Ask Dr. Z

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

Ask Dr. Z Disclaimer

3D Transthoracic Echo

Can 76376/76377 be reported on the same day as 93306, 93307, or 93308 when 3D imaging is used? Or are 76376/76377 only reportable when the 3D rendering occurs on a different day from the base procedure?

VATS resection of right 4th rib

Would the below VATS procedure be coded as 32662 or unlisted?

"The 3rd and 4th inner intercostal muscles were widely dissected off of the posterior 4th rib to make room for division. Arm #2 was removed and a Stryker Pi drive drill with a long shaft was placed allowing precise division of the posterior 4th rib. Division of the posterior 4th rib allowed the rib to be retracted inward like a trap-door, which facilitated division of the surrounding muscles from the outer surface of the 4th rib. As the tumor was approached, a rim of external intercostal muscle and likely serratus anterior were taken with the specimen. Dissection continued anterior to the prior costal cartilage division, at which the remaining muscular connections were divided, completing the 4th rib resection."

Ascending aortogram with diagnostic card cath

During diagnostic cardiac cauterization, aortogram was performed to locate origin of the circumflex. Would the ascending aortogram be coded in this case?

Per cath report "Anomalous origin of the left circumflex. Prior CT chest from 5 years ago reviewed during the case. Circumflex does not originate from the aorta, it may originate from a branch of the pulmonary artery, although difficult to visualize origin. Non-aorta take-off was confirmed with aortogram."

Bilateral renal artery stent placement - 37236, 37237 or 37236-50?

Should bilateral renal artery stent placement be reported as 37236, 37237, or 37236-50? We understand that past guidance (such as from question IDs 5462 and 8218) states to use 37236, 37237 in this given scenario. The rationale given in Question ID 8218 was that modifier -50 “applies to lower extremity revascularizations, but not to renal, visceral, [or] upper extremities”. However, code 37236 is a "conditional bilateral" code as per CMS, meaning that modifier -50 is applicable to it. Is this to say that modifier -50 is only applicable to code 37236 when lower extremity revascularization of non-occlusive disease is performed? Or, should it apply to any applicable anatomy that has bilaterality, such as the renal arteries?

Perfusion bypass catheter with ECMO

As we begin to see patients on ECMO longer and longer, surgeons are adding another catheter to support continued perfusion to the extremities. Would this be considered included in the ECMO, or could another CPT code be applied? I found that code 36620 might be a good representation code for this work. What are your thoughts?

"The 5 French catheter in the Right SFA was serially dilated to accept a 6 French distal perfusion catheter and flushed with hep saline. Contrast was administered through distal perfusion catheter with confirmation of flow down the SFA. The SFA cannula connected to the side port of the arterial cannula. ECMO flow initiated with good color change."

Pocket Revision for erosion prevention

Physician performed a pocket revision for device erosion prevention and placed an Aigis antibiotic pouch. For this, would 33222/33223 be applicable depending on the device used?

cpt 93306,96374, and Q9957

Provider billed 93306, 96347 and q9957 and claim was partially paid. Payer denied 96374 as inclusive it this correct and/or can we add modifier 59

Biventricular ICD pocket infection with extraction

Incision extended to pre-existing pocket. Device was freed from the pocket. There is pus coming from the pocket which was irrigated & culture sent. Leads disconnected from old generator. All 3 leads were able to be easily removed with placement of stylette and retraction of the screws with gentle traction. The upper pocket incision was then. Access obtained to left IJ under ultrasound guidance with placement of guidewire. A 6 French peel-away sheath was then advanced over which a Boston Scientific pacing lead was advanced to the right ventricular apex and secured with active fixation. The explanted generator was then cleaned and attached to the lead and the atrial port. The RV and LV port were then plugged with pin plugs. Externalized device and lead used to continue backup pacing for a few days.

I am new to EP I currently have 33244, 33241. Would I also add 33234 since there were 3 leads removed, or since there was a new lead attached for the external device leave the 33234 off of the claim?

