Ask Dr. Z

Ask Dr. Z Knowledge Base houses over 7,500 coding questions and answers dating back to 2013.

Ask Dr. Z Disclaimer

Spider filter to remove thrombus from the peroneal

Dr Z MD does atherectomy of SFA and then uses a spider filter to remove thrombus from the peroneal. What should he bill? He marked 37203 and 37225. I think 37184 and 37225. Help. Thank you,

NG tube is placed by the radiologist and left in place

I saw the question and answer below. My question is if the NG tube is placed by the radiologist and left in place to feed the patient until they start using the G-tube would you then code the 43752? Question: Hi Dr. Z When we place a G-Tube(49440) we put a NG tube down so we can inflate the stomach. We have been charging 43752, but a person at another hospital said your not to charge that because its part of the procedure. We do pull out the NG when the case is finished. Thank you for your time Answer: 43752 should not be used for a G-tube placement. Code 49440 for G-tube placement includes fluoroscopy, NG tube placement, all guidance and imaging to perform the procedure. Dr.z Revised 02-18-10

Percutaneous placement of a drainage cathter into an anterior abdominal wal

How would you code percutaneous placement of a drainage cathter into an anterior abdominal wall fluid collection? The fluid is located between the abdominal wall and the peritoneal lining. The CT scan prior to this procedure says the fluid collection is adjacent to the inner abdominal wall in the midline and extends inferiorly to the left into the pelvis. There was spontaneous drainage of brown, partially clear fluid from the tube when it was placed. Is it unlisted CPT 49999 and 75989?

Can an add on code, such as 93462, be left off a claim

This is more of a billing question. Can an add on code, such as 93462, be left off a claim if it is causing the main procedure, such as 93651, to be overlooked? Thanks for your time.

37186

Please do NOT include any actual patient medical records with your question. contralateral catheterization of SFA(36247)with ekos lytic catheter infusion (37201, 75896) performed on first day of the SFA; patient returns following day and follow up angiogram (75898) finds occluded peroneal artery and peroneal artery is selectively cannulated and AngioJet Thrombectomy is performed of peroneal artery (37184)---Do we code the catheter selection of peroneal artery (36245)on second day or is it still the same catheter placed on the first day and only 37184 and 75898 would be coded for following day? Thank you.

Difference between a device interrogation and a device programming

Please do NOT include any actual patient medical records with your question. Could you please clarify the difference between a device interrogation and a device programming? When our Docs do a device check,93279-93281 and 93282-93284, I am being told that when the doc does the check he will make changes to the device, i.e. check the impedance level and parameters, to check it and then set the program back to the original setting, and this should be considered a reprogramming, CPT codes 93279-93281,93282-93284. I have also been told that these codes depend on whether or not the doc made changes to the final programming of the device, if he changed it from the original setting prior to the device check. I also was under the impression that If the doc did a check and made no changes to the device, "the final program" that this would be considered an interrogation of the device and to use 93288 or 93289.Your input on this would be appreciated. Thank you! Rick

Documentation of aorta for use of 75630

Please do NOT include any actual patient medical records with your question. Hello Dr. Z, I have a physician who dictates abdominal aortogram performed, along with unilateral or bilateral peripheral angiogram. However, findings start with the iliac arteries and proceed down the leg. Does a description of iliacs support 75625, or do I need to have a description of the abdominal aorta or renal arteries to support 75625? I have been coding 75710 or 75716 unless there are findings describing the abdominal aorta or renals, at which time I code 75625 along with 75710 or 75716. Thanks!

Attachment of an LV lead to an existing generator

If patient presents for replacement of an LV lead with attachment to previously placed BIV ICD generator, is 33244 and 33224 appropriate to describe theses services? I think that since the new revisions have come out to the CRM codes that the definition of "replacement" seems to be gray- some people interpret this as one word describing two actions-removing an old item and inserting a new one, while others interpret this word as meaning just inserting a new item. 33224 seems confusing additionally in this matter as it reads "Insertion of pacing electrode, with attachment to previously placed pacemaker or pacing cardioverter defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator). Are we supposed to assume that the text within the parentheses is discussing removal and insertion of a pulse generator only, or are they inferring that removal of the old LV lead is included in the code? Which way you land on this debate has a heavy RVU impact, as the addition of 33244 adds 15.23 ceus to this case! Please help!

