Ask Dr. Z

spinal angiogram, 75705

This was a involved case and I'm not sure we captured all the charges. Based on HIM's reply we were told not to charge for 36215, but I can't find anything that says to eliminate 36215 just bill 36216 & 36217. The catheter was used to select the right subclavian artery, followed by the right vertebral artery and a cerebral angiogram was obtained. The catheter was returned to the subclavian artery and used to select the thryocervical trunk and an angiogram was obtained. The catheter was advanced into the costal cervical trunk and an angiogram was obtained. The catheter was returned to the arch and used to select the left subclavian artery, followed by the left vertebral artery and a cervical and cerebral angiogram were obtained. The catheter was returned to the subclavian artery and used to select the thyrocervical trunk and an angiogram was obtained. The angled wide catheter was then exchanged for a Milaelsson catheter, that was 5-FR in diamter. The catheter was used to select the T5 radicular artery and angiograms were obtained bilaterally. angiograms were obtained of all the radicular arteries, down to L4. At this point the catheter was removed from the arterial system. The right femoral artery angiogram was obtained. This was obtained through the sheath. Hemostasis was achieved using a f 6 FR angio Seal closure device. 75685 x 2 ; 75705 x 24 ; 75774 x 4; Place cath add order x4; Place cath art 1st order x 24; cath art 2nd order x 1 & cath art 3rd order x 1?

Posterior Communicating Artery. Posterior Fossa. Vertebral Cerebral.

Dear Dr. Z: Which intracranial vessels are included in the vertebrobasilar system for assignment of 75685 via selective catheter placement / injection of the vertebral artery? I know vertebral origin to basilar,posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), and superior cerebellar artery (SCA). What about the posterior communicating artery? I assume any cerebral arteries are included in 75671. Thank you and have a good day. mlb

77012 versus 77002

Dr. Z Our Radiologists are performing MR Hip Arthrography using CT Fluoroscopic guidance. My question is can I charge both 77012 & 77002-59? Or is more appropriate to charge just the CT 77012?

Fluoroscopic insertion of spinal fiducial marker

What are the appropriate facility codes for the fluoroscopic insertion of spinal fiducial markers for a spinal tumor? If the patient is a medicare outpatient, would HCPCS C9728 and 77002 be the correct codes for this type of case?

62311 bilaterally

Dr. Z, Good morning! Radiologist will dictate "Left L5-S1 interlaminar epidural steroid injection", I charge 77003/62311. Radiologist dictates "Bilateral S1-2 interlaminar epidural steroid injection", I charge 77003/62311-50. I spoke to my radiologist, he says usally it is a bilateral injection, but ocassionally if the patient has had previous surgery or injury only one side is done. I asked that a bilateral charge be built in our chargemaster for the bilateral injections. They are getting challenged with this request, they say this code should not have a 50 modifier. What are your thoughts on this issue? I thought I was doing the charges correctly, no edits, but now the challenge from the the charge master software auditor. In your Interventional Radiology Coding book I find that 50 modiifers are to be used for the facet joints/64493, page 451, and nerve root blocks/64483, page 455. So I need help with the Epidural Injections. As always, thank you for your help, R Mercer

93623

Dr. Z, Question regarding EP study. Sometimes we code from the log and my question is can we code 93623 from the medication orders and medication list of given meds in the cath report? The order has information of route and dosage, our cath lab saying this is good enough to charge 93623 but for me to charge 93623 need better documentaion, please advice. Thanks

Cholecystostomy tube check 47525

Hi Dr.Z: I would just like to clarify the coding for a cholecystostomy tube check with change of the tube. According to the information on Ask Dr. Z Database the coding could vary for example 49424/76080 & 49423/75984 for tube check & change or 47505/74305 & 47525/75984. Your new IR reference book (2011) implies to always use 47505/74305 & 47525/75984. Please advise?

93463

Since there was a code established for cath lab 93463 for administration of pharmacologic agent. Has there been any rules established for billing of the nitric oxide when administered in cardiac cath lab to study vasoreactivity?

92995

What code would you recommend to use when a laser atherectomy is done during an interventional cardiac cath? Code 92995 makes no mention of a laser. Thank you.

