When the procdure was completed the vascular surgeon closes the artery. My question is, is it correct to bill 34812 (Femoral artery exposure) and the cardiac surgeon bill for their portion procedure (unlisted code) or should both the vascular and the cardicac surgeons bill the same unlisted procdure code with the 62 modifier? It seems to me that since the vascular surgeon only exposes and closes the artery, we should only bill for that portion of the procdure. Thank you for your expertise.

33206

Dr. Z. Need your help with the following scenario: Patient with dual chamber pacemaker came in for upgrade to a bi-v pacemaker. Found to have a defective atrial lead which was removed (33234?) and new one inserted (?). Both done transvenously. LV lead was then inserted (33225)and new bi-v generator was inserted (33229). How should we code for the removal and reinsertion of the atrial lead? Thank you in advance for your help with this case.

Codes 20500 and 76080 for non-vascular ablation

Hi Dr. Z - In the December 29th issue of the ZHealth online newsletter regarding Non-Vascular Sclerosis, reference was made to SIR and ACR recommendations to use codes 20500 and 76080 for these procedures. There is much conflicting information from other industry sources recommending that a UPC code be used for these services. Can you please provide the SIR and ACR sources/articles that you are referencing? It is my understanding from discussion with physicians that alcohol ablation/sclerosing (i.e., liver, kidney) involves more work, time, and risk than the RVU's assigned to 20500 and 76080. Was the recommendation of 20500 only in reference to lymphocele sclerosing or should this code be applied to all non-vascular sclerosing regardless of anatomical site? Thanks in advance for any insight you can provide.

venous thrombecotmy and thrombolysis 37187

Would appreciate assistance on the following: The patient had extensive DVT in bilateral iliac, femoral, and popliteal veins as well as the IVC. Three infusion catheters were placed (one in each lower extremity and one in the IVC). The next day, followup angios were performed through each of the catheters. Based on findings of extensive residual filling defects, mechanical thrombectomy (Angiojet) was performed in both lower extremities. Additional venograms continued to show extensive residual clots, so an angioplasty balloon was used to macerate the clots. We understand that we would code only 75898 1x for the followup angios. However, since additional intervention was performed in both extremities, are we able to code for catheter placement for the mechanical thrombectomy? Would 36005 with a modifer 52 be appropriate? Also, use of an angioplasty balloon to macerate the clots is included in 37187 and not coded separately as 35476, correct? Thank you.

Mapping and AV node ablation

We need your assistance! Can we bill mapping with an AV node ablation. EncoderPro.com no longer shows a CCI conflict. As always, thanks for your help.

Physician documentation regarding 76937

Dr. Z: I have a question regarding CPT 76937. The radiologist documents the following: "A limited ultrasound examination was performed to confirm the existence and patency of the right internal jugular vein. An image was saved in the chart. The skin was anesthetized with 1% lidocaine. Under direct ultrasound guidance the vein was punctured with a 21-gauge micropuncture needle." Must the radiologist specifically state that permanent US recording was made of the needle access? Thank you for your assistance!

Multiple attempts to place PICC

Hi Dr. Z. I need your help. Scenario 1 A 50 year old patient presented for placement of PICC line, the right basilic vein was accessed, this access site was abandoned due to an occlusion of the vein, the PICC line was then successfully placed via the left basilic vein. Is it safe to say only the successful PICC placement should be reported 36569? Scenario 2 50 year old patient presented for placement of a PICC line, right basilic vein access was occluded the physician performed a formal extremity venography to evaluate the abnormality with documentation of the clinical findings, the PICC line was successfully placed via the left basilic vein. I coded the successful PICC line 36569 Would it be appropriate to additionally report the extremity venography (75820) and the vein access (36005)?

Sphincteroplasty and biliary stone extraction 47999

I have a question about a biliary procedure. When the physician uses a balloon to dilate the ampulla to allow passage of the stone into the duodenum, are the stone removal codes 47630 and 74327 used in addition to 47999 and 74363 for the dilation? There was no stricture, it was only dilated to allow the stone to be pushed through. I wasn't sure if the stone passage was included in 47999 or not since it wasn't actually "removed" with a basket or other device. Thanks.