Medicare coverage of sacroplasty

We are trying to determine if sacroplasties are covered by Medicare with the diagnosis of compression fracture (w or w/o osteoporosis/osetopenia). We have had claims denied in the past for medical necessity but we cannot find a LCD or NCD for Michigan indicating what is considered medically necessary. Do you have any information on this?

AV fistula 35476

Please do NOT include any actual patient medical records with your question. Dr. Z, patient has brachial basillic arteriovenous fistula came for fistulogram and PTA. Fistulogram confirmed presence of stenosis in the proximal aspect of the arteriovenous fistula. Is this 35476 or 35475? Thanks

Mechanical thrombectomy on mutliple dates of service

Can I use 37184 per Date of Service. Lets say that a the radiologist does a mechanical thrombectomy on the same patient multiple days (same leg) while the patient is going through thrombolisis infusion.

Thanks,

NCCI edits and children with congenital heart defects

Do you know if there is any place in one of Dr. Zielske's books where it says certain edits do not apply to children with congenital heart defects?  I'm specifically wondering about angiography prior to an intervention.  CPT says the intervention includes all angiography for roadmapping and hemodynamic data, but the physician says this edit doesn't apply if it's a child with a congenital heart defect.   I'm trying to find a place in one of his books to support the fact that 93531 is included in 92997 unless the angiography a true diagnostic procedure as defined by CPT.

CPT says:  Diagnostic angiography performed at the time of an interventional procedure is separately reportable if:
1. No prior catheter-based angiographic study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study, OR
2. A prior study is available, but as documented in the medical record:
a. The patient's condition with respect to the clinical indication has changed since the prior study, OR
b. There is inadequate visualization of the anatomy and/or pathology, OR
c. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention.

Thanks for your help!  Jane

Difference between codes 34201 and 35371 or 35372

I am wondering how this should be coded....we have had many a discussion on the difference between the two codes of 34201 and 35371 or 35372. We were hoping you would be able to clarify the difference. The procedure is as follows: 7 cm incision was made just below the inguinal ligament...dissection was carried distally to the deep and superficial branches of the common femoral artery. A puncture site was noted with clot coming out of it...arteriotomy made through arterial puncture site..clot was removed. Fogarty catheters were placed....no more clot was retrieved. The arteriotomy was closed with a Hemashield patch in both directions with 6-0 Prolene suture allowing backbleeding and forward bleeding before tying the last stitch.

Codes 33225 can be added-on to

Please do NOT include any actual patient medical records with your question. We are using 33264 and 33225 for the removal and replacement for the ICD and the insertion of the CS lead to new device for the upgrade to a BiV ICD system. My concern at this time is that as an add on code 33225 does not show 33264 as a primary procedure code. Is this an error of omission on the part of the AMA?

37221 vs 34900 (dissection with incidental small iliac aneurysm)

A recent comment by a vascular surgeon caused me to research the appropriateness of using Iliac Vascular Repair(75954)vs. Iliac Stent(37221). Ex.1 - A patient developes a dissection in External Iliac Artery during a procedure. Attempt to "tack it up" with angioplasty is unsuccessful leading to a Viabahn covered stent placement. Ex. 2 - A patient presents for stenting of External Iliac and small aneurysm is found when roadmap image is taken. Use a Viabahn covered stent for stenosis and to cover area of aneurysm. The comment was made that anytime you "repair" an iliac regardless of product used - it is 75954. The CIRCC study guide states the codes are specific to the devices and techniques used and to the location of the abnormalities. So does 75954 require a specific device in addition to technique and location? Thank you for clarifying and for your assistance!

Third order selective catheterization of renal artery

Dr Z My question is regarding the new renal angiography codes and embolization. The physician does a right renal diagnostic angiogram from the right main renal artery. He then moves into 3 branches off the main renal artery to embolize a renal mass (37204, 75894, 75898). Although the diagnostic angiogram was from the main artery (36251) should I use 36253 instead since the catheters were moved super-selectively to do the embolization? As always, thank you for all your help.