Bilateral Iliac Vein IVUS

How would you code the following? Surgeon accesses right IJV, advances the sheath and performs a bilateral LE venogram. After diagnostic venogram, they proceed with intervention. Catheter is placed in IVC, then in RT CIV, LT CIV, RT EIV, LT EIV, RT common femoral vein and LT CFV; all with IVUS performed in each vessel. Compression is found in each vessel and measurements are documented. Surgeon decides to place stent in RT CIV, RT EIV and RT CFV. I am coming up with 37238-RT, 36012-RT, 37252, 37253x5, 75822-59.

AVF Angioplasty Medical Necessity

An AVF angioplasty and embolization was performed and provider queried because stenosis percentage was missing for intervention. The provider responded that the stenosis was greater than 50% but angioplasty was performed for low flow volume due to failure of maturation and treated with assisted maturation (angioplasty) to increase the diameter of the AV fistula to allow for access in dialysis and adequate flow volumes to achieve dialysis. The patient also underwent coil embolization to redirect outflow of the fistula at the same time to increase flow volumes in the distribution of access in the cephalic vein. When angioplasty is performed for this reason, is stenosis percentage still required in the documentation?

2ND TIME! Epicardial Hybrid Thoracoscopic Sinus Node Modification for IST

Facility charges only. Performed by CT Surgeon and Cardio Interventionalist in EP Lab. Pericardium retracted, exposed right atrium SVC and IVC. Exposed the pulmonary veins and posterior SVC. SA node mapped by CIV in baseline and on isoproterenol. Area marked and SVC RF ablation line with 2 burns above SA node, series of burns along the crista terminalis of RA. 3 burns places across the IVC RA junction. Elevated heart rate on isoproterenol so further mapping and RF ablation- 34 burns on CTI. 2 more burns at SVC RA junction. Further mapping by CIV as well as endocardial ablation via femoral access with RF ablation catheter. Due to cross-clamping of the patient's pacemaker leads during the SVC lesions, we performed testing both before and after the case. All lead parameters including impedance, threshold and sensing we restable both before and after. The patient's device was programmed to DDDR, 60-125 beats per minute at the end of the case. I am thinking 33265, 93631, 93286, 93623 for the facility charges. Please help!! Thank you in advance, you're the best!

TIPS with Coronary variceal shunt embolization

1. Successful creation of a TIPS from (likely) the middle hepatic vein a branch of the left portal vein with placement of a 10 mm x 9 cm Viatorr stent graft, extended cranially with a Viabahn VBX 10 mm x 37 mm stent graft. The portosystemic gradient

decreased from 12 mmHg to 10 mmHg following placement of the TIPS.

2. Embolization of a large coronary variceal shunt leading to esophageal varices.


93656 verses 93653

93656 vs. 93653. To save space, I am only including the actual ablation portion of the report. 

"Pt presented for atrial fib ablation. A complete 3D electroanatomic map of the left atrium, pulmonary veins, and region by the left atrial appendage was drawn with an Octaray mapping catheter. All four pulmonary veins were still electrically isolated from prior ablation. There was a fragmented signal anterior to the right-sided PVs and one lesion was placed here on the septal side. Some scarring was noted along the roof and inferior posterior wall of the LA, with a few areas of other scattered scarring. Next, using a thermocool Smart Touch ST SF DF ablation catheter , the roof line connecting the left and right superior PVs was reenforced. A floor line was created conecting the left and right inferior PVs. A "+" was created in the PW creating four quadrants, and fractionated signals were ablated within each quadrant. Entrance and exit block were demonstrated. A repeat map of the LA confirmed posterior wall isolation. All lines were then removed, and protamine was given."

"Recent" CTA

From your seminars I've attended in the past, there is always a slide regarding physician documentation best practices. Regarding peripheral studies, one of the bullet points is to state reason for repeat diagnostic study such as: change in clinical status since prior study, prior study doesn't include the area of current interest, prior study was inadequate for visualization of area of concern, emergent transfer and images not available. Is there guidance on what time frame is considered a recent CTA/MRA/Angiogram? Within that certain time frame the physician would need justification for repeat diagnostic at time of intervention. There is a discussion amongst our team as to whether recent means within the past 1,3 or 6 months. As always, our team greatly appreciates your guidance.