34001 35371 37203 Spider filter

Need to find where it says that only one method of thrombus removal is to be used. I had a doctor, do an open thrombectomy of the brachial, then the axillary/subclavian, then the radial and ulnar, used a spider filter, then did angioplasty and stent of axillary/subclavian no stenosis documented. He wants to bill 36215 75710 75650 37203 75961 35475 75962 37205 75960 34101 34111x 2. I am trying to find documentation to show him that only one method of thrombus removal is to be used. The codes 36215 75650 and 75710 were from rt common femoral access, all others were done through the open brachial access.

Hero device 36830

Dr. Z. What codes would you use for the radiologic services provided in the O.R. for a Hero graft placement? Basically, the tech is providing fluoro and saving pertinent images for the vascular surgeon. Thanks, Judy A.

10160

How do you recommend coding an ultrasound guided drainage of an anterior abdominal wall seroma? I found a Q&A from 2008 about a breast seroma where you recommmended 10160 & 76942. Our physician inserted a Yueh sheath then a wire and drainage catheter w/holes. He removed 3300ML of fluid then kneaded, palpated, and compressed the abdominal wall to eliminate all fluid. Ultrasound revealed no remaining fluid. The catheter was attached to JP bulb suction and abdominal binder was applied. We're leaning toward unlisted codes 49999 & 76492 because it isn't an abscess (10160) and it isn't an open drainage (10140) and would appreciate your opinion. Oh, the seroma doesn't appear to be infected - if that helps at all. Thank you.

Reprogramming a loop recorder

Is there a specific code for reprogramming of a loop recorder? Patient came in and had an EPS, and at the end of the procedure they reprogrammed the loop recorder. Not sure if I should use 93285 or 93286. Thanks, Cynthia Boyer, CPC, CCS

Intravascular imaging of coronary vessel by optical coherence tomography (O

Dr. Z, what would you suggest for intravascular imaging of coronary vessel by optical coherence tomrgraphy (OCT), not sure if we can use 93799? Thanks

Aneurysm sac sensors / cardiomems

Hi Dr. Z., We have a question regarding aneurysm sac sensors/cardiomems. A patient came in 2010 for an abdominal aortic endograft. The doctor also implanted a sensor (34806). Now he comes back into IVR, and the doctor measures the pressures using the previously implanted sensor and inserts a Palmaz stent. Can we charge 93982, or this code is to be used exclusively when performed in an office setting? Thanks for all your help!

Femoral arteriovenous fistula for a pedicle free flap to lumbosacral area

Greetings, I have a physician completing a femoral arteriovenous fistula for a pedicle free flap to the lumbosacral area. They tried a iliac artry exposure first but due to scar tissue they had to expose the femoral vessels. The physician harvested the entire greater saphenous vein,then anastomosted the vessel to the common femoral artery. This was then tunneled to the lumbosacral area. While tunneling the illiac vein was injured. How would I code this? A fistula tranposition code with a 36818- 22. The unlisted code 37799. Do you have any advice? Thanks, LW

Date of service on operative report

I have an odd question and will understand if you choose not to answer. I have one physician who refuses to put the date of service on her dictated operative/procedure reports. She insists that the DOS is not required. When I review our hsp policy regarding all physician documentation it doesn't include any reference to DOS on op report either, nor apparently does the JCAHO reference on this. The manager of Medical Records said he figured it was assumed that a dos was a reasonable data element to expect. He too was surprised to see it not mentioned. Do you have any advice on this? Thanks

Removal of broken tunneled CVA with port

Greetings, How would gou code the removal of a broken tunneled CVA with port? The physician had to perform a cutdown to remove part of the cath and he also removed the port from the pocket. The physician then repaired the jugular vein. Would you code 35201 and 36590? It seems like a repair would be bundled. I thought about 22 and also about a unlisted code and base the RVU on the cutdown code but I just don't know. Any ideas? Thanks, LW

93922 if ABI not performed at both posterior tibial and anterior tibial/dor

Can we bill 93922 We have a testing device that uses pressure cuffs at the arm, ankle and toe with the method: oscillations in the cuff caused by pulsations of the patient's artery are recorded and converted to mmHG. Software algorithms determine systolic pressure values. The technician places blood pressure cuffs on the patient's arm and ankles and the machines provides the brachial and ankle pressure and ankle/brachial index and PVR waveforms. Does this meet the requirements to bill 93922. 93922 requires ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries. The machine we have cannot differentiate the 2 ankle pressures (distal posterior tibial and anterior tibial/dorsalis pedis arteries). We are not utilizing this machine as a screening tool. We have diagnoses acceptable for 93922.