Replacement of generator and RV lead with repair of atrial lead

Dr. Z, The patient came in for replacement of an AICD generator (dual chamber) due to battery reaching end-of-life and replacement of the RV lead due to there being an increased risk of fractures. During the procedure, it was noted that the atrial lead had an insulation break which was also repaired. With the new Pacemaker/AICD codes, is the advice given on July 13, 2011 still correct - 33249/33241/33220-52 - since the lead repaired was not the same lead that was replaced? Also, wouldn't the 33249 need a 59 modifier based on the NCCI edit that states it is mutually exclusive with procedure 33220? Thanks for your assistance.

76937 with lower extremity revascularization

76937 is allowed to be billed with the lower extremity revasc. codes correct?  Encoder doesn't show those codes as appropriate primary procedures for 76937, so I wanted to verify.  I'm also hitting a billing edit for it because of the prim. code.

thanks!

Foley catheter placement in the cath lab or EP

Can we code/charge for foley catheter placement in Cath lab or EP lab? It's done prior to long procedures in EP. It's done in the Cath lab if the bladder is too full or patient will have difficulty using bed pan after procedure. As always, we appreciate your assistance! Thank you!

Catheter placement at time of SFA intervention

Dr. Z. Can you please provide clarification on the below scenario below: Catheter placement if from a RT femoral access site, catheter is advanced to the aorta, contrast injectected with run off of both extremities. Catheter was exchanged for a SOS 2 cath which was manipulated anegrade in direction and advanced into the SFA. The area of stenosis was angioplastied. Can we use the catheter placement of 36200-59 for the aorta as this is technically another tree as this was retrograde, then physician went antegrade and performed angioplasty. As this has been allowed previously, new literature is only providing generic information stating that a cath placement cannot be charged in addition to intervention. I cannot find anything concrete for documentation to show coders who have this question. Thank you, Tami

KUB

Patient is pre-op for planned gastric bypass. 74241 was coded. The question is whether 74246 would be more appropriate. Coder is questioning with KUB. No diagnostic info regarding kidney/ureter/bladder is given, but in the coders desk reference KUB is referred to as a general abdominal exam. Is diagnostic info pertaining to kidney/ureter/bladder necessary to append code 74241? Clinical Notes: Pre-Op Gastric Bypass ESOPHAGRAM AND UPPER GI SERIES - 4/6/12: HISTORY: Obesity. FINDINGS: Preliminary film of the abdomen is unremarkable. The patient swallowed barium without any difficulty. There is no evidence of a hiatal hernia or gastroesophageal reflux. The esophagus is unremarkable. The stomach shows normal motility and distensibility. Mucosal folds of the stomach are unremarkable. Duodenal bulb and loop are well seen. There is no evidence of peptic ulcer disease. CONCLUSION: THERE IS NO EVIDENCE OF A HIATAL HERNIA OR GASTROESOPHAGEAL REFLUX. THERE IS NO EVIDENCE OF PEPTIC ULCER DISEASE. ROOM TIME IS 45 MINUTES. FLUOROSCOPY TIME IS 2 MINUTES 45 SECONDS.

Complex aortic and iliac stent graft procedures

Please do NOT include any actual patient medical records with your question. Would you be able review these codes and let me know if the case was coded correctly. Operation : Aortagam with pelvic runoff, occlusion of right internal iliac artery with Amplatzer plug, repir of left iliac aneurysm with branched iliac device, repair of infrarenal aorta with bifurcation stent graft (cook zenith) angioplasty and stent of left external iliac artery. Dx is aneurysms of infrarenal aorta and bilateral common iliac arteries. The cpt codes chosen are: 34803,34900,34825,34808,37221,36247-59,75952-26,75952-26/59,75953-26,76937-26,75937-26/59 Should you need copy of pt. case please let us know. Thanks, Renata

Gray zone 37204

Dr. Z: Would following be consider one operative field or two separate operative fields?: Following removal of an existing nephrostomy tube and placement of a new tube through a separate access site, active bleeding was noted from the lower pole of the left kidney to the posterior abdominal wall from the old nephrostomy tract. Embolization was performed on a segmental branch of the left kidney. Followup angiograms confirmed adequate occlusion of the vessel. A small focus of contrast extravastion was seen in the hematoma in the left posterior abdominal wall, fed by the left T12 intercostal artery. The T12 artery was embolized. Thank you for your assistance!