Trans-Apical Access for TEVAR

What is the CPT code for transapical access for TEVAR with coverage of the left subclavian artery: 33880, unlisted, or something else?

Percutaneous ethanol ablation of the bilateral pudendal nerves


- Target organ: pudendal nerves

- Image-guided chemical ablation

Chemical ablation

Under CT guidance, the ablation needle was advanced and positioned within the target(s). For each target lesion, the needle was placed and repositioned as necessary to achieve the desired ablation zone. Contrast injection through needle: Performed, confirming extravascular position.

Ablation needles: 21 gauge Chiba

Target #1

Ablation position 1

- Volume of chemical (mL): 5

Ablation position 2

- Volume of chemical (mL): 5

Intraprocedural imaging findings: appropriately positioned needles in the pudendal canal.

Needle removal :The ablation needle was removed and a sterile bandage was applied.

Imaging following ablation

Post-ablation imaging: noncontrast CT

Post-ablation imaging findings: post ablation changes without complication.


Contrast agent: Omnipaque 180

Contrast volume (mL): 8

Radiation Dose

CT dose length product (mGy-cm): 2208

Will this be coded as 64999? What is an equlivent procedure for billing purpose?

Tomosynthesis core needle biopsies

I know there's official guidance that states if both stereotactic AND tomo are used to only report 19081, and if it's just tomo to report 19499. What code would you consider for this excerpt below? I'm getting confused when a report states, "Mammo guided WITH tomo."

"TECHNIQUES: Patient was placed sitting upright and erect.  FINDINGS: Mammographically guided with tomosynthesis core needle biopsies of calcifications in the upper-outer quadrant of the anterior left breast. This was done with aseptic technique and local anesthesia, 1 percent lidocaine with bicarbonate. The breast was compressed in the CC projection and biopsy was from the superior aspect of the breast. A small dermatotomy incision was made. Twelve biopsies were done with the vacuum assisted 9 gauge Eviva needle. A top hat marker was placed at the site."

93598 with 93505

Can we report thermodilution code 93598 with 93594 and 93505 for a congenital heart biopsy case? I know we cannot report it with non-congenital heart codes 93451-93460; however, nowhere in the CPT Codebook says that it cannot be reported with 93505. Moreover, the CPT Codebook says to use 93598 in conjunction with 93593-93597. Now my question is, can it be reported separately with 93505 in congenital cases? Is thermodilution still considered part of 93505? I'm not talking about Fick cardiac output method.

Initial AV synthetic vein graft along WITH neighboring vein graft

The patient came in for AV graft(36830) along with basilic vein graft after a diminished distal brachial pulse. Would there be a separate code for the vein patch angioplasty?

"Following initial construction of a brachial–axillary left upper arm AV graft, there was a complete loss of left radial pulse and Doppler signal, as well as a diminished pulse in the distal brachial artery. Due to significant concern for ischemic steal, I elected to revise the graft with more proximal looped inflow. The arterial anastomosis was taken down and the brachial artery was repaired with a patch of neighboring basilic vein. New inflow was constructed onto the axillary artery adjacent to our venous outflow anastomosis and a second graft segment was tunneled in the more medial upper arm. The 2 grafts were anastomosed to 1 another, creating a looped upper arm axillary–axillary AV graft. Upon completion, there was a palpable thrill in the graft, an ongoing faintly palpable radial pulse, and a multiphasic radial Doppler signal."

Central Venogram thru temporary hemodialysis catheter and removal

How would you code for the central venogram through the central venous catheter and then the removal of the catheter? I was thinking of only using code 36598.

"The left neck was prepped and draped, and the anchoring sutures were removed. The indwelling catheter was retracted into the peripheral aspect of the left brachiocephalic vein, from which a central venogram was performed. Imaging showed no central venous stenosis or central venous mural thrombus. It was felt that this patient would best be served by placing a Quinton catheter in a different location (reported separately). The Quinton catheter was then removed, and manual compression achieved hemostasis."

Venous stenting Lower Extremity

Is 37238-RT, 37239-LT, 37239-LT appropriate?