Percutaneous laminotomy

There is a new category three code for a percutaneous laminotomy of 0275T which I am using as of July 1st however what code should I have been using prior to July 1st?

47011

For five hepatic cysts that were drained, 10-20cc each with a yueh cath just for theraputic reasons, would you use 47011x5? The coder says to use 10022x5 because he didn't make an incision. Does the blade knick for insertion of catheter fall under incision subterm in the cpt book? Paracentesis and other absess drainage are under incision also. Thanks,

Carotid angioplasty

Are coders using the unlisted procedure when a PTA is done to reopen a previous stent? Not seeing anything else to use and don't think they cover it.

CT brain w/o contrast with cerebral perfusion exam

Is a CT brain w/o contrast included in a cerebral perfusion analysis exam?

Migrated coil during embolization

Dr. Z Physician performed gonadal vien embolization for vacicocele. While doing the procedure the final coil migrated to left renal vein. Physician made several attempts to remove the coil using several catheters and snare but unsucessful. He even considered using different access however after viewing the images decided the the diameter and high flow of the renal vein make future clinically significant events related to this short protruding segment of coil very unlikely.He left the migrated coil and successful embolization of gonadal vein. We are charging embolization of gondal vein however not sure if we can charge 37203-74 75961-74 since multiple attempts, time and effort to retract the migrated coil and also we have different opinions what to code for the diagnosis of the migrated coil? Please advice. Thanks

Flecainide challenge

Dear Dr. Z, Thank you for taking the time to consider my question. Our facility treated a patient who they suspected as having Brugaga Syndrome so a flecainide challenge was done. The patient had a base EKG done then was given 400mg of oral flecainide. EKG’s were then done after one half hour, one hour, two hours, three hours and four hours. My question is what CPT code (if any) would be appropriate for this procedure? I have reviewed the Noninvasive Physiologic Studies and Procedure section of the CPT book and 93799 – unlisted cardiovascular service or procedure is the only one I feel can be used. The other option I have considered is to only code the EKG’s and not apply a code for “flecainide challenge”. Thank you in advance for your input. Debra Patterson, RHIT

CPT code 35875, 35876

Greetings, Would a open thrombectomy of a fem pop bypass graft be coded as 34201 or 35875? LW

AV graft creation, angiography, angioplasty

Dr.Z, Question for AV graft creation. Hand venogram performed and peripheral veins looked fine howver central venogram demonstrated extensive collateralization around the left subclavian and innominate veins. The decision was made to proceed with a left subclavian and innominate veins prior to creation of an AV fistula. The post op diagnosis states left subclavian and innominate vein stenosis. After PTA performed creation of left upper extremity b rachiobasillic AV fistula. My question can we charge PTA separate from the creation or it is part of the creation. If we can charge PTA can we charge two or one PTA? Thanks

36010, 37620, 36580

Dr. Z. Doctor performed an IVC Filter placement and a temporary hemodialysis cath replacement via the IVC including a inferior venacavagram peformed using carbon dioxide gas. I'm using cpt codes 75940,37620,36010-59 & 36580 are these the correct cpt codes for this procedure.

76937 with other procedures

Is this code billable with procedures other than tunn cath's, central lines, etc...I know it's able to be billed with other codes but it either won't get paid by insurance or it edits out in our system as being an add-on, etc...

I just wasn't sure if we're supposed to be pushing this through, if it's correct to be billing it, etc...I hadn't heard anything recently so I was curious what info. you may have.
 

Billing heart catheterization with 59 modifier

I have a provider that did a radial access attempts to advance the J wire into the aorta from the right radial was not successful, therefore a JR cath was advanced to the level of proximal subclavian and an angiogram was performed. Apparent that the pt had about 75-80% right sublcavian stenosis. Glide wire was advanced into the ascending aorta and the JR-4 and AL-2 multiple angulated view of the Rt and Lt coronary performed. JR-4 was used to selective engage the vein graft to the RAMUS and vein graft to the marginal and selective angiography of these grafts were performed. LIMA was patent because of competitive flow in LAD. No attempt was made initially to engage the LIMA. At this point the provider did a common femoral arterial access was obtained, LIMA cath was selective engaged into the left internal mammary, angio performed. Pigtail cat was advanced into the ascending aorta, aortic root ang was performed. AL-6 guiding cath then selectively engaged into the the Rt coronary artery, multiple agulated views of Rt coronary artery were performed. This was performed after 300mics of IC nitroprussied. Pt given ANGIOMAX bolus and drip in .014 whisper wire dilated from distal RCA to mid RCA. Drug eluting stent was then done.

