Ask Dr. Z

Hi Dr Z,

Which CPT code can be billed for following procedure.

This is facility billing

Left forearm arteriovenous graft declot

Fistulogram and central venogram

Balloon angioplasty of AV graft, venous inflow, and outflow basilic vein with 7mm x 60mm Dorado balloon, 6mm x 40mm Lutonix DCB, 8mm x 60mm conquest balloon

Findings: there is a Left forearm AV fistula with a PTFE interposition graft. There is significant stenosis > 75% in the inflow anastomosis between the vein and the graft. There is severe > 75% stenosis at the outflow forearm basilic vein.

Thank you in advance

"5 French angled glide catheter was advanced over this wire into the distal radial artery. Fistulogram with radiological supervision and interpretation was then performed. This revealed near occlusive stenosis at the arteriovenous anastomosis and proximal outflow. 4 mm x 40 mm Mustang balloon was brought to the arteriovenous anastomosis, and balloon angioplasty was performed of the segment. The 4 mm x 40 mm balloon was also used to perform balloon angioplasty of the proximal outflow. Fistulogram was performed, which revealed significant improvement of the severe arteriovenous anastomotic stenosis. The 6 mm x 40 mm balloon was then brought into the proximal venous outflow, and balloon angioplasty was performed." 

Would you report codes 36215, 75710, and 36902 since the catheter was advanced to the distal radial artery? I reported code 36902 only. Can you give more explanation to what is considered arterial inflow in the dialysis circuit? Isn't this beyond perianastomotic segment for 36215 and 75710 to be used?

Left upper extremity fistulogram. The stenosis in the graft venous anastomosis was crossed with the wire. Angioplasty of the stenosis in the graft venous anastomosis was performed using 8x40 mm Balloon; then sheath was redirected towards the arterial inflow. Balloon angioplasty of the arterial anastomosis with a 6x40 mm balloon. (Same Access) do I bill both 36902 and 36907?

What if the physician uses a second access to access arterial anastomosis, any other access code to bill for second access? 

What codes are supported for billing the endovascular procedure and why?

"Ultrasound-guided cannulation right common femoral artery- Selective left leg angiogram- Left anterior tibial lithotripsy with 3 mm x 40 mm Shockwave lithotripsy balloon- Angioplasty distal left anterior tibial artery with 2 mm x 100 mm ultra verse balloon-

Operative findings:

#1. The left posterior tibial artery still patent with minor areas of disease proximally and distally. The posterior tibial goes into the foot but does not appear to supply much of any blood flow to the digits on the left foot.

#2. The anterior tibial was able to cannulated with 0.018 wire and 0.014 wire. The wires could not be advanced all the way into the foot. After treatment of the anterior tibial with 3 x 40 mm lithotripsy shockwave balloon, it was quite obvious that the lithotripsy balloon could not be advanced all the way into the foot. This was replaced with 2 mm x 100 mm balloon which once again could not be advanced across the heavily calcified and diseased distal anterior tibial artery into dorsalis pedis. The procedure was then terminated."

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.

Our provider performed a balloon angioplasty on the superior mesenteric artery. CTA demonstrated a high-grade stenosis on a previously stent in the same SM artery. Our system is telling us that it requires a laterality modifier (which we have used in the past for upper extremity interventions). Being that in this case we have the balloon intervention in the superior mesenteric artery, we are seeking information on if possibly another CPT code is required or if a laterality modifier will be required.

Do you still recommend using code 37246 for lower extremity PTA for treatment of a thrombus? The physician documents a thrombus causing an 80% stenosis of the popliteal artery.

"There was separate thrombus resulting in 80% stenosis of the native distal (P3) popliteal artery and the tibioperoneal trunk. An additional 3000 the lesions were administered corresponding to a total of 100 units/kg. The lesion was angioplastied with a 3 x 200 mm followed by a 4 x 150 mm and a 4 x 60 mm Armada balloons. The final angiogram showed good results with less than 20% residual stenosis and only a minute amount of residual thrombus. The heparin effect was reversed with protamine.

Conclusion: This is a patient with acute thrombus of the native distal (P3) popliteal artery and tibioperoneal trunk treated with balloon angioplasty."

