Ask Dr. Z

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

Multilead generator replacement with addition of LV lead

Dr. Dunn, I am getting conflicting information. I have been told that on one of your webinars that you say the new gen replacement codes such as 33264 can not be used with any new leads. In all the Zhealth products I have purchased I do not see that. Maybe this is new infromation I missed??...So even though it has been asked before: how do you code for multi lead gen replacement (33264) attached to exsisting RA and RV leads with a new LV lead inserted, DFT testing. I thought it was 33264, 33225 and 93641. Has this information changed? From what I have read from the Zhealth and other sites is that the new gen replacement codes cannot be coded with new RA and RV lead insertion because combined codes exist but the LV lead is different because there is not a seprate code that combines them so they are coded seperatly. Let me know if I missed something or maybe I am not understanding....Thank you for your help and hopefully I will understand it this time!

Stress echo without contrast coding

Please do NOT include any actual patient medical records with your question. What codes should a facility be reporting for a stress echo(without contast)? Would 93350-TC and 93017 be correct? Thanks.

Nitrous oxide administration with repeat cardiac catheterization

Hi Drs. Z & Dunn, I am coding a cath in which the patient has "tetralogy of Fallot, pulmonary atresia with continuous PAs. She is status post tetralogy of Fallot repair which included an RV-to-PA conduit and branchpulmonary artery. At the time of operation, her VSD remained open due to concern for small pulmonary artery caliber. Patient's more recent history is significant for respiratory insufficiency which progressed to full respiratory failure requiring intubation earlier this morning. She presents today for diagnostic cardiac catheterization." Patient had a right & left heart cath while on 30% Fi02. Then the Fi02 was increased to 100% and right & left cath was repeated. I realize there was no pharmacologic agent administration, but oximetries and hemodynamic measurements were done under two separate conditions. So I am asking if 93463 would be appropriate to bill in this scenario? Thanks so much for your help!!

35011

Greetings, A patient had a enlarging aneurysmal stump of a ligated BC fistula. It is starting to cause the pt pain. The physician excises the aneurysm and performs a patch to the artery. I think this would be coded as a 35011. Medical records is using a unlisted 37799. I do not think this would be a 36832 as the fistula was ligated over a year ago and is no longer functional. Do you agree with the 35001? Thanks, LW

Non-selective catheter placements and stents

Dear Dr. Z: It just came to my attention that non-selective catheter placement is not billable with stent placement codes 37205, 37206. It is unusual for the stent to be placed on the same side as vacular access but is it incorrect to bill 36299 for non-selective venous catheter placement when a stent is placed in an extremity vein (no diagnostic venogram is performed)? Thank you. mlb.

37607

Please do NOT include any actual patient medical records with your question. a patient comes in to have their AV fistula ligated. not sure what code i should be using. a short transverse incision is made. the underlying cephalic fustula is double ligated .

codes 93922 and 93925 together

Please do NOT include any actual patient medical records with your question. Can we code 93922 and 93925 together. What would be the appropriate documentation that we would be looking for?

Securing a port

What do you believe is the correct code for the following report? Fluoro was not used. Following informed consent and sterile preparation, an incision was made over the right chest port. There was considerable scarring encountered which was negotiated with blunt and sharp dissection. Eventually, the port was identified and was not flipped; it was, however, quite mobile. Sutures were placed in the port to secure it. The port was accessed and flushed and aspirated easily. The incision and pocket were generously irrigated with antimicrobial solution. The incision was closed with resorbable suture. It was noted that the port was deep to at least 1.5 inches of scar tissue and could not be relocated more superficially. It will require an extra long Hubner needle to access the port, of at least 2 inches. The patient tolerated the procedure well.