My question on this case is can I bill anything for the first access that was not able to complete the heart cath?
I have one coder that feels we should bill 93459, 93459-59 or 74, G0290,93567.

The other coder feels we should bill 93459,G0290,93567 and 36216 and 75710 for the subclavian access and angio.

Any guidance you can give use on this case would be greatly appreciated.
Thank you for your assistance.
 

Multiple procedure discounting lower extremity revascularization

For the new revascularization codes, are there any multiple procedure payment reductions we should be aware of? Like if they do stent in 2 places or even a primary and 2 add on’s in the iliac or tib/peron territory, would the 2nd add-on payment be reduced or would they get full reimbursement?

Docs are asking and I really am not sure where to find this info!
 

33220-5952

We come across a case where the patient scheduled for upgrade of AICD to Bivent AICD however after unsuccessful multiple attempts decided to place only a dual chamber AICD. During the procedure found to have insulation breach proximal to the suture sleeve and was repaired with silicone glue and the old generator explanted. A new atrial lead was placed which attached to the new dual chamber AICD along with the existing RV lead. There are NCCI edits for 33249 and 33220 or 33218 edits can we assign with repair codes with ‘59’? And also in this scenario if we can code the repair which one you suggest 33218/33220?

Thank you for your time.

AAA endoleak with catheter placement under CT guidance

Patient has an infrarenal AAA with type 2 endoleak. Bifurcated endograft is in place. Patient goes for a CTA abdomen for identifying the endoleak. Patient in prone position and CT fluoro used to advance the needle into the posterior aspect of the sac near the site of the endoleak. Bentson wire advanced into the aneurysm sac. After "successful placement of access system into the aneurysm sac" the patient goes to IR suite for coil embolization. Kumpe cath advanced into the aneurysm and coil embolization with follow up images obtained. I found Q&A 2182 that appears to be a similar but different sort of scenario. I don't think there is anything to code for the access in this case, but wanted to get your opinion. Very unusual access I've never seen before. Thanks Dr Z.

TIPs placement with ultrasound

Can we bill for u/s guidance (permanent image on file and documentation of vessel patency is in report) when placement of TIPS is performed?

Catheter placements and lower extremity revascularization

Our hospital recently purchased both the cardiology and the IVR books. I have a question on one of the examples in the book.
In the Interventional Radiology book on page 232---example no. 1, when they did a selective catheterization in the contralateral leg and an S&I-there is no catheter placement code. I see they also did a PTA in same leg. Is it because they did a PTA also on same side? If that is the reason, then-if they had did a select cath and S&I on left leg and a PTA on right leg-then could you code the selective catheter placement, S&I and PTA?
 

Ablation of tumor in renal fossa kidney removed

Dr Z, Hello! I have a question regarding percutaneous ablation procedures. In my hospital we do RFA, Cryo, and Microwave of liver, lung and renal tissue. In your January 21, 2011 newsletter, Percutaneous Tumor and other Ablation Procedures, I found the codes I was looking for to use for soft tissue masses, 17999. I had these built in the chargemaster, but in checking the reimbrusment for this code it is not in the same category as the liver, lung and renal tissue. Is there another code for soft tissue ablation that we should be using? One example that has come up is renal cancer, the kidney was removed and now there is recurring tumor in the renal fossa. The radiologist read it as a soft tissue mass that was ablated with a microwave technology. In your book on page 395 number 7 says to use "unlisted codes for RFA of soft tissue and organs not specifically listed with a code". I think that maybe I misunderstood the newletter and that I need unlisted codes for different anatomical areas, and different procedures-RFA, Cryo and Microwave. I hope you can help. Thanks, R Mercer

CT guided nephrostomy placement

Dr. Z This is a CT-Guided Nephrostomy Placement question. CT is used to direct entry into the left collecting system. Left back is sterily prepped and draped. There is placement of a 17-French introducer guide and the needle is removed. Bloody urine is obtained. 0.038 Benson wire is placed through the introducer guide and the needle is removed. Over the wire a 6-French dilator is placed. That is removed. Finally there is placement of an 8-French pigtail type catheter which is coiled in the left renal pelvis and its pigtail locked. Codes 50392 and 74475 were used but the question is can we also code the 77012 for the CT-guidance? Your interventional book mentions that fluoro and ultrasound are both included but is the CT?