VT study. 93612, 93618

Hi Dr Z. Your help with this case would be appreciated. Patient underwent an EP study for ventricular risk stratification for a possible ICD implant. Access was via the right internal jugular vein with catheter placements (described as dual-catheter technique) in the RV apex and the RVOT. Stimuli were delivered at the ventricular sites. Arrhythmia induction was attempted with and without provocation including programmed stimulation. No arrhythmia could be induced. Catheters were removed. Would 93612 and 93603 adequately describe this procedure or should other codes be added? Thanks again.

Thrombectomy and fem-fem bypass

Greetings, Pt has a rt Cm.fem to lt Cm.fem bypass placed along with a thrombectomy of the superficial fem and a stent placement in the superficial fem. 37226/34201/35661 are the stent and thrombectomy considered completed in a seperate vessel or are the bundled in the bypass? LW

Extremity angiography before transfemoral heart valve implant (TAVR)

This may be the second time I'm sending this, I can't tell if the first one went through.... Hello Dr. Z and Associates, Our physicians have started performing peripheral angios and IVUS to evaluate lower extremity peripheral arteries for possible transfemoral heart valve implant (0256T). This is normally done a few days before scheduled valve implant. Would this meet medical necessity requirements for 75716 and/or 75945/75946? Thank you!

50395

All refernces I have found refer to the use of 50395 on the same date as the litho procedure. We frequently see patients one to days prior to the OR procedure & the IR doctor places a nephrouteteral catheter. Then on the day of OR lith procedure, the IR doctor goes to OR, removes existing nephroureteral catheter & dilates existing tract for placement of 30 Fr litho sheath, after which the case is turned over to the Urologist who then proceeds with the lihto procedure. Is 50395 still appropiate for this scenario?

37191

Dr. Z, Patient comes in for IVC filter placement (37191). RT & LT renals were selected for venous inflow and the left iliac vein for venography. There is no findings for the renals & left iliac. Is this considered roadmapping? Thanks

Abscessogram and tube change in same setting

In your IR coding reference page 382 example 1 you state we can code an abscessogram and an abscess catheter change together with not modifiers. So for these we code 49424, 49423, 76080 and 75984. We have a situation where Medicare is denying the 49424 and 76080 is bundling with 49423. There is not NCCI edit saying any modifier has to be used as per your example. So my question is have you seen that Medicare is no longer allowing 49424 with 49423? Would you appeal these to Medicare? Thanks for your help. Julie

Device edit involving C1882

Question on the procedure to device and device to procedure edits. We inserted a new system for the first time (RA lead, RV lead, LV lead, & ICD generator). We billed for cpt 33249 and we are billing the device codes of C1882, C1900, C1777, and C1898. In looking at the procedure to device edits, we pass. However, in looking at the device to procedure edit, C1882 is failing as proc code 33249 was terminated as of 1/1/12, so is no longer listed as one of the procedure codes for the C1882 device. To me, this seems to be contradictory of each other. Any suggestions????

76930

Our cardiologist do pericardiocentesis with echocardiographic and fluoroscopic guidance. Would code 76930 be assigned for the echocariographic guidance? Thank you

36147 with cardiac cath and EP

Please do NOT include any actual patient medical records with your question. Can CPT code 76937 be reported with coronary cath/interventional and EPS CPT codes? Pediatric's here at our medical school have some patients that require ultrasound guidance when placing catheter(s)because of difficulty accessing the vessel. This happens rarely but there are times when ultrasound is necessary. Look forward to your response. Claire Shumate, RHIT, CCS, CPC Compliance Analyst WUSM - St. Louis

35661

Greetings, A patient has a fem-fem graft that adheared to the bladder wall. The physician transects the graft on the left and right side of the bladder and removes the graft and repairs the bladder wall. Next he places a PTFE graft on top of the rectus sheath and attatches this to the ends of the PTFE graft that was still attached to the left and right femoral artery. I'm thinking this is a unlisted 37799 and basing the RVU on 35881. I do not think I would code excision of the graft (bundled). Thoughts? LW