33264

Please do NOT include any actual patient medical records with your question. Dr. Z, I have a question about the coding question dated Jul 5, 2012 involving a Bi-v ICD generator change with romoval and replacement of LV lead. You recommended 33244, 33225 & 33263 since there was only a RV & LV lead. My question is on 33263. The C code for the Bi-v device is C 1882. Can this C-code be used with 33263 ? Thanks, Dr. Z. Diane

35091

Patient has pararenal aortic aneurysm and due to the pararenal extension of the aneurysm and multiple accessory renal arteries, we felt the patient would need renal artery bypasses in addition to repair of his aortic aneurysm. A splenorenal bypass was performed to the mid left renal artery. A superior mesenteric artery to the renal artery bypass was performed to the most inferior left renal artery. This was performed with a ringed 6-mm Propaten bypass graft. Pararenal aortic aneurysm repair was performed with a 20mm x 10mm bifuracated Dacron graft. The right distal anastomosis was to the right common iliac artery and the left distal anastomosis was to the left common femoral artery. We have the following codes: 35091 35631 35636

Use of proximal (balloon) portion of MERCI device as an EPD

Good morning, Dr. Z We are seeing an increase in intracranial stent with mechanical thrombectomy cases where the standard embolic protection filter device is not able to be used. The patient has a known clot that is not able to be treated until the vessel is opened with the stent placement. The doctors have started using a Merci Concentric DAC dual lumen balloon guide catheter instead of the filter since it provides the necesssary embolic protection and also provides the necessary support for the thrombectomy device being used--"Solitaire" in most of these cases. My question is, if the documentation supports the use of the Merci balloon as embolic protection, even though it has a dual purpose, are we allowed to code the stenting procedures as 37215?? If so, what recommmendations do you have for documentation. Also does Medicare recognize these balloons as embolic devices?? Thanks from TL in KC, MO

36832 37799 15878

My Physician coded this as 15878? but i am unsure of the correct code for this procedure. Unlisted? Thank you PREOPERATIVE DIAGNOSIS: Left brachiocephalic fistula that is too deep. OPERATION: Removal of fat over the vein with liposuction. OPERATIVE FINDINGS DETAILS: The vein was positioned at about 6 mm from the skin at the completion. PROCEDURE IN DETAIL: The patient was taken to the operating room and placed in the supine position. Following smooth induction of general anesthesia, the left arm, hand and upper arm were prepped with Chloraprep solution and draped with sterile linens. A transverse incision was made just above the elbow and another just proximal to the shoulder over the vein. A subcutaneous tunnel was then made over the top of the vein being directed by ultrasound. A suction catheter was vigorously passed over the top, and using finger manipulation, the fat was squeezed from the top of the vein. There was a moderate amount of reaction from multiple previous needle sticks. The vein was verified to be about half as deep at the end of the procedure.

37618

Hello, This patient has extensive soft tissue infection/necrosis involving the entire posterior compartment of the groin region that extends distally to the mid thigh region with involvement of the femoral bifurcation The surgeon obtained inflow occlusion via an angioplasty balloon that was inflated. Question 1--can I bill for the access and the balloon? If so, would I use 37220 or 36245 and 37799? A triple ligation of the femoral artery to include the CFA proximally and the Profunda and SFA distally was done. Question 2--can 37618 be coded once or three times? Thank you, you are a great help!

Procedure cancelled as patient wanted general anesthesia

Patient was prepped and draped for a left and right heart cath. Pt consented, began conscious sedation time out completed. Pt decides she wants to be under general anesthesia and does not want to continue. Procedure aborted. What can be coded?

ICD downgrade to pacer 33229

Patient received a "down grade" in a device. Patient had a BIV ICD and we replaced it with a BIV PPM. We coded 33229, removal and replacement of a BIV PPM, is this correct?

75630 with 75710 or 75716

I attended a webinar hosted by one of the vendors. It was said that we could bill 75630 with 75710/75716, and it had come from SIR. Please advise.

Epidural and transfemoral injections in same encounter

What are the correct CPT codes if radiologist performs L5 epidural injection followed by L5 transforaminal injection, followed by S1 transforaminal injection, uncomplicated procedure. The only diagnosis is radiculopathy. CCI edits state that the transforaminal injection is a component of the epidural injection, but isn't the transforaminal a more selective injection? I see a prior answer that states only 1 injection procedure should be coded, but which injection? 62311/77003 or 64483? thank you.