Daily Management of VAD

I had attended the 2011 Cardiology Conference in Florida in December. Dr. Dunn was one of the guest speakers and he had given us information on how to code the Ventricular assist device (VAD). He provided us with the Initial 24 hours use of transseptal VAD (0048T), Prolonged use of VAD beyond 24 hours (33999) and Removal of percutaneous VAD (0050T). I had asked Dr. Dunn if there was a code for the Management of the VAD. He wasn’t sure if we were to bill 33999 so he had asked me to contact your office. He stated that Dr. Z performs this procedure more often than he does.

Any information would help.

93460

Should 2011 CPT code 93460 be used for R/LHC even if Left Ventrigulography is not performed? The coronaries were injected.

Thank you,
 

Open and percutaneous AV dialysis graft intervention

Hello - If an open thrombectomy of an AV graft was performed in the OR and took care of the thrombus, and the patient was then transferred to the CATH lab immediatley after open procedure and angioplasty and stenting was also performed of the AV graft to treat the stenosis causing the thrombolysis. Can we code for all the procedures?

36831 open thrombectomy of AV graft
35476 Angioplasty of AV graft
75978,26
37205 Stenting of AV graft
75960,26

Shouldn't the Dr. have to state that after the angioplasty flow there were suboptimal results therfore they proceded with stenting in order to bill for angioplasty and stenting? Also, can we code for the open thrombectomy with the percutaneous angioplasty and stenting?

Thank you for your help!

We found this in the CMS NCCI guidelines:
7. If a failed percutaneous vascular procedure is followed by an open procedure by the same physician at the same patient encounter (e.g., percutaneous transluminal angioplasty, thrombectomy, embolectomy, etc. followed by a similar open procedure such as thromboendarterectomy), only the HCPCS/CPT code for the completed procedure, which is usually the more extensive open procedure may be reported. If a percutaneous procedure is performed on one lesion and a similar open procedure is performed on a separate lesion, the HCPCS/CPT code for the percutaneous procedure may be reported with modifier 59 only if the lesions are in distinct and separate anatomically defined vessels. If similar open and percutaneous procedures are performed on different lesions in the same anatomically defined vessel, only the open procedure may be reported.

 

EKOS

What is an EKOS considered? We infuse TPA and use ultrasound to break up the clots. We bring patient back between 6 and 24 hours for a recheck. Is it a mechanical thrombectomy because of the ultasound or infusion for thrombolysis?

Nephrostomy tube placement

I have two questions:

1. Patient came for nephrostomy tube and the following day scheduled for nephrolithotomy. Nephrostomy tube was placed by IR physician accessing the renal pelvis and nephrostogram performed and there are findings for the collecting system. Then inserted a nephrostomy tube. Coded 50390-59, 74425, 50392, 74475, however, since scheduled for nephrolithotomy we can only code 50395, 74485?
2. How do you suggest coding when nephroureteral stent was placed for PCNL. Patient came and the IR physician performed nephrostogram and nephroureteral stent was inserted. Same as nephrostomy tube?
    

documentation

Do you have any material published or available that explains how the procedures need to be documented? Is there specific verbage necessary? Are there any CMS guidelines stating specifically what they are looking for in a cath lab procedure report? Thank You

Chest x-ray and tube placement

I was at your recent seminar. I want to thank you for a great experience. I’ve learned so much and can’t wait for next year’s seminar. One of the many things that I’ve learned is that we should not bill for a chest x-ray on the same date as any line or tube placement. I’ve also tried to research and googled this information but was unsuccessful. Please forward the document to support this so I can properly educate the radiology department.

complex pneumothorax treatment 32551

Physician inserted 3 indwelling chest tubes on the left with radiological guidance for treatment of hydropneumothorax. Can we code 32551, 32551-59, 32551-59, 75989?

Sclerotherapy of pelvic varices at time of embolization

Is there an additional charge for sclerotherapy performed of the pelvic varices at the same time of the embolozation?