Renal mass ablation and biopsy

Dear Dr. Z: A CT guided needle biopsy of a renal mass was performed and then CT guided cryoablation of the same mass was performed (same patient encounter). Is it appropriate to code 50200, 77012-59 for the needle biopsy and 50593, 77013 for the cryoablation of the renal mass? Or should only 50593, 77013 be coded since it is the same mass? Thank you. mlb

Coil embolization of a biopsy tract

I am sorry, I had another question I forgot to ask in my submission a few minutes ago. After the hepatic access and ablation a coil was used to close the access site. Would this be 37204 without the follow up angiogram? Thank you again.

Venography with EP ablation

Adult patient with fontan baffle and bilateral occluded femoral veins comes in for SVT ablation. Direct hepatic puncture was done for access and an ablate catheter placed into the hepatic sheath. A 20-pole EP catheter was placed through RIJ access. LFV injection was performed and revealed already known occlusion. The access and injections were done by the Peds interventionalist and the EP/Ablation was done by the Peds electrophysiologist. I would not code for the access and injections. Would you? Thank you.

Unsuccessful attempt to place left ventricular ICD lead

Dr. Z, This patient was coming in for a dual chamber ICD generator replacement with a CS lead insertion. ( 33249 and 33225 ) The pocket was opened and the genertor was removed and detached from the endocardial leads. The pt. was paced off the R vent lead during the procedure. By use of a pertutaneous dilator and introducer a 7 french coronary sinus guiding cath was introduced and advanced to the R atrium. After several attepmts and several guiding caths used cannulation of the coronary sinus was unsuccessful. The generator was reattached to the leads and replaced in the pocket. Medical records coded 33249 and 33225. Is this correct? All that was done was removal and re-insertion of generator. Thank you, Kim H.

93613

Is it appropriate to report 93613 when the physician documents that he was unable to induce an arrythmia even when Isuprel challenge was done and "non-contact mapping was performed so as to produce activation maps"?

93799, 92973

Dr. Z. In your August 2011 newsletter you stated that per the AMA 92973 was to be used only when the thrombectomy was done with an angiojet. You further stated that 93799 could be used to report a "stand alone" aspiration thrombectomy of a coronary artery. And that a thrombectomy done by any other means is a part of any other intervention performed. At your Scottsdale seminar it was our understanding that the 93799 could be billed for all coronary thrombectomies that used catheters other than the angiojet. Please clarify what can be billed using the 93799. Thanks!

50390, 50394

Patient with kidney obstruction. Antegrade pyelogram was performed followed by insertion of a nephrostomy tube. The report says "it was injected with contrast, aspirated, and flushed with saline. The nephrostomy tube was secured in place." I know I can code 50390/74425 and 50392/74475. But what about also using 50394? Or is the nephrostogam in this case part of the placing the tube? Thank you for your guidance.

75630, G0275, G0278

Please do NOT include any actual patient medical records with your question. What codes do I need to bill if a patient is Medicare Pt., and what codes for a none Medicare. Procedure is: Left heart cath with Cors, with LV, and Abdominal aortography and bilateral illiofemoral run off.

35201

Please do NOT include any actual patient medical records with your question. Can you please clarify your Q&A 3525? Code 35141 does not fall into the range referred to in the answer. Can 35141 be reported for direct repair of pseudoaneurysm without insertion of graft? Date: Tuesday, February 28, 2012 Question: Greetings, Pt. has fem-peroneal bypass graft with spliced saphenous vein originating from the hood of aortobifemoral graft. At the hood connection of the vein a pseudoaneurysm develops. Pt taken back to the OR for repair. After draining partially thrombosed pseudoaneurysm he sutures the hole in the hood would you code this as 35141 or repair of a blood vessel Thanks, LW Answer: The note just prior to code 35001 states “For direct repairs associated with occlusive disease only, see 35201-35286”. Since this is a pseudoaneurysm I would not use the repair codes but stay with the aneurysm codes. Thanks, Dr. D

Aortic stent graft for trauma

If you stent graft an aorta due to trauma and not aneurysm, would you code 38400/75952? Thanks!