64% compression in the right common iliac

58% compression in the right external iliac

57% compression in the left external iliac

60% compression in the left common femoral

Stent to the right CIV that covered the compression of the right EIV

Stent to the left EIV

Stent to the left CFV

IVUS shows separate compression of the left CFV.

Insurance has denied 37238 for modifier. "After review of the medical record, bilateral stent placement in the lower extremity venous system was supported. There is a more appropriate modifier available."

37215 and 61635

I know these two codes bundle, but are they billable together same side when cervical and cerebral artery stents are placed?

Angioplasty and stenting of left internal carotid artery origin with distal embolic protection

Angioplasty and stenting of the intracranial left internal carotid artery petrous/lacerum segment

Ecmo Decannulation with Venorraphy

How would you code decannulation with vein repair? 33969 says cannulated vessel repair is included, but the provider feels it should be coded separately for additional work.

"The incision was carried down to the level of subcutaneous tissue using electrocautery. Fibers of the SCM muscle were then divided longitudinally to allow access to the IJ and the cannulation site. Once the cannulation site was exposed, we placed stay sutures using 5-0 prolene at the 12 o clock and 6 o clock position to help with retraction. With manual pressure being held proximal and distal to cannulation site, the cannula was withdrawn slowly in its entirety. The cannula was then passed off of the field. With the venotomy visible, we performed a venorrhaphy using 5-0 prolene in a running fashion. No obvious bleeding from the venorrhaphy was visible after pressure was relieved at proximal and distal ends."

Billing Wound Vac's with Skin Grafts

When would it be appropriate to bill a wound vac on the same day as a skin graft application?

Liver Embolization

Would coding be 36247 (rt hepatic) and 36248 (Segment 8) for the catheter placements only or 36247 only for the below? I am having trouble with the catheter selection is segment 8 going further or an addition placement? A mesenteric catheter was used to select the celiac artery. An arteriogram was performed demonstrating the origin of the right hepatic artery. A microcatheter was used to select the right hepatic artery. An arteriogram and cone beam CT were performed demonstrating tumor enhancement from the segment 8 artery. The microcatheter was used to select the segment 8 artery. An arteriogram and cone beam CT were performed confirming tumor enhancement. The tumor was embolized with 0.5 mL lipiodol. A completion non-contrast cone beam CT was performed confirming adequate tumor staining. I appreciate your help with your this question!

severe stenosis distal aorta&common iliacs &localized dissection aorta

Due to the fact that it was obvious that the distal aorta had to be dilated an angiogram was first obtained with the finding of the renal arteries to be higher than the area to be treated and therefore, the wires were placed on both sides. Next we dilated the area of the distal abdominal aorta to be able to place the stent there, which was an 11 mm across and 39 mm long. The wires were still both inside that stent and therefore, both of them were to be used to place the stents into each of the iliacs on each side, and both had to be simultaneously inflated. Once the stents were placed on both sides in the form of kissing stents, the patient had an angiogram done, which showed no obvious extravasation. the 8-French sheaths were used on both sides to make sure that upon injection of the sideports, the internal iliacs were not involved. Given the fact that the angiogram was acceptable, the patient had Perclose devices placed . Considerations: 37221-50, 37236 (stenosis bridging?) vs. 34701 or 34703, 37221-50 treatment of dissection or stenosis?

Breast aspiration with mammography or stereotactic guidance

If the providers are performing a puncture aspiration of the breast (19000) stating with "mammographic or stereotactic guidance", what codes would you suggest to capture the guidance? We can't report 19081-19082, 19281-19284, as they are not using any localization devices and no biopsies are being performed. I understand that a mammogram could be done in advance or post-op, and in those cases a mammogram code could be used. But the provider is calling this mammographic or stereotactic GUIDANCE.

Bicipital Groove injection for Chronic biceps tendinitis

Would you charge 20550 or 20551 for the following?

"Ultrasound identified the biceps groove, and with transducer in a transverse view, an access site was selected. 1% lidocaine was administered for local anesthesia. 100 mg Solu-Cortef with 3 mL 0.25% bupivacaine were injected into the bicipital groove immediately deep to the biceps tendon."