Upgrade of a dual chamber defibrillator to a biventricular defibrillator

Hi Dr. Z I looking for a clarification from a question posted from March 8, 2012 "Question: Upgrade of a dual chamber defibrillator to a biventricular defibrillator. Remove and replace generator, insertion/addition of left ventricular lead and attachment of generator to previously placed atrial and right ventricular leads. How would you code this utilizing the new 2012 cpt codes? Thank you! Answer: I would code the removal of a dual chamber generator and replacement with a multi-lead ICD generator (as the final device placed is a multi-lead) as a multi-lead generator replacement, along with the LV lead at time of generator change. So the codes are 33264 and 33225. Dr.z" My question according to 2012 CPT manual 33225, in the parenthetical note, 33264 isn't listed as a CPT code to use in conjuction with 33225. I apprciate any clarification to this matter. Thank you!

Upgrade of dual-chamber pacemaker at ERI to biventricular pacing system.

Hi Dr. Z -- Upgrade of dual-chamber pacemaker at ERI to biventricular pacing system. Pacemaker generator removal; addition of left ventricular pacing lead. Re-use of right atrial and right ventricular leads. Implantation of biventricular pacing pulse generator. Is this as simple as the lone charge of 33224? THANK YOU!

Left main coronary artery DES

Dr. Z, Hi -- would appreciate your opinion. MD placed LEFT MAIN DES. He describes "high-grade disease in the proximal circumflex" and subsequently describes intervention (DES) "distal left main." Cath Lab reviewed the films and says, "Treated lesion(s) are continuous - the distal left main and into high proximal circ/OM branch were target lesions. MD ballooned multiple times at this site. THE STENT IS CLEARLY IN THE LEFT MAIN." MD has summarized: "LM = DES and PTCA; Left circumflex = PTCA" Would you charge/code: G0290-LC only or G0290-LD with 92984-LC? THANK YOU.

AV fistula resection or excision

My question is in regards to an AV fistula resection or excision .. The patient presented with a hemorrhage at the AV fistula access site. He was taken to the OR. The ulcer site was opened. The fistula was mobilized both proximally and distally to the site of the perforation. Clamps were applied proximally and distally. The doctor excised the ulcerated segment of the fistula, then mobilization of the arterial end allowed for an end-to-end anastomosis between the arterial end and the venous end of the fistula. Would this just be a revision of an AV fistula (36832) or is this more in depth? I am struggling with finding a code that fits this procedure.

Renal transplant non-selectively 75710

Good afternoon all, Please give me your thoughts on the following procedure. 36140 and ? 75710 CLINICAL DATA: PELVIC TRANSPLANT, RENAL FAILURE PROCEDURE: Informed consent was obtained, patient placed supine on the fluoroscopy table. The left groin was prepped and draped in the usual sterile fashion. The skin was anesthetized with 1% xylocaine. Using single wall technique, the left common femoral was cannulated. A 6 french sheath was placed over the wire. Multiple retrograde arteriograms were performed via the sheath. The sheath was removed and hemostasis was obtained with manual compression. FINDINGS: There was a stent noted at the ostium of the renal artery transplant/iliac artery anastomosis. The stent is in adequate position. No stenosis was identified. The visualized intraarterial branches are widely patent. The visualized iliac artery is widely patent. IMPRESSION: Indwelling stent noted in the pelvic transplant renal artery/iliac anastomosis is widely patent. jb

AV shunt intervention

How to code this procedure- Argon cleaner thrombectomy device? Hx: AV fistula occlusion. Stenosis in existing left subclavian stent. The stent underwent balloon dilatation with a 10cm x10 cm balloon. The argon Cleaner Thrombectomy device was used to displace the visible thrombus. A 6 cm x 40 mm Bard Conquest balloon was used to dilate the venous anastomosis. At the conclusion of the device there was difficulty obtaining hemostasis. The insertion sites were closed using two 2-0 absorbable sutures. Thank you.

36832

Greetings, A patient presents with compression of a fistula due to a hematoma. The physician evacuates the hematoma. Upon evacuation of the hematoma, pulsatile bleeding was still present originating from the back wall of the transposed brachiobasilic fistula present in the mid upper arm. I think this is coded as a revision of a fistula (36832) and not a revision of a fistula w/ thrombectomy (36833). I was wondering if repair of a blood vessel (35206) is better. What are your thoughts? Lesley