37186

Dr Z, MD does atherectomy of SFA and then uses a spider filter to remove thrombus from the peroneal. What should he bill? He marked 37203 and 37225. I think 37184 and 37225. Help. Thank you

35475

Just when I think I get these I always question myself and get confused.  Would you consider this a venous or arterial angioplasty?  Is there an easy way to “get these”  no matter how much I read on these I still get confused.

Thanks!!

TECHNIQUE: The risks, benefits and goals of dialysis fistula/graft evaluation with possible stent placement and possible angioplasty under conscious sedation were discussed with the patient prior to the procedure. The patient desired to proceed and signed informed consent. The patient was placed supine on the angiography table. The right upper extremity was prepared and draped in the usual sterile fashion. 2% lidocaine with epinephrine was used as a local anesthetic. Access to the fistula was obtained using US guidance and micropuncture technique directed toward the arterial inflow. Evaluation of the fistula outflow was performed with digital subtraction venography to the level of the superior vena cava. A 6 Fr short sheath was inserted over a Bentson wire which was positioned into the brachial artery. Over the wire, a Bern catheter was inserted and positioned in the brachial artery. Digital subtraction angiography was performed to evaluate the arterial anastomosis and the perianastomotic region of the fistula.

Multiple segments of moderate-length narrowing were noted in the perianastomotic region.


A 5 x 4 angioplasty balloon was inserted and positioned such that multiple, overlapping angioplasties of the perianastomotic region were performed to treat the stenoses. The balloon was then positioned at the arterial anastomosis and angioplasty of the arterial anastomosis was performed. Post-angiography DSA was performed through a Bern catheter inserted into the brachial artery, demonstrating a good angiographic result with brisk flow centrally through this fistula. The catheter and wire were withdrawn. Hemostasis was obtained with manual compression. The patient tolerated the procedure well and exited the angiography suite in stable condition. FINDINGS: There is brisk flow through the fistula. There are multiple segments of 30-50 % narrowing in the perianastomotic region of the fistula, as well as at the arterial anastomosis. The outflow the brachio-cephalic fistula is otherwise unremarkable. IMPRESSION: Successful venous angioplasty of the peri-anastomotic region and arterial anastomosis of the right brachial artery-cephalic vein fistula. PLAN: The fistula can be used immediately.

36832

I'm stuck on this one, any info. on your end would be greatly appreciated.

this pt. had 36819 (Arteriovenous anastomosis, open; by upper arm basilic vein transposition) done in November.
I'm not sure what this is exactly…36832-58??

PREOPERATIVE DIAGNOSES:
1.  End-stage renal disease.
2.  First-stage right brachiobasilic fistula.

POSTOPERATIVE DIAGNOSES:
1.  End-stage renal disease.
2.  First-stage right brachiobasilic fistula.

OPERATION PERFORMED:  Second-stage superficialization of right brachiobasilic fistula.

ANESTHESIA:  General endotracheal anesthesia.

ESTIMATED BLOOD LOSS:  Less than 10 mL.

COMPLICATIONS:  None apparent.

INDICATIONS:  This 64-year-old male had failed autogenous access in the left upper extremity and had underwent a primary first-staged right brachiobasilic fistula in November 2011.  He presents now for creation of a second-stage brachiobasilic fistula on the right to superficialize the fistula.

SPECIMEN:  None.

FINDINGS:  Patent right brachiobasilic fistula.

OPERATION:  The patient was brought to the operating room and placed in a supine position.  After a time-out was performed, the right upper extremity was prepped and draped in a sterile fashion.  The brachiobasilic fistula was palpable with a thrill from the antecubital fossa up to the axilla.  This was marked and an incision sharply created over the arteriovenous fistula.  Any small additional side branches were divided between 3-0 and 2-0 silk ties.  The fistula was then mobilized and brought more anteromedial in a superficial position.  The subcutaneous tissues were then closed with running 3-0 Vicryl suture followed by 4-0 Monocryl and Dermabond.  The patient remained with a palpable radial pulse and an excellent thrill in the superficialized fistula.  I was present for the entire portion of procedure.  The patient was extubated and transferred to the recovery area in stable condition.