From my research the bicipital groove is the place where the long tendon of the biceps brachii muscle passes through.

MRI Cardiac with 3D recons

I am getting an edit that code 75561 is allowed with 76376 or 76377 but only with a modifier. Complete documentation is missing, but I want to check if the reconstructions are inherent in the cardiac MRI, before I query the physician. Thank you.

"TECHNIQUE: This examination was performed at UCI inpatient imaging facility on a Siemens Avanto 1.5T MR scanner. Axial truFISP survey of chest , multiplanar truFISP cine SA, VLA, HLA, LVOT, AV, phase contrast imaging through AV and multiplanar inversion recovery images were obtained at 10 minutes post contrast administration to assess for delayed myocardial hyperenhancement were performed. A total 18cc of Gadolinium contrast agent (MultiHance) was given without adverse effect. 3D post-processing was performed using a special cardiac software."

Balloon Occlusion of Fontan Fenestration

The patient was born with hypoplastic left heart syndrome who underwent staged palliation including Norwood/Sano, bidirectional Glenn anastomosis, fenestrated extracardiac conduit Fontan procedure, stent placement into Fontan fenestration and subsequent balloon angioplasty of stented Fontan fenestration and left pulmonary artery stent placement. She has plastic bronchitis and was scheduled for lymphatic imaging and possible occlusion of abnormal lymphatic collaterals to the lung. Transient balloon occlusion of Fontan fenestration was needed because of open fenestration with potential for right-to-left embolization of lipiodol droplets.

6F balloon wedge catheter was inserted thru right femoral venous sheath, advanced to extracardiac conduit and manipulated across stented Fontan fenestration. Transient balloon occlusion of Fontan fenestration was performed twice by interventional cardiologist during IR lymphatic procedure with lipiodol injection. I'd like to know how to report balloon occlusion of Fontan fenestration for facility and physician billing please.

Fluoroscopy CPT code

Our doctor did a multiplane fluoroscopy of the mitral and aortic mechanical valves to assess motion with image X-ray interpretation, and X-ray data fluoroscopy time 0.2 minutes with a dose of 47 mGy dose area product of 9.44. since the doctor did not mention chest x-ray (how many views). Regarding a doctor who does both the mitral valve and aortic valve, can we use 76000 x 2?

Add on 93657

Would 93567 be used here? PVI was performed. During isolation of the right sided PVs right phrenic nerve pacing was performed throughout ablation to ensure intact right phrenic nerve conduction. Right superior PV ablation had to be aborted due to transient right phrenic nerve palsy. The flexcath was exchanged back over the wire to the veracross sheath & repeat EAM was performed. The RSPV showed a persistent connection to the left atrium, so supplemental RF ablation was performed after mapping out the position of the right phrenic nerve. Ablation was successful in achieving PVI for Afib. Would this be considered part of the 93656 and no additional code would be supported? Would the physician have to state that a remaining afib was treated to support the additional code? Thanks!

-RT and LT modifiers on lower extremity interventions

You answered a question in 2011 regarding -RT and LT modifiers being appended to lower extremity interventions (CPT codes 37220-37235). There was a disclaimer that the question was answered in 2011 and the answer may have changed. Have there been any updates to the guidance you provided? At the time you said no but should check with the payer. Thank you in advance for re-visiting this question.


MD performed debridement of three separate lesions of the lower leg. 1) Debridement including muscle and tendon 8 x 4 cm lesion.  2) Debridement skin & muscle 6 x 3 cm lesion. 3) Debridement skin & muscle 11 x 9 cm lesion.

Do we code 11043 x 3 for each lesion with 11046 x 4 or 11043 x 1 and 11046 x 6?

Bilateral common iliac vein and IVC stenting with AFX Endologix Endograft

"The endograft was placed in the main body and two iliac components. Under angiographic imaging, I noticed some larger lumbar collaterals and they were marked as our limit to IVC coverage with a covered stent. cc x 7.5 Enodlogix infrarenal endograft was deployed within the IVC stent overlapping the previously placed bifurcated endograft. Distal end was deployed immediately below the lumbar collaterals. The remaining infrarenal segment of sclerosis was treated with 18x100 Abre stent. The pararenal and suprarenal segment of IVC was treated with 36x80 Zenith dissection endovascular bare metal stent."