The innominate artery was selected, followed by the right common carotid artery. Biplane cervical and intracranial angiograms were performed from the right common carotid artery before stenting. Measurements were made from magnified oblique projections and an 8 mm x 2.5 cm GORE Viabahn covered stent was selected. This was prepped in the usual fashion with an Aristotle 18 microguidewire. The stent was attempted to advance through the Cerebase, but the sizes were not compatible.The Cerebase was fully removed from the body. Next, a 90cm BMX96 was advanced over the 130cm Berenstein selection catheter and Terumo Glidewire to the level of the aortic arch and the right common carotid artery was selected.  The 8 mm x 2.5 cm GORE Viabahn covered stent was then advanced over the Aristotle 18 microguidewire to the distal right common carotid artery. Next, the stent system was removed and we proceeded with balloon angioplasty to ensure good wall apposition. Would this qualify as 37215, EPD not specified?

DX : Severe SMA stenosis/abdominal pain. I was able to navigate into the SMA and placed a catheter in the distal portions performing an angiogram demonstrating the distal portions of the SMA. Placed a Rosen wire down and performed a 6x60 balloon angioplasty first, followed by a 7x60 shockwave (IVL) to the proximal and mid portions of the artery. Selected a 7x37 stent, landing this into the aorta itself and in a portion of the artery that appeared free from disease. How would this be coded and are there codes for shockwave in the SMA?

a 0.014 wire was passed into the peroneal artery, which was single vessel runoff and intravascular us was performed of the peroneal artery, tib trunk, popliteal artery, and the sfa. the pt has 72% stenosis in the peroneal, 67% stenosis in the tib trunk, 70% stenosis in the popliteal artery & 73% stenosis in the sfa.

a laser atherectomy was performed across the sfa, pop, tib trunk & peroneal artery followed by balloon angioplasty using 2.5 mm balloon in the peroneal artery and tib trunk & a 5mm balloon in the pop artery and sfa.

findings: pt's aorta and iliac vessels appear widely patent. the pt has a stent in the rt sfa with intrastent stenosis. also evidence of popliteal stenosis & single vessel runoff via ant tibial artery. left sfa stenosis including intrastent pop, tib trunk, & peroneal artery stenosis which was single -vessel runoff.

we billed 37229 lt, 37225 lt, 37252, 37253 but uhc isnt paying 37229 based on this doc. does anything look like 37229 should NOT be paid

How should we code an AVG angiogram, balloon maceration with 8 x 40mm Conquest balloon, angioplasty of venous outflow anastomotic stent with 8 x 40 mm Conquest, Fogarty, angioplasty of inflow artery, arterial anastomosis and juxta-anastomotic segment with 6 x 40 mm Charger, 6 x 60 mm Lutonix balloon, and angioplasty of the intra-graft stenosis 6 x 40 mm Conquest balloon. The doctor reported codes 36905, 37246, 75710, and 36215. Is this correct coding?

Hi Dr. Z. Besides 93458, can we bill 92920-74 (hospital) for the attempted intervention? The doctor spent 35 minutes on the attempt, no balloons, just wires and microcatheter. “I used a 6 French EBU 3.75 guide catheter and selectively engaged the left main. I then attempted to cross into the 1st diagonal (culprit vessel) which is a small caliber that is less than 2 mm in diameter with a 95% stenosis and reduced TIMI 2 flow. The 1st diagonal branch has an extremely angulated takeoff. Essentially it goes backward 180° and then turns another 180° in an S shaped with extreme acute angulation that makes wiring essentially impossible. I could not wire with a run-through. I attempted wiring with a different wire she is a choice PT floppy wire crossed into the proximal diagonal but with an S shaped that prevented it from further advancing across the lesion (any time I would advance it it would flop back into the LAD). After a prolonged attempt I elected not to proceed ...” Thanks in advance!

Our physician performed Shock Wave balloon lithotripsy of the Lt SFA (6x60 mm) along with Drug coated balloon angioplasty LT SFA (6X40mm). We are trying to determine if this is 37224 angioplasty or 37225 atherectomy which includes angioplasty and not billing both CPT codes. Our department feels we are not coding this correctly. Does Shockwave balloon lithotripsy mean an atherectomy was performed? If you need any additional information, please let me know. Please advise since Dr. Z is the Expert to clear this up. Just waiting for an answer.