Diagnostic imaging at time of an intervention

Dr.Z, Before a Kissing Balloon and Stent placements were performed Bilaterally on the Common Iliac Arteries, an Abdominal Aortogram with the catheter positioned above the bifurcation for a Bilateral Lower Extremity Run-off Angiogram. In a case like this with intervention in the Common Iliacs, would 75625 and 75716 still be reportable? There were findings and interpretation provided for the abdominal aortogram and extremity angiograms.

77001

Dr. Z, We are having a coding stand-off and are hoping you can assist. All your coding manuals indicate during a catheter exchange that no further catheter codes (ie: 36010) should be coded if the only access point is the existing cath tract (for which I agree). For 75827 to be billable the SVC should be documented itself, not just "no presence of fibrin sheath". The question is as follows: If the descriptor is: "Contrast injection and superior venacavagram revealed no evidence of fibrin sheath stenosis", would that warrant a 75827? Part two: if the following occurred: Using blunt dissection, the catheter cuff was exteriorized. A 150-cm glidewire was advanced through the catheter and under fluoroscopic guidance into the IVC. The catheter was then removed and exchanged for a 9F sheath. The 9F sheath was advanced over a glidewire and under fluoroscopic guidance into the SVC. An SVC gram revealed a widely patent SVC. The sheath was then removed and exchanged for a new 14F 24-cm Medcomp split-tip catheter. A catheter was advanced over the glidewire under fluoroscopic guidance into the atriocaval junction", can a 36010 be billed if the only point of access is the catheter tract? We would love to have this dispute settled once and for all! Thanks for all your help!!

NCCI edits

I need clarification Column 1/Column 2 edits. With the Column 1 being the major component if a Column 2 code (71010 is perform after the Column 1 code)is performed, the column 2 code should not be coded/charged. Coding both codes would be unbundling. The column 2 code should only be charged if there is a new symptom post prodecure documented as reason for exam. Fluoro is not used. In the below it says "When billed together, 75625 (the Column 2 code) should not be paid." but they should not have been coded on the bill together at all. I want to make sure I understand it. Thanks Column 1/Column 2 edits, previously called Comprehensive and Component, are to detect when a procedure is billed separately that should be included in another procedure billed. When used together on a claim, these procedure codes are considered unbundled. The Column 1 code represents the major procedure. It requires greater effort and time as compared to a Column 2 code. The Column 2 code represents the lesser procedure or service, is Considered part of the Column 1 procedure, and is often represented by a lower payment. An example of this is code 75724, bilateral renal arteriogram, and 75625, abdominal aortogram. Code 75724 is the Column 1 code and is considered to include the work that is described by 75625. When billed together, 75625 (the Column 2 code) should not be paid.

The replacement of only an ICD generator (with a new dual chamber generator

Has there been any issues with Procedure to Device edits or Device to procedure edits that are causing coding issues? I know recently CMS identified C1882 issue with 33249 just this month which is scheduled to clear April 1st, 2012. Recently,I had a patient that returned for end of life Battery depletion. Incision is made & device pocket opened. Medtronic model D154ATG,which was a BI-VI was removed. The atril, RV shock & RV p.s leads were then tested and adequate pacing thresholds obtained. The new Biotronik Dual Chamber ICD was then attached to the leads and inserted into the pocket Model # 360346 DDDR. The subcutaneous tissue was first closed with interrupted stitching using 2-0, 3-0 Vicryl. The skin was closed with running subcuticular stitching using 4-0 Vicryl. After the procedure, the incision was secured with Derma-Bond and Steri-Strips and a sterile dressing. On leaving the Cath Lab, the leads were in proper position and patient was hemodynamically stable. A chest x ray was ordered and the patient was transported back to the Telemetry Unit in stable condition. Coded 33249 with C1721 attached to the Generator. Please advise if you have any additional information that will help us get this claim out the door. Thanks, MC

Need to ask Dr.Z?

Don't see the answer you're looking for in the knowledge base? No problem. You can ask Dr. Z directly!
Ask Dr. Z a question now!