Please help. What all stents would be coded? Also, regular vein stent codes or is there a code set for endograft stents in the IVC and vein? I only see the EVAR codes for aorta and arteries.

Catheter placement for non-selective iliac vein stenting

Patient presents for a planned stent placement in the left external iliac vein due to a stenosis seen on a previous lower extremity venogram. Physician accessed the left common femoral vein and placed a stent in the left external iliac vein. Physician documented that stent deployed nicely and flow now open. Code 36005 is specific for injection procedure for extremity venography. What catheter placement code do we use in this case?

Multiple Peripheral Access sites due to claudication

Left Femoral access was obtained; RT Common Iliac was imaged and the catheter would not advance further due to claudication. RT Anterior Tibial access was obtained; angiography was performed and the stented lesion could not be crossed. A third access was gained; antegrade of the RT Common Femoral Artery; to SFA where PTA was performed. The hospital is capturing: CPT-37224 only. Generally the catheter placements are bundled with the intervention; however here there are multiple access sites (3) obtained. Should the other access sites also be coded for RT Common Iliac and Rt Anterior Tibial and if so what CPT's would apply here? CPT-36247/CPT-36140 or just CPT-36140 times two? Thank you for sharing your expertise on this issue!

34710 bundling with 33881

Patient has a previously placed EVAR device now with an endoleak of the iliac limb. An initial TEVAR was performed during the same session as delayed placement of an extension to the iliac. What would be the proper coding for this since code 34710 bundles with 33881?

TEE / Interpretation and report

Provider performs TEE on 11/15 but does not dictate/sign off on the report until 11/16. Is the probe placement (93313) billed on 11/15 and the (93314) Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only and (93325) Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) billed on 11/16?

ECMO Initiation

A surgeon who specializes in CT surgery places the VA ECMO cannula for pediatric patients, and then the cardiologist monitors the function of ECMO subsequently. Does the surgeon bill 33946, or is this the beginning of management for the cardiologist, which occurs on the same day that the surgeon has placed the ECMO cannula?

CRTD Generator Replacement

I have a portion of the surgery documentation below, and am wondering, based on what I have provided, if this would be CPT 33264?

PROCEDURE: CRTD generator replacement. CRTD interrogation and programming.

After local lidocaine infiltration, a 4 cm incision was made along the left deltopectoral groove. The subcutaneous pocket was opened with blunt dissection, and local hemostasis was obtained with cauterization. The CRTD generator and the leads were extracted from the pocket. The leads were disconnected from the generator. The underlying rhythm is AF. Sensing P wave 1.5 mV, impedance 400ohms. Sensing R wave wave 14.5 mV, pacing threshold 0.75 V and 0.4 ms, impedance 360ohms. LV epicardial lead pacing threshold 1.5 V and 0.4 ms, impedance 265 ohms.

A new CRTD generator was connected to the leads and into the pocket after antibiotic irrigation. An antibiotic envelope was used for prophylaxis. The wound was closed. Pacemaker interrogation showed stable RA, RV and epicardial LV lead measurements.

Xray Arthrogram

Is the use of fluoroscopic guidance required to report arthrography RS&I codes (e.g., 73040, 73525, etc.)? If the physician performs pre-injection x-ray for localization, inserts the needle intra-articularly and injects contrast, then performs post injection xray to identify/evaluate contrast within the joint and takes additional x-ray views in neutral, flexed and/or internal rotation for diagnostic interpretation, does this satisfy the "radiologic examination" component of the code description?

Sentinel Device used during a lead extraction

Patient arrived for AICD laser lead extraction with distal embolic protection, revision of pacemaker to AAI pacemeaker. Sentinel device was advanced through the radial approach to the ascending arch and under fluoroscopy. The proximal basket was deployed in the innominate artery. The distal basket was deployed successfully in the left carotid artery. Prowater wire was used for the advancement and monitoring. Device was secured. After the completion of the lead extraction, we were called into the Cath lab. Device position was documented by fluoroscopy, baskets were retrieved per protocol over a wire. Device was retrieved through the right radial sheath appropriately with no complication. The parentheticals for 33370 say to use with a TAVR code. What about when done during another procedure like this one? Unlisted 33999?