Attempted left heart catheterization

A LHC is planned via right brachial artery access however the procedure is abandoned as the guidewire will not advance. What can be coded?

Carotid cerebral imaging

Please do NOT include any actual patient medical records with your question.Can you please help us with this case? A 6 French sheath was inserted into the right common femoral artery and catheters were inserted. Selective catheterization was carried out of both common carotid arteries and both subclavian arteries. An arch was also performed with injection in the ascending aorta. The aortic arch and origin of the great vessels are widely patent. Both common carotid arteries and subclavian arteries and innominate arteries are widely patent. Both internal carotid arteries and both carotid siphons are patent bilaterally. Intracranial circulation showed no evidence of masses or arteriovenous malformation. . Both vertebral arteries are small and widely patent. The basilar artery is patent. We coded 36215-59,36216,36218,& 75671. Radiology charged for 36215, 36215-59,36216,& 75671 Help please

92973

Need clarification: It is my understanding that 93799 add on code can be used for export catheter of i.e., LAD as long as an intervention is not done in that vessel. Is this correct? Also, 92973 can only be used for Angiojet is this correct? thank you

Two transseptal punctures 93462

When we do an A-Fib. ablation the Dr. does 2 transeptal punctures to put 2 catheters into the left atrium. Can we bill for both of them or one? Thanks! Sarah Cardona

Aorta with run-offs and selective lower extremity

Dr. Z Normally my doctor will do catheter placement in the aorta L1 then pull catheter down to the birfurcation and do a bilateral run-off. (36200 75625 75716) Now he is starting to do catheter at same level but then moves the catheter to the contralateral side (CFA) to do leg run-off then he goes to the popliteal does another arteriogram and so on down the leg. He will dictate what he sees in the aorta and the common and external iliacs.(75630 or 75625. At the CFA level he reports what he sees there and then at the popliteal level what he sees (75710 and 75774 or more depending on what he documents) I think this is over coding because he does not document why he is doing all the different levels. I have read the book and looked at the questions and answers and don't see anything that exactly fits. Help Suzan

G0269 and procedures CPT says it is bundled into

Dr. Z, At a resent conference, the speaker said that CMS wants us to charge for the closure device procedure, G0269, even if it is bundled in the procedure. The speaker said they want to know when the closure device is used for statistical reasons. Do you know of this being true with CMS? Thanks!

93623

Dr. Z, During an EPS can 93623 (Programmed stimulation and pacing after intravenous drug infusion)be coded when no ablation is performed? Here is the procedure description:"...After insertion of diagnostic catheters a comprehensive EPS-including multisite pacing-is performed. NO arrhythmia is induced even with aggressive maneuvers and despite Isoproterenol infusion. There is no evidence for dual AV node physiology, or accessory pathways. No ablation is performed." Thank you

RIMA

Hi Dr. Z Hope you can help me in my question. A patient is brought in for heart catheterization. Catheter placement and imaging are done in the LIMA to the LAD (patent), saphenous vein graft to OM (this has 80% stenosis), saphenous vein graft to RC (patent), they also engage the RIMA (which isn't used as a bypass graft but is found to be occluded from angiography). They also perform LVEP. they place a stent in the saphenous vein graft to the OM. I know to bill 93459-59-26 along with 92980-LC using dx code 414.02 but my question is in regards to the RIMA. Would it be permissible to bill the catheter placement for the RIMA36217-26 using dx code 440.20? Any help would be appreciated. thanks!

75827 with 36147 and LEG shunt

We have a physican who wants to charge for a central venogram 75827 with a AV fistulogram 36147 because the patients lower extremity graft (superifical femoral artery to femoral vein PTFE loop graft) does not drain into the SVC thus imaging could not be obtained from the leg graft. The SVC, right atrium and the innominate were catheterized and imaged looking for possible placement of new graft. I am uncomfortable with charging for 75827 as CPT guidelines indicate that 36147 includes imaging up to and extending into the right atrium. What is your advice? Thank you.