Question 18154

"The left radial to perforator arteriovenous fistula is patent.  There is early filling of the brachial vein. selection of the AV anastomosis and drug coated balloon angioplasty of the AV anastomosis and the perforator vein was done, Volume flows demonstrated adequate flow in the perforator vein and decreased insufficient flow in the cephalic vein.  Decision was made to coil the brachial veins-multiple Nester coils were deployed in brachial vein. Decision was to band the distal basilic vein.  0.018 wire was advanced into the basilic vein.  Over the wire, 2 mm balloon was inflated. silk suture used to band basilic vein."

Would this px be revision? 36832- angioplasty of the arteriovenous anastomosis, coiling of the brachial vein, and banding of the basilic vein were done.

"Left superficial femoral artery proximal, mid, and distal scattered 40 to 70% fibrocalcific stenoses. Right superficial femoral artery proximal, mid, and distal scattered 40 to 60% stenoses. Atherectomy of the left proximal, mid, and distal superficial femoral artery with a Hawk 1 atherectomy device; embolic protection with a EV 3 spider X 6.0 mm filter. Drug-coated balloon angioplasty to the left mid and distal superficial femoral artery with a Medtronic Inpact 6.0 x 150 mm, and proximal superficial femoral artery with a Medtronic Inpact 6.0 x 120 mm, in overlapping fashion. Ultrasound-guided access of right common femoral artery."

Can we report codes 37225, 75716-26, 76967-26?

Can you please help me figure out this case. How can I capture the work for the pediatric interventionist who is helping another provider during difficult cases of balloon angioplasty (92990) or pulmonary artery stent? Is it possible to report the service the main code with modifier -80 or -82?

Can both billed together? 37241 and 37183

TIPS revision 12 mm balloon angioplasty of the TIPS was done with balloon sweep of thrombus (thrombectomy). Post intervention venogram demonstrated patency of the TIPS with an area of residual thrombus/occlusion at the superior portion. The portosystemic gradient measured approximately 25 mmHg. Subsequently, the superior portion of the TIPS was extended with 11 mm VBX stent Which was post-dilated to 12 mm.

EMBOLIZATION AND SCLEROTHERAPY: Through the retrograde groin accesses, the following interventions were done:

1.  Deployment of multiple detachable coils to occlude the renal venous communication to the shunt.

2.  Exchange to long 10 French sheath and subsequent deployment of 2 cm Amplatzer plug within the shunt in vicinity of the caval/lumbar communication

Should this be reported with 37215-78-52 or 37246-GZ?

"Poor expansion of the right internal carotid stent was likely an embolic event. After extensive workup and anticoagulation and antiplatelet regimen instituted, the consensus opinion was had, and repeat TCAR with ballooning of this poorly expanded stent would be immediately helpful as well as for long-range stent durability and patency. Left common femoral vein access had been obtained with ultrasound guidance, and this was upsized to 8 French silk sheath. We then initiated passive flow reversal checking for excellent flow, then clamped the common carotid artery proximal to the sheath to allow for active flow reversal. We performed angiography in two views, and stent was then decompressed and inadequately expanded, used first-day #5 and then a 6 x 40 mm balloon for re-angioplasty with full flow reversal." 

Would this be considered congenital 33897, or would the scar tissue/cord lesion mean this was 37246?

"Patient was admitted for a cardiac cath for evaluation of CHD consisting of recurrent coarctation of the aorta. He was diagnosed with a discrete juxtaductal coarctation and ascending aorta hypoplasia. He underwent a surgical coarctation repair via extended end-to-end anastomosis. At recent cardiology visit, the velocity across the descending aorta had a large increase from his post op echo. He presents for cardiac cath balloon angioplasty of recurrent coarctation of the aorta. A pigtail catheter was inserted into the descending aorta. Angio and pressure gradients were obtained. We advanced a balloon over across the cord lesion. An inflation was performed by hand. There was a discrete post-surgical coarctation of the aorta just distal to the lower segment artery. Angiography demonstrated much improved angiographic appearance of the cord lesion. Patient had successful balloon angioplasty of recurrent coarctation of the aorta. An angiogram suggests that the scar tissue has been liberated." 

