Ask Dr. Z

Is it appropriate to code bilateral fistulogram and angioplasty on both sides for stenosis with 36902-RT and 36902-59LT? I know that this has an MUE of 1. Is there a more appropriate way to code this?

In review of question ID # 13757 dated 3/25/20 with response from Dr. Dunn, I am asking for clarification and an explanation for correct coding when placing a stent or providing an angioplasty to the PDA. Previously an unlisted procedure code was recommended for use. Is it now your consideration that CPT codes 37236 and 37246 better describes these procedures?

"Two-week-old infant with Tetralogy of Fallot with severe outflow tract obstruction and threatened discontinuity of pulmonaries. He is status post modified right Blalock Taussig shunt and pumonary artery arterioplasty. A pigtail catheter is inserted in the right femoral artery, advanced retrograde into the ascending aorta, and LHC performed. Selective cath was used for innominate angiography with findings of complete occlusion of BT shunt. Tyshak II angio cath was advanced across the shunt. Three inflations were performed to 6 ATM. Terumo catheter was advanced into pulmonary artery for pulmonary pressures. Selective angio of transverse aorta with findings; selective angio of pulmonary arteries, innominate artery, Blalock shunt all with findings. Successful angioplasty of BTS." For coding, I think 93452 for congenital LHC, 93568 for pulmonary angiography, and 37246 for BTS angioplasty, but I'm unsure about the codes for the transverse aortic and innominate artery angiography. I would appreciate your thoughts on this.

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."

Should we follow the revascularization guidelines for lower extremity arteries when coding venous stent or angioplasties? Would an angioplasty in the femoral and popliteal veins be coded as a single angioplasty? Do you have any official guidelines supporting either way?

"Our physician did excision of infected femoral to femoral graft, excision of left femoral-popliteal infected graft, patch angioplasty of the right femoral artery, and embolectomy of the left popliteal artery. On the left side the femoral anastomosis was isolated and the graft subsequently divided. We were able to clear the origin of the previous deep femoral artery endarterectomy and had sufficient artery for primary closure without impingement on the deep femoral artery. The graft was completely excised. Adjacent saphenous vein was harvested for a length sufficient enough to create a patch for the femoral artery once the graft was removed. The vein was then sewn as a generous patch onto the artery taking generous bites both on the vein and artery." Would I report codes 35903 and 35903-59LT for the excision of the two grafts? Would I report code 35256-RT for the patch angioplasty of the right femoral artery? Would I be able to code for the embolectomy of the left popliteal artery?

Does the shockwave device have a HCPCS code, and is it still considered like angioplasty?

Is 35883 or 35876 be more appropriate? Maybe 35883, 34203, 35371 for this case? "We began by opening up the left groin incision and removing the previous sutures. We then gained control of the CFA, profunda, SFA, and the bypass graft. We opened up the proximal portion of the graft. We identified acute thrombus within the lumen of the bypass graft. We also ID what appeared to be an obstructing flap in the LT CFA. We, at this point, decided to make an incision over the entire CFA and performed revision bypass angioplasty. We extended it proximally towards the inguinal ligament. We then confirmed there was a large flap within the lumen itself that was causing the obstruction. Endarterectomy of the entire CFA was performed. When then took a 0.8 x 8 mm bovine pericardial patch graft and performed patch angioplasty. We then reopened the distal incision above the knee, ID the distal graft, and gained control of the pop. A graftotomy was made and using a Fogarty catheter thrombus was removed from the entire graft and the SFA and then distally to the tibial vessels."

How do you code a patch angioplasty of the common femoral artery onto the superficial femoral and the profunda femoris artey? Is patch angioplasty the same as PTA?

Can we report 36905 (balloon angioplasty, peripheral dialysis segment, including all imaging, radiological supervision) with 76937 (US guidance for vascular access requiring US)? We were previously told that 76937 is included.

My doctor did an angioplasty of a pop-dorsalis pedis bypass graft. Would this be coded with 37228? Can you recommend anything that I could access/buy that would help me to understand which vessel I should be billing when there is intervention in a bpg?

Please explain the difference between codes 37246 and 61630 for intracranial angioplasty.

Quite often, one of our cardiologists will do the diagnostic cath, and then the interventional cardiologist will step in right after to do the angioplasty/stent. For years, I have been applying the -59 modifier to the diagnostic cath, and I am now being told that this is incorrect since two separate docs are involved. Since they are from the same group, isn't this recognized as one and the same doctor and a -59 modifier will be needed on the diagnostic cath?