Removal of graft

I have a question for you - One of my resources allows codes 35903, 35286-59, but I am hesitatant to add the patch closure. How would you code the following procedure? Thanks for your help. BILATERAL GROIN INFECTIONS WITH INFECTED FEMORAL-FEMORAL BYPASS GRAFT. The bilateral groins were prepped with a Betadine solution and draped aseptically. I began by aggressive debridement of the obviously necrotic, foul-smelling fatty tissue in the right groin. This was carried down to allow identification of the right limb of the bypass graft. Proximal and distal control were achieved in the femoral artery. Five thousand units of intravenous heparin was administered. The graft was clearly not incorporated in the surrounding tissues. Thus, it was removed from the common femoral artery and the artery was closed in a patch fashion with bovine patch with 5-0 Prolene suture. The groin was then copiously irrigated with a pulse irrigator with 3 liters of normal saline. A layer was closed over the artery and the rest of the groin left open given the presence of the infection and packed with Dakin's soaked Kerlix. Next, attention was directed to the left groin where necrotic tissue was sharply debrided down to healthy granulation tissue. The groin was once again copiously pulse irrigated. Of note, the graft had been removed through the right groin. The pocket was copiously irrigated. The groin was then packed open with Dakin's soaked Kerlix. Sterile dressing was applied.

Placement of a carotid stent via an open approach

Dr. Z, My question concerns placement of a carotid stent via an open approach. I do not think we can use 37215 because it states "percutaneous" in the code description. Here is his dictation: An oblique incision at the lower neck level, I dissected out the common carotid artery and isolated with a vessel loop towards the cranial end. I then placed a 7-French sheath over a wire and performed diagnostic imaging demonstrating the stenosis and then crossed it primarily stenting with a 7 x 22 iCAST covered stents. We then postdilated to 8 mm and then removed the sheath and balloon and opened the arteriotomy a little bit wider so that we can get good antegrade flushing of the artery. The performing physician did dictate an addendum (to document distal protection, he said): The common carotid artery had been clamped cephalad of the entry site for placement of the sheath. After deploying the stent, the artery was flushed aggressively in order to remove all debris prior to closing the arteriotomy and then restoring flow antegrade to the brain. I cannot find a CPT code for an open placement of a carotid stent. Am I missing it or should this be an unlisted procedure code? I have tried to contact his office coder to see how it was submitted from his office, but I haven't had any success to date. Thanks, Chris McCoy

Revascularization of superior sagittal sinus with balloon

Hello from KC, MO--Unusual case, not seen in database. Briefly...Stroke patient seen in IR dept. Inital plan was to perform embolectomy of thrombus seen in superior sagittal sinus. Unable to advance Penumbra device, proceeded to succussfully revascularize superior sagittal sinus utilizing various balloons. What CPT & ICD codes would you use?

WADA testing 95958

Plese provide some clarification regarding 95958 - WADA Test. The test is being performed by a neurologist who is reporting this CPT. Our radiologist performs diagnostic angiography, places catheters, and injects amytal for the WADA Test- the radiologist will report the angiography and the catheter placements. Since the radiologist is not performing the WADA Test, there is no additional CPT reported, or is 95958-52 reported for the injection of the amytal for the WADA Test (I would think this would be incidental, similar to injection of MAA for chemoembolization workup)? Of course, if the radiologist performs the WADA Test, he may also report 95958. Thank you.

Dissection and 37221

Does the dissection below justify 37221 ? I have 34802,34812-50, 75952-26, 36200-50 with no true extension? Could you please advise? Bilateral groin incisions were created and we dissected down to the common femoral artery. We gained proximal and distal control and heparinized the patient with the appropriate amount of heparin. We cannulated each artery with large bore needles and inserted wires into the suprarenal aorta. Wires were switched out appropriately with a guide caths and placement of a stiff wire. We planned for deployment of the Medtronic Endurant stent graft, main body through the right limb and contralateral limb being managed by Dr. Kunstmann. We performed angiography and identified renal artery orifices. We planned for deployment of the stent graft in an infrarenal artery location and using spot fluoroscopy, we deployed the stent graft in an AP cross limb fashion. The contralateral gate was cannulated from the left lower extremity. Left lower extremity was measured to length with pigtail and fluoroscopy and when we had appropriate length, the left lower extremity or contralateral limb extension was placed by Dr. Kunstmann and brought down to the internal, external iliac junction. We deployed the remainder of the main body and limb into the right common iliac artery. ** There was a small area of dissection with aneurysmal dilatation that we felt needed to be covered and, therefore, we brought an atrium stent into the case and placed it into the sheath and further into the common iliac artery and deployed the atrium stent which was 8 x 38 stent, but ballooned up to a 12 balloon proximally.** Once this was complete, we used a Reliant balloon and ballooned as usual the proximal and distal extensions and gait junctions. Then we performed completion angiography. Completion angiography was satisfactory and; therefore, we removed the wires, catheters and sheaths, repaired the common femoral arteries with 6-0 Prolene suture in a running fashion.