"Patient with hypoplastic left heart syndrome (mitral/aortic atresia). Patient underwent stage I palliation with Norwood, Sano conduit, PDA ligation and atrial septectomy as a neonate. He then underwent Sano takedown, creation of a right cavopulmonary anastomosis (bidirectional Glenn shunt) and intraoperative direct aortic balloon angioplasty. A 4 French was placed in the right femoral artery. Complete right heart and left heart catheterization via abnormal native connections was performed with oximetry, hemodynamics, and angiography in multiple planes." Would these cases be coded to 93597?

"Patient called EMS for CP that woke him from sleep, along with diaphoresis and N/V. STEMI. No cardiac hx. Doctor arrives to bedside in the ED and requests Brilinta and heparin. Patient then goes into v fib arrest. ACLS protocol followed and patient goes into pulseless v tach. ROSC then achieved. Intubation noted to be difficult but pt has no periods of hypoxia. Levophed required after multiple doses of epinephrine. Pt taken to the cath lab for LHC, coronary angiogram, IABP placement, balloon angioplasty, and placement of one stent for a 100% wrap around LAD occlusion. Patient was then transferred to Hospital B for further care of cardiogenic shock.”

The patient had inpatient-only procedure 33967. Patient presented to ED, went to cath lab, and did not get admitted. The patient was then transferred out. How should this be billed?

"On day 2 of thrombolysis to right leg from EIV to popliteal vein, the physician removed the EKOS catheter and performed inferior cavogram and right lower extremity venogram followed by mechanical thrombectomy to CFV, EIV and CIV. Venogram was repeated and showed minimal clot and stenosis in CIV, EIV, and CFV. Balloon angioplasty and stents were placed in the CFV and EIV. Repeat IVUS performed and showed stenosis in the EIV above the stent. A single 18 mm x 80 mm Wallstent was used to across CIV, EIV and CFV without any extension into IVC."

I have coded 37187, 37214, 37238, 37239 x2, 37252, 37253 x2, 75825, and 75820-RT. Are RLE venogram and inferior cavogram billable with the additional interventions?

A patient presents for diagnostic coronary angiography. Per the procedure report: "There was 100% occlusion in the proximal to mid left main coronary artery due to leaflet from a pre-existing surgical bioprosthetic valve after valve-in-valve TAVR with complete effacement of the sinuses by the transcatheter heart valve with no visible antegrade filling of the left main during this or by prior angiograms performed after TAVR. This lesion meets the definition of a chronic total occlusion, greater than three months old." A CTO device was used to facilitate crossing the chronic total occlusion prior to intervention, and balloon angioplasty was performed. Since the left main's occlusion was not caused by atherosclerosis, intimal hyperplasia, thrombus, inflammation, etc., but rather by an aortic valve leaflet, does revascularization code 92943 still apply? If not, what CPT code should be reported and why?

"Thrombosed LUE dialysis (carotid bovine graft): The SVC and brachiocephalic veins are patent. Pullback venography demonstrates thrombosis of the venous outflow to extend to the graft venous anastomosis. A total of 4 mg alteplase was injected through the Kumpe catheter into the clot burden. After approximately 5 minutes, an orbital thrombectomy device was used in the proximal venous outflow extending to the level of the intragraft stenosis. This was followed by a 6 mm mm balloon angioplasty of the throughout the mid and distal graft, as well as the venous anastomosis, covering the areas of known clot burden. Then, stent graft placement across the venous anastomosis to the irregular distal graft segment was performed with a 6 x 100 mm heparin-coated stent graft (Viabahn). This was then postdilated with a 6 mm balloon."

Per query reply: PTA/stent to distal & graft vein anast graft to L brach vein. What vein should be used for intragraft thrombectomy for ICD-10-PCS coding?

Can do we code an ultrasound duplex venous with an AV fistulogram intervention? For the following example I'm thinking: 93971, 76937, and 36902. Is this correct?