Regarding the previous Q&As about billing open thrombectomy with open angioplasty or open stent placement, the advice was to bill 36833 for revision. We have been using 36833 instead of 36831 for open thrombectomy with open stent or angioplasty in the dialysis circuit. We have received several denials from Humana and Healthsprings after they have requested and reviewed the procedure notes. They are stating that all angioplasty and or stent placement in the dialysis circuit is bundled and we are billing 36833 in error. The only guideline we can find in CPT states open dialysis circuit creation, revision, and or thrombectomy (36818-36833) bundles peripheral segment angioplasty and or stent placement (36901 36902 36903) However dialysis circuit central segment angioplasty or stent placement may be reported separately (36907 36908). Is there any CPT guidelines or any other references that we can use for the appeals to show that we are correct in using 36833 for open thrombectomy with open stent or open angioplasty in the dialysis circuit? 

Can you please clarify whether it would appropriate to code both pulmonary angioplasty codes (92997, 92998) and arterial vascular stent placement codes 37236, 37237 for pulmonary artery stent placement at the same session and in the same vessel? MD performed right heart catheterization, pulmonary artery angiography, LPA/RPA angioplasty – due to LPA,RPA narrowing bilateral stents were deployed. Of note the intent was not initially for stent placement but to determine why there was pulmonary stenosis. Please see reference below from Dr Z’s Medical Coding Series -Interventional Radiology coding Reference. Pg 278 #17. Separate cardiac codes for pulmonary artery angioplasty (92997,92998). Use established arterial vascular stent placement codes 37236/37237 for pulmonary artery stent placement(s). These procedures included catheter placements at the time of cardiac catherization.

For physician billing, if the intent of procedure is CTO but only angioplasty is performed, is a modifier -52/53 required? Or since 1 of the 3 components is performed would no modifier be required?

A patient with an AV graft undergoes open thrombectomy of the graft, along with balloon angioplasty and stenting of the axillary vein. Selective cath and thrombectomy of the radial artery are also performed as follows: "....Fistulogram was performed, which showed evidence of persistent thrombus in the proximal AV graft. There was also evidence of thrombus at the origin of the radial and interosseous arteries. Wire was then directed in the radial artery under fluoro guidance. A Fogarty balloon was then passed into the proximal radial artery, and a thrombectomy was performed until all clot was evacuated. A completion angiogram was performed of the left forearm and hand that showed no residual thrombus and improved flow through the radial, interosseous, and ulnar arteries." We have 36833 for the open thrombectomy with axillary angioplasty and stenting. Is the radial artery thrombectomy to be reported with 34111? 37186 and 36215? Would we also need code 75710?

Doctor performed mechanical thrombectomy and angioplasty of left subclavian and axillary veins. I asked if this was one long lesion of the subclavian/axillary OR was it separate lesions in both vessels. He responded it was one long lesion. I billed only 37248 because it was one lesion crossing two vessels. "A 14 x 40 balloon was inflated in the subclavian, deflated, and pulled back into axillary vein." Should I have billed 37249 also?

Would it be appropriate to bill multiple endarterectomies in this case through one incision? "Anterior common femoral arteriotomy was made and carried proximally. Endarterectomy with freer elevator of common femoral artery was performed with patch angioplasy. Profunda did not back bleed. Profunda was opened and endarterectomy performed of anterior branch into ostium of posterior branch with patch angioplasty. SFA was explored in the first portion. Foreign body Angioseal was removed from SFA. Endarterectomy of first portion of SFA with patch angioplasty was done on SFA as well." Could we code 35302, 35372, 35371 with separate arteriotomies and patch angioplasties? Would foreign body removal be bundled into the endarterectomies?

Our coders are struggling to agree on how to code this procedure. We cannot come to an agreement of the best suited codes to use. "Patient has left brachiocephalic fistula that has two aneurysms that developed two ulcerations. Physician performed incisions in vertical fashion, excising the aneurysm and excessive skin on two aneurysmatic area, one above the antecubital area and the other in the distal upper arm. Incision taken down to the dilated aneurysmatic vein. Vein entered, skin and ulcer were excised in both lesions. Aneurysmatic vein wall then excised so about 1 cm of conduit on each incision. Closed venotomies on each incision. Clamp released for flow thru fistula. Then punctured access in mid upper arm, placed sheath, obtained shuntogram which showed the cephalic arch had a stent and vein was present. Superior vena cava was patent but innominate vein 80% stenosed. Angioplasty performed; sheath removed site closed."