35741

Hello Dr. Z I have a problem finding the correct cpt code for "Release of popliteal artery entrapment" Would you be able to dirct me what series of codes I should be looking for? The op note states ; Once the popliteal artery was identified in the midportion of the popliteal fossa, it was quite normal at this location however dissection distally, the popliteal artery was trapped under the tendon and the medial head of the gastroc. Therefore the medial head of the gastroc was dissected circumferentially and then traced down to its insertion on the bone and the insertion point was now transected with electrocautery. This allowed the muscle belly for the gastroc to be reflected medially and a more normal continued exploration of the popliteal artery. Just beyond where the muscle crossed the artery, there was an aneurysmal degeneration of the popliteal artery. The artery then became normal caliber and had normal external appearance. Thank you for your help. Renata

Exploration of vessel

Hi Dr. Zielske and Dr. Dunn, I need some assistance with coding a femoral vein venotomy and foreign body removal. This is a condensed portion of the procedure: During an IVUS procedure of the IVC and lower extremity veins stenosis was found in the left common iliac vein. Angioplasty was done on this vein. Balloon ruptured and upon removal the balloon remained in the left common femoral vein and became detached from the catheter. An incision was made over the left groin and a left femoral vein exploration was carried out. The femoral vein was identified and a venotomy performed. The ruptured balloon was then extracted under direct vision from the left femoral vein and the venotomy was repaired with 4-0 Prolene until hemostasis was achieved. I have searched my CPT book and have come up with 35226 for repair of a blood vessel or 37799 for an unlisted vascular procedure. Is there a better way to code this? As always, thanks for your assistance. Pam Johnson

MRI and fMRI on same date of service

If a patient has a brain MRI in the morning and an fMRI later in the evening, can we bill for both?

34800 aneurysm repair

Hello Dr Z, Is a percutaneous endovascular repair of the abdominal aortic dissection coded the same as open AAA repair (34800 & 75952)? We did a percutaneous mid abdominal aorta repair using 3 Gore Excluder as an outpatient procedure. CPT 34800 and 75952 require inpatient stay. How would I code this? Thank you in advance and see you in Nashville Melissa Russo

37191 with IVUS

I understand that 37191 includes fluoroscopy and ultrasound. However, my physician often does this filter placement at bedside and uses IVUS instead of fluoroscopy. Would you still just code 37191? Thank you so much for your help.

3399

Dr. Z, How is an attempted interventional cardiac procedure coded when no device such as balloon or stent was used in the attempt and no repeat dx coronary study was performed. I can't use an interventional code because I don't have a device C-code to enter with the cpt code. Can the cpt code go through with a -74 on the cpt code because it was aborted after the attempt? Or just go with unlisted code 33999. If there was a dx study done with the atempted intervention, is it just the heart cath code billed or can we add the intervention code on with a modifier? This is when we attempt and have no device code open. Also, I've read that 33999 is used when an impella is inserted. When do you use 33999 (cardiac surg) and 93733 (cardio interv)? Thank you!

93651

HI Dr. Z, I am having difficulty with AVNRT ablation and can't find the answer in the Interventional Cardiovascular Coding Reference or in the on line Q&A. When AVNRT ablation is done, is this considered ablation of the AV node or an ablation of an accessory pathway. If AVN ablation is done then code 93650 would apply. Would 93651 be assigned for accessory pathway ablation? If 93651 is correct, then we can also charge for the EPS, mapping etc. but not if we assign the 93650. Thanks you so much for your help.

Cimino shunt av fistula 35475

Could you please explain difference between Cimino and AV fistulae coding. If a physician performs angioplasty of the arterial anastomosis of the Cimino fistula what is a correct code to report? Thanks.