Follow up CT MRI during 90 day global

Dr. Z, Our radiologist does Discectomies, vertebroplasties, and kyphoplasites quite a bit. He always has a follow up CT/MRI in 2 weeks to 1 month. These procedures have a 90 day global, can I charge for the follow-up CT/MRI? Thanks

Pipeline embolization device 61624

Dear Dr. Z, Would the use of the "Pipeline Embolization Device" for treatment of carotid wide-mouth aneurysm be considered 61626 / 75894? No coils are placed so I'm wondering if it is still considered an embolization. Thank you. mlb

34803

This patient was brought in for repair of iliac aneurysm and AAA. A bifurcated graft was placed and in addition, a stent was placed inside of the iliac limb of the graft due to vessel tortuosity. CPT book indicates that 37221 iliac stent is for occlusive disease. We have 34803, 75952, 36200 x2. Main body stent graft 32 x 96 was advanced from a right approach into the abdominal aorta. The contralateral limb was oriented anterolaterally. Proximal 2 stents were deployed and position adjusted to just below the level of the renal arteries. Contralateral limb was deployed. The suprarenal stent was deployed and catheter was pulled back to the distal abdominal aorta. Catheter was exchanged to a Kumpe catheter and later a Vanshee catheter. Contralateral gate was cannulated using the Vanshee catheter. Intraluminal position was confirmed by injecting a small amount of contrast within the graft. Lunderquist wire was advanced to the upper descending thoracic aorta. The catheter was removed. Left iliac arteriogram was performed to evaluate the common iliac bifurcation. A left limb 14 x 90 was advanced from a left approach to about 1-1/2 stent overlap. The stent was deployed proximal to the common iliac bifurcation. Due to tortuosity of the common iliac artery, it was decided to place a self expanding stent to increase radial force. A 14 mm x 60 mm SMART stent was deployed within the left iliac limb. The remaining 2 stents from the main body were deployed and nose cone was retrieved. Right iliac arteriogram was performed. Right limb 12 x 107 was advanced from a right approach to the right iliac limb. 2 stents overlap proximally and distally. The stent was deployed in the proximal right external iliac artery covering the origin of the right hypogastric. The infrarenal neck areas overlap and distal limbs were dilated using compliant balloons. The stent on the left was dilated using a 12 mm angioplasty balloon. Completion arteriogram was performed through a pigtail catheter from a left approach.

ICD 33249

I need some help coding the following. The patient was brought to the heart catherization laboratory and draped in the usual sterile fashion. Consent was obtained prior to the procedure. IV conscious sedation as given using Versed and fentanyl thoughout the case. Next we attempted to cannuulate the left subclavian vein.We then took a venogram of the left subclavian vein and it was found to have diffuse collaterals and no good discrete subclavian vein to proceed with the implant on that side. Therefore, we went to the right side of the patient and we took a venogram and this time there were good images seen of the right subclavian vein. Next approximately 15Ml of lidocaine were used to anesthetize the planned pacemaker pocket on the right side of the patient.Next using Seldinger techinique two subclavian access sites were obtained and then the pacemaker pocket was created using a scapel and cautery. At this point over a 7-French introducer sheath the right ventricular lead was positioned into place near the lower RV septum. This sheath was torn and peeled away and another 7-French introducer sheath was inserted and the lead was then placed at the right atrial appendage. RV pacing leads were kept on the patient due to the fact that he had a baseline left bundle branch block. Next the coronary sinus sheath was inserted and a specific sheath for the right-sided coronary sinus was inserted and using a J-tipped guidewire we able and contrast we were successfully able to cannulate the coronary sinus. Tehre was found to be a mild lateral vein though small which was used as our planned placement for the LV lead. At this point the LV was positioned over a coronary guidewire into the mid lateral vein and successfully wedged into that position. The sheath was then slit appropriately and the lead was kept in place. At this point pacing thresholds were also checked here and they were within normal limits. Next the sheath was torn and peeled away and all 3 leads were sutured using 0 silk to the left pectoral muscle. Next antibiotic solution with consisting of Bacitracin and gentamicin was used to flush the pocket at this point. At this point 2-0 and 4-0 Vicryl sutures were used to close the pocket. Steri-strips were applied on the skin level. The estimated fluoro time would be 25 minutes. Implanted Device: Boston Scientific Guidant Contact Renewal CRT pacemaker. the patient had a heart cath with grafts: 93459-26 ICD Insertion: 33249 33225 71090-26 Is this correct codes to use?