Iliofemoral, SFA, deep femoral Endarterectomies

EIA, CF, DF, SFA were dissected free, vessel loops proximally and distally, branches, pulled taut. Cooley clamp placed on EIA, 11-blade used to create arteriotomy in SFA, carried proximally onto the CF to the proximal CF artery. Total arteriotomy was approximately 8 cm. SFA endarterectomy performed. Distal end points tacked down w/sutures. Iliofemoral endart performed. Eversion was taken more proximal to the arteriotomy and up to the clamp. Iliofemoral endart was completed. 8-cm long arteriotomy and 0.8 x 8 cm Bovine patch was sewen into place using suture x 2. Patch went onto SFA approximately 3 cm.

Dr. wants to bill all 3 Endarterectomies-his response- Separate skin incision or separate artery incisions? Each artery is distinct/separate from the other arteries. Difference in work between a single iliofemoral endart vs a iliofemoral, superficial femoral endart, and deep femoral endart is extremely significant. Easily double the time of the procedure. They are separate arteries with separate CPT’s. Please help explain, 1 or 3 to be billed out?

Closure device with 36227 and 36228

The CPT Codebook, under Diagnostic Studies of Cervicocerebral Arteries, states 36221-36226 include closure of the arteriotomy by pressure or application of an arterial closure device. In the paragraphs regarding 36227 and 36228, the includes lists are stated, and are identical to 36221-36226, except for not mentioning closure by pressure or device. Can G0269 closure device be coded separately with 36227 and 36228, or is it included there also?

36002 or 37242

Catheter guided thrombin embolization of bleeding right femoral pseudoaneurysm/retroperitoneal bleed - Ultrasound-guided right proximal SFA access with catheter placement in common femoral artery with thrombin embolization. If it is direct puncture for thrombin injection to femoral aneurysm we bill 36002 . For this catheter based thrombin embolization do we bill 36002 or 37242?

34111 vs 34101

My physician is stating that 34101 should be used since the thrombectomy was done via a brachial incision rather than just 34111. Thoughts?

"There was thrombus that could be seen in all 3 of these vessels. I then pulled up on the vessel loops on the brachial artery. I removed the stitches that were in the brachial artery arteriotomy and I passed #3 Fogarty thrombectomy catheter proximally for approximately 20 cm and pulled the clot out of the brachial artery until I had pulsatile inflow. I then retrograde flushed with heparinized saline. I then placed a Yasargil clamp on the brachial artery. I then took the vessel loops off tension on the ulnar artery and I passed #3 Fogarty balloon catheter down the radial artery for approximately 28 cm and pulled out clot 3 successive times. The fourth time I did not pull clot back. I then flushed with heparinized saline, but did not re-clamp the vessel. I then passed a #3 as well as #2 Fogarty thrombectomy catheter down the ulnar artery for approximately 20 cm."

36215 or 36225

Can you explain under which circumstances you would choose 36215 over 36225?

In our recent example, the doctor documents that he "selectively engaged the left subclavian" during a left heart catheterization, would I use 36215 or 36225?

Thank you!

"Mildly reduced ejection fraction" in Interpretation of echo

In one of our cardiology clinics, they are billing I50.1 whenever the provider documents "mildly reduced ejection fraction" of the left ventricle in the findings/summary/interpretation of the TTEs without any mention anywhere else of the patient having heart failure. Is it appropriate to bill I50.1 when they only say there's a reduced rejection fraction, but there's nothing else about heart failure in the report? I thought having that key word "failure" was required to qualify for a heart failure code.

Reprogramming in person of the Cardiomems Device

For the cardiomems device 33289 i know the remote interrogation code is 93264. Our doctor performed reprogramming in person is the cpt code still 0417T. I can't locate any information. Thank you for your help,

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!