"Patient had carotid endarterectomy (35301) and three weeks later returned due to infection. Saphenous vein is harvested, neck opened, and Dacron patch removed. Area was washed, phlegmon was removed, and vein was sewed as patch angioplasty." How do we code this: as exploration for post of infection (35800) or as endarterectomy (35301)? Neither feels right to me.

Patient has ICA occlusion. It was treated with thrombectomy and angioplasty of cervical portion of the same vessel. Distal embolic protection was used for angioplasty. Can we code both procedures, or only thrombectomy?

Would a failed attempt at treating an acute MI require a -53 modifier on 92941? There was no stent placed, and the angioplasty failed to restore flow.

"A 2.2 cm CP covered stent mounted on a 16 mm x 2.5 cm BIB balloon was implanted in the proximal aspect of the RV to PA conduit (5ATM). After this stent was implanted, my doctor did balloon angioplasty again. The CP stent was future balloon dilated with a 16 mm x 2 mm Vida up to 14ATM." I know we cannot report balloon angioplasty before we implant the stent, but my doctor usually does balloon angioplasty again after he implants the stent. Should I report this balloon angioplasty (92997) ?

Would CPTs 36581, 36595-5952, 75901 or 36581, 77001 be appropriate for the following procedure? "The right neck was prepared and draped in sterile fashion. The patient's existing catheter was prepared and draped. A wire was passed through the catheter into the inferior vena cava under fluoroscopic guidance. The catheter was removed through the existing tunnel. A 10 mm x 4 cm balloon was placed through the existing tunnel into the lower superior vena cava and right atrium. Balloon angioplasty was performed with the intention to remove any residual fibrin sheath in the lower superior vena cava and right atrium. The balloon was removed. The patient's catheter was replaced with an identical line. The catheter was flushed and sutured into place. There were no immediate complications. A final spot radiograph shows the tip of the catheter to be in the right atrium."

"Diagnosis: Left arm AV graft pseudoaneurysm with very thin overlying skin. Procedure: Loopogram with stent placement and revision of left arm AVG. A 5 French micropuncture needle was used to access the AV graft at the apex, and the micropuncture sheath was inserted. A loopogram was performed, revealing the large pseudoaneurysm at the arterial limb. An 8 French sheath was then inserted and exchanged over a J-wire, then a Bentson wire was inserted across the lesion. A 7 mm x 10 cm Viabahn covered stent was deployed across the area of the pseudoaneurysm, and balloon angioplasty was performed. Repeat imaging revealed resolution of the pseudoaneurysm. Wire/sheath were removed. A 4-0 Prolene U stitch on an RB needle was performed. Next, the area of the thin overlying skin was removed in elliptical fashion, and then the healthy skin was closed with 3-0 nylon vertical mattress sutures in an interrupted fashion." Should we code separately for removal of skin, as the stent was placed percutaneously? What code(s) should be used?

My doc did an angioplasty for a chronic occlusion of the left innominate vein before placing a CVC. "Occlusion/Vein" in the ICD book brings me to thrombosis, I82.B21. Do I code for CPT 37248 for stenosis (he doesn't use the word "stenosis," only "occlusion"), or do I code 37187 because of the DX occlusion says? The doctor says this is not a clot/thrombus. Can I code 37248 with I87.1 since an occlusion is 100% stenosis??

"Needle entry into AV graft, diagnostic angiogram of graft revealed large false aneurysm, which compresses the true lumen by 60%, as well as stenosis in mid portion of the graft. Stent deployed to repair stenosis and simultaneously exclude false aneurysm. Skin was anesthetized over false aneurysm and needle placed directly into false aneurysm to fully drain. Seal was not complete, so balloon was inflated in stent to exclude false aneurysm. Second time, a Yueh catheter was placed to drain. 0.7 cc thrombin was injected directly into false aneurysm to dwell. No further leakage to aneurysm - successfully thrombosed. With incision and drainage, clot was removed from false aneurysm. Incision was closed with suture. Next, angioplasty was performed to treat stenosis in mid portion graft." What CPT codes can be assigned for this case?

What CPT code we would use for the removal of the AV graft stent? "1) Antegrade and retrograde ultrasound-guided access to the right forearm AV graft (image stored x2) with fistulogram and left brachial arteriogram. 2) Foreign body retrieval, arteriovenous graft covered stent removal. 3) Pharmaco-mechanical thrombolysis of AV graft. 4) Percutaneous transluminal angioplasty of arterial and venous anastomosis with completion fistulogram. PROCEDURE: Through the antegrade sheath, wire access was obtained through the arterial limb stent graft and into the venous limb of the graft. A 10 mm Gooseneck snare was advanced over the wire. The stent was constrained with manual compression on the skin and captured with the snare. The snare and sheath were removed as a unit over the wire. Covered stent graft was removed in its entirety. Successful retrieval of the constrained indwelling covered stent in the arterial limb of the graft. The previously noted iatrogenic graft-venous fistula is no longer present. Successful arteriovenous graft thrombolysis."