"Ultrasound examination of the left upper extremity and intravenous fistula from the arterial anastomosis through the peripheral venous outflow demonstrated wide patency of the till anastomosis, juxta Esmarch segment, cannulation segment, and peripheral venous outflow. Prone images were saved. Using ultrasound guidance, needle was advanced antegrade into the cannulation segment. Sheath was used to perform outflow angiography through the central veins, which demonstrated multifocal stenosis within the cephalic arch. Angioplasty balloon was advanced, and prolonged balloon angioplasty of the cephalic arch was performed. Postplasty angiography demonstrated significant resolution of multifocal stenosis. Real-time concurrent ultrasound was used to visualize needle trajectory and a permanent image was stored in the medical record."

Our provider is using AGENT IDE - RESEARCH TRIAL balloon for his PCI procedure. I would like to know if there is any change for the balloon angioplasty code (92920). Or does it need to report with Q0 or Q1 modifier and Z00.6 Dx?

AGENT IDE: A Prospective, Randomized (2:1), Multicenter Trial to Assess the Safety and Effectiveness of the AgentTM Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis (ISR)

We are not very familiar with this type of service.

Thank you..

Patient is ESRD and on HD. Right upper extremity AV graft with swollen arm. Patient had chronic occlusion in the right innominate (central segment) vein stent. Surgeon preformed balloon angioplasty of the stent without a hemodynamically significant residual stenosis. Can I still assign 36907 for it, and chronic occlusion is considered as stenosis?

How would you code this case? 36221, 36902, 0237T?

"Pre/post op diagnosis: left AV fistula inflow stenosis. Description: The right common femoral artery was accessed using a micropuncture needle. This was exchanged for 5 French sheath using Seldinger technique. A pigtail catheter was advanced into the ascending aorta and arch angiogram was performed. Please see above findings for details. Next the left subclavian artery was selectively catheterized and a left upper extremity angiogram and left upper extremity fistulogram was performed. 5 French short sheath was exchanged for 5 French 90 cm sheath positioned in the left brachial artery. The proximal left brachial artery was subsequently balloon anigoplastied using a 4 x 60 drug coated ranger balloon. Completion angiogram and fistulogram revealed widely patent left radial artery without residual stenosis. Findings: high grade proximal left radial artery stenosis successfully treated with atherectomy and balloon angioplasty."

Would 36902 and 36907 be appropriate to code in this case?

"Patient brought back to the hybrid room and placed in supine position on the table. Right arm prepped and draped in sterile fashion. I accessed the AV fistula. A micropuncture needle and sheath were placed. A fistulogram was performed with retrograde filling into the artery. There was a severe stenosis in the right innominate vein into the SVC associated with the TDC. A stiff angled Glidewire was then brought in, and we brought in a 7 French sheath. The patient was systemically heparinized. I then used a Mustang 12 x 60 millimeter balloon angioplasty, which was performed multiple times. After the angioplasty, a repeat fistulogram showed good flow. At this point in time wires were removed. I used a pursestring 4-0 Monocryl stitch and more pressure. Occlusive dressings were placed. The patient tolerated the procedure well and was transferred to the recovery room."

Can you please elaborate on how to code for this (92997/92998)? We are specifically wondering how many times we should code 92998 in the following scenario: successful balloon pulmonary angioplasty in two subsegmental branches of the right A5 segment, one subsegmental branch of the right A4 segment, and two subsegmental branches in the right A3 segment.

We are also wondering if selective catheterization can be coded with the intervention?

When is it appropriate to bill codes 76377 for 3D and 93612 for ventricular pacing when performed during rotational angiography along with pulmonary artery angioplasty (92997)?

"Example: Patient presents for a diagnostic cardiac cath and possible intervention on the conduit. Complete right heart and retrograde left heart cath was performed. 6 French Berman angiographic cath was placed in the right ventricle. A 4 French pacing cath was inserted in the LFV sheath and placed in the right ventricle. Right ventricular pacing was performed at 180/min with breath hold, and rotational angiography was performed. Rendering and post-processing of the rotational images was performed. After post-processing, the image was used for overlay on the fluoroscopy. Angioplasty was then performed within the RV-PA conduit and the right pulmonary artery. There was adequate arborization bilaterally. Post angiography demonstrated adequate relief of the stenosis. Improved angiographic appearance of the RPA post balloon angioplasty with no evidence of vascular injury."