IVUS with lower extremity revascularization

Is IVUS 37250 and 37251 reimbursed on top of endovascular revascularization 37220-37235?

Replace pacemaker and LVL

Please do NOT include any actual patient medical records with your question. I have a replacement of a biventricular pacemaker with a replacement of the LV lead. The LV lead was removed as well. The encoder takes me to 33208, 33225, 33235 and 33233. I believe at least I should change the 33235 to 33234. Thank you

Fluoroscopy and G0260

Dr.Z, Since code 27096 now includes fluoro, does G0260 follow the same rules and include Fluoro? Thanks so much Henri

Pacemaker insertion followed by EP followed by programming

Please do NOT include any actual patient medical records with your question. Dr. Z, Indication: A-Fib with rapid ventricular responsse refractory to medical therapy with amiodarone and rate slowing drugs. Referred to EP physician for AV nodal ablation and single chamber PPM. First performed PPM insertion then proceeded to AV nodal abaltion at the end of the procedure reprogrammed to VVIR mode. Is this enough to code 99286 even though it is included in the initial insertion since this scenario is different that they have to reprogramm because Of AV nodal ablation? Thanks

AV shunt intervention

Please do NOT include any actual patient medical records with your question. Dr. Dunn, The patient came in with AV fistula and revision was done with new Flixene graft was sewed to the old venous limb and also open thromebctomy performed. Shuntogram was done with evidence of innominate vein stenosis. This was treated with ballon angioplasty. Can we code thsi with 36832 75790 and 35460 and 75978? Dr. Z's vascular book 2009 page # 313 instruction #9 refers PTA is included within the graft (anastomosis to anastomosis) when performed with revision/thrombectomy. Is central vein stenosis can be coded separate since stenosis is not anastomosis to anastomosis? Please clarify. Thanks

33225, 33263, 33244

Please do NOT include any actual patient medical records with your question. Hi Dr Z, I would really appreciate your help with this question. Pt comes in for a Biventricular defibrillator generator change. The LV lead is found to be fractured so it is extracted and a new LV lead is placed. So pt had bivent generator change, extraction of LV lead and placement of a new lead. Would this be coded with 33244, 33224 and 33264? Thank you.

Cryoablation of bone tumor 20999

Please do NOT include any actual patient medical records with your question. Our physician performed a CT guided core bone biopsy of a right tibia mass. Following the biopsy a 17 gauge cryoablation probe was inserted into the mass. Limited CT images were obtained at 2 minute and 6 minute intervals to evaluate the progression of the ice ball. These demonstrated circumferential coverage of the mass. Following removal of the cryoablation probe, limited CT was performed revealing hypodensity within the region of the mass consistent with the ice ball. Sterile dressing was applied. How would you code the cryoablation portion of this procedure? Would you use 20999 or 20982? Thank you.

36147 and IVUS

I have a physician who accessed a left arm AV graft then used IVUS to study from the venous anastamosis to the subclavian vein. I am unsure how to charge this. 36147 generally covers access and imaging, but would this include IVUS? The dictation has no documented contrast injections. If I should charge for the IVUS, how many are appropriate? Should I charge one for each vessel examined and interpreted or, similar to PTA/stenting, charge once per "zone"? Thank you for your help with this!

Catheter placement CFA

My question is whether to bill the catheter placement if after placing catheter in LEIA from a RCFA access (36246) with left lower extremity arteriogram (75710) is included with a then open endarterectomy of LCFA (35371) and a open Stent placement in the LSFA (37226). Since this was percutaneous to open procedure (sep access sites) I wasn't sure if the catheter is still considered included with LSFA stent. Thank you for you time.

35221

Hello~ Can you tell me what the difference between codes 34502 and 35221 when coding the repair of an injury to the IVC? Brief summary for this procedure is....patient was undergoing a nephrectomy involving the right kidney and the IVC was injured, the vascular surgeon was called in to repair. The IVC was was directly repaired with suture also repaired was a branch that avulsed form the IVC which also required additional direct repair with suture. Would this be 35221? Can you give me an example of when I would use 34502? Thank you!! Joanne

Roving catheter during EP

Our EP physicians frequently mention a "roving" catheter when listing catheter locations during a EP study. A current example shows catheter placements in the RV apex and RV outflow tract and a roving St Jude quadripolar catheter. How would this be coded. Thank you.