"A 5 x 40 mm Bard conquest balloon was then positioned across the arterial anastomosis and the proximal fistulous inflow and a prolonged and insufflation performed with balloon achieving profile. Kumpe catheters repositioned in the brachial artery angiography performed. 1.5 cm cleaner device was passed from the distal sheath and attempt to break up thrombus within the aneurysmal segment of the cannulation zones fistula without success. This appeared to be very mature thrombus. Despite further attempts at balloon angioplasty and balloon maceration never achieved beyond temporary patency with residual thrombus occlusive in nature unable to be removed. Selective left upper extremity angiography was performed via the fistula using Kumpe catheter positioned in the brachial artery proximal to the anastomosis. Serial dynamic imaging obtained from this location distally to the fingertips."

They want to bill 36905, but I would like your opinion of the failed thrombectomy.

"PROCEDURES:

1. Repair of left femoral to tibial bypass aneurysm with Gore-Tex interposition using hybrid graft.

2. Intraoperative arteriogram.

3. Balloon angioplasty to left femoral-tibial bypass.

INDICATIONS: The patient has a 7 cm aneurysmal dilatation to a left femoral to posterior tibial bypass that was felt to be in need of repair.

FINDINGS: The area of the aneurysm had significant inflammation that did not allow for good end point dissection. Because of this, the aneurysm was punctured for wire and balloon control and then an interposition graft was placed using hybrid grafts on the proximal and distal ends for control."

I'm confused with this one. I was thinking 35884, but they also placed a graft on the distal end of the bypass as well as the proximal end. Would we then code this with LE repair codes?

At the same time as common femoral artery endarterectomy is performed, balloon angioplasty is performed of the superficial femoral and popliteal arteries on the ipsilateral side. Is this reported separately or considered a way of establishing outflow? Establishing inflow and outflow is included in all of the lower extremity endarterectomy codes.

Can you tell me what CPT I would use for the aortic arch angiogram that is done with a congenital heart cath and balloon angioplasty of coarctation of the aorta? I am unsure if the 93567/75605 are the correct codes.

"There is a short segment occlusion of the radial artery upstream to the AV fistula anastomosis. Via retrograde access of right common femoral artery, the catheter was advanced to the left subclavian artery, brachial artery then into the left radial artery where balloon angioplasty was performed." To code this, I'm thinking 36217-LT and 37246-LT. Is this correct?

My provider is doing balloon angioplasty for atherosclerotic disease in the left common artery (61630). He is also treating pre-existing vasospam in the left vertebral and left ICA. Would he be allowed to bill the left ICA 61650 when he has treated the left common with 61630 during the same session? With these being the same vascular family, I'm unsure if we can use modifier -59 to bypass the NCCI edit. The following is the proposed coding: Left common 61630, left ICA 61650, and left vertebral 61651.

"Access was gained in both directions. Multiple injections of intravenous contrast were given, and a fistulogram was performed and evaluated. Arterial anastomosis and JA segment stenosis occluding more than 80% of the flow. 6 mm balloon angioplasty was performed. The flow was sluggish. Therefore, a catheter was introduced into the upstream radial artery than 10 cm away from the arterial anastomosis. Digital subtraction imaging revealed patent upstream and downstream radial artery with sluggish flow into the fistula. The more inferior collateral vessel was smaller and more tortuous. This vessel was then coil embolized. Follow-up imaging shows cessation of flow through this collateral vessel. The larger collateral vessel within the arterial limb of the fistula had more laminar and direct flow to the more central circulation and therefore required ligation. The skin anesthetized with lidocaine, and a 1 to 2 cm incision was made overlying this collateral vessel. The vessel was bluntly dissected/ligated." Can 36832, 36909, 36215, 75710 be coded?

I have a case where the physician is performing a thrombectomy (37184) with a Penumbra catheter as well as an atherectomy/balloon angioplasty (37229) in the right anterior tibial artery. Anterior tibial stenosis is documented as well as an "occlusion" in the same artery. Is it okay to capture the thrombectomy even though he is only naming it an occlusion?

Left vertebral artery DSA biplane, intracranial: left vertebral artery balloon angioplasty and stenting of the V4 segment for a medical refractory intracranial atherosclerotic disease. Can we use code 61635 for left vertebral artery balloon and stenting?

Cardiac catheterization: If a balloon was inflated three times at a high pressure inflation and ruptured all three times, does this qualify as a successful balloon angioplasty or does it require a -52/-53 modifier?

When coding a TEVAR, is the Coda balloon also considered a balloon angioplasty?

Patient had a flow diverter placed for brain aneurysm. After placement of flow diverter, an endoleak was seen. Balloon angioplasty was indicated. Can we pick up any CPT codes for the endoleak?

"Using US, I was able to visualize the left upper extremity AVG. Exchange was then made for wire and micropuncture sheath 035 wire was advanced into the central venous system. Exchange was then made for 7 French sheath. I did the same maneuver with cannulization into the arterial system. Exchange was made for stiff Glidewire Bernstein catheter, which was navigated into the brachiocephalic trunk. Angiogram was then completed, which demonstrated stenosis within brachial artery. I then exchanged this for a 6 mm balloon angioplasty of the brachial artery was then completed which promoted excellent inflow. Given the findings change was then made for a Trerotola which was utilized to clean the arterial limb and subsequently the venous limb. Stiff Guidewire was then navigated into the venous limb where balloon angioplasty of the AV graft was then completed along the venous outflow system. Complete angiogram showed excellent flow." What all can I code here? Brachial angioplasty also?

My question concerns coding 35666 and 37228/37224 together when the same vessels are involved. My physician placed an SFA femoral-posterior tibial bypass graft (35666) in the lower extremity due to atherosclerosis, and then following this procedure he did a balloon angioplasty in the superficial femoral artery (37224) and posterior tibial artery (37228) at the anastomosis to optimize inflow to the bypass graft. Would the balloon angioplasties be billable, or are they considered establishing inflow and outflow and are not billable?

"Patient is status post stage II Glenn shunt and closure of the Sano conduit. There was anastomotic obstruction at the Glenn anastomosis. 018 guidewire was positioned in the RPA and balloon angioplasty of the SVC/Glenn anastomosis was done using 10-2 Tyshak 2 balloon." Would this angioplasty be captured with 92997 (pulmonary artery angioplasty)?

I had to do a balloon angioplasty but also had to ligate side branches of her saphenous vein bypass graft. How do I bill for the ligation of those side branches (which was the main part of that procedure since it created an AV fistula and was stealing flow from the bypass graft)?

Received a denial stating that code 35351 was documented in the record. Here is what was documented: "9 x 40 balloon angioplasty balloon was advanced into the common iliac artery and used to provide control. Distal external iliac artery was clamped distally. Longitudinal arteriotomy was made with a 12 blade and extended proximally distally with the Potts until adequate endpoints have been achieved. Thin endarterectomy plane was created and plaque was passed off. 5-0 Prolene and bovine pericardial patch was used to create left external iliac patch angioplasty. There was excellent distal external iliac pulse at this point after balloon control was withdrawn."

My provider treated a left carotid for stenosis. Once the provider had placed the stent (DPD) he performed balloon angioplasty within the stenotic portion of the stents. The angioplasty revealed wide patency of the distal common and proximal cervical left internal carotid artery without any residual stenosis. Can the office bill for 37215 and 61624 for the left carotid?

Do you recommend codes 36573 and 37248 for the following? "The left arm was prepared and draped in sterile fashion. The brachial vein was shown to be patent by ultrasound. A spot image was stored. The vein was punctured under direct sonographic guidance and local anesthesia. A wire was advanced to the SVC. The tract was dilated. The wire did not pass centrally. Contrast was injected to confirm a stenosis at the level of the thoracic outlet. Ultimately, a catheter wire was associated across the stenosis. 4 mm balloon angioplasty was performed to facilitate passage of the PICC line. The catheter was measured and cut to length. A dual lumen PICC line was placed through a peel-away sheath. The final tip was confirmed to be in the lower superior vena cava with a spot fluoroscopic image. The catheter was secured, flushed with Heparin, and a sterile dressing was applied. FINDINGS: Central venous stenosis at the level of thoracic outlet protruding wire passage. Area treated with 4 mm balloon angioplasty to facilitate PICC line placement."