"We started the procedure by locating the left arm cephalic vein fistula. Access was achieved, and a 5 French was advanced without difficulty. Left brachiocephalic AV fistula angiogram and central venogram done, and a recurrent stenosis at left cephalic arch was noted and crossed with torque wire. Balloon angioplasty of cephalic arch with 8 x 40 mm Charger balloon (36902). Completion angio shows excellent flow via cephalic arch without residual stenosis. We then noticed presence of chronic clot adherent to proximal cephalic vein at aneurysmal segment without complete occlusion. Another access was done with micro puncture kit and proximal location and upsized to 8 French. We utilized an 8 French LIMA guide for suction thrombectomy and were able to remove some clot from cephalic vein. Completion angio shows some residual clot at cephalic vein without any flow compromise. Repeat duplex US shows residual clot, which was not able to be removed with suction catheter." For the thombectomy, since it is being done via a separate access site, would this be 36905-59 or 37187-59?

"12-year-old male with congenital heart disease of double outlet right ventricle, ventricle septal defect, interrupted aortic arch, sub aortic stenosis, and hypoplastic ascending aorta. He is status post arch reconstruction, aortic balloon angioplasty, and balloon angioplasty of the RV-PA, pulmonary valve replacement, and pulmonary valve conduit homograft and a 2018 Melody Wave implant. A selective PA demonstrates moderate insufficiency of the Melody Wave; angiography provides severe distal Melody Wave stenosis secondary to moderate sized vegetation. Now - status post successful balloon valvuloplasty of Melody Wave." I am not finding a listed CPT code for a Melody Wave valvuloplasty. Would this be unlisted code 377999? Can I charge 93533, 93566, 93568, 93567 for this patient's cath procedures?

Attempted to stent the 3rd diagonal from the graft but unable to pass the wire into the diagonal branch due to torturous branch. Can I bill for an attempted angioplasty?

"The right internal jugular vein was accessed under real-time ultrasound guidance. The needle tip was visualized accessing the vessel. Permanent imaging was archived in a picture archiving and communications system. A 5 French sheath was placed. A 4 French flush catheter was used to catheterize the left upper arm fistula through the right internal jugular vein access. A fistulogram was performed, demonstrating patent arterial anastmosis. A 4 French angle glide catheter was used to select the left brachial artery followed by angiogram with fistulogram and central runoff. Angioplasty of the 50% pre-existing venous outflow stent stenosis was performed using a 7 mm x 8 cm drug-coated balloon catheter. Angioplasty of the 50% stenoses in both left subclavian and left brachycephalic was performed using a 12 mm x 4 cm balloon." Are the codes 36902-52, 36907, and 36012 for the jugular access?

"Occluded right CFA limb of a right axillary-bifemoral bypass. Previous right groin incision reopened. Fresh inflammatory tissue surrounded the graft and femoral dissection. Dissection carried down to SFA and 2nd order branch of PFA. Graft removed from CFA and found with semi organized murky thrombus. Thrombectomy of the right limb of bypass graft with a forgarty to establish inflow, then from CFA, SFA, and PFA. Arteriotomy extended onto the SFA and PFA where occlusive dissection flaps were found, removed, and tacked down with prolene stitches. Arteriotomy was patched with bovine pericardium with extension of the patch onto both the SFA and PFA. Arteriotomy was made into the patch at the CFA, and the bypass was reanastomosed to the patch in an end to side manner." Is this coded with 35876 only? Or with 35302 and 35876?

Per CPT, "Up to two coronary artery branches of the LAD (diagonals), LCX (marginals), and right (posterior descending, posterolaterals) coronary arteries are recognized." Can you please explain what this means and how it impacts CPT coding for coronary interventions? Does it mean that only branches with these names are eligible to have their interventions coded? For example, if the physician performs an angioplasty in the mid RCA and then angioplasties a branch of the RCA - but not a PDA or a posterolateral - may we report 92921 in addition to 92920? Also, if, for example, the PDA branches off the LCX instead of the RCA, can we still consider it to be a branch for interventional coding purposes?

During an attempt to create an endovascular AV fistula, the physician performed a balloon angioplasty of a lateral branch of the cephalic vein to try to disrupt the valve in order to allow the deep system to fill the superficial system, allowing him to proceed with the endo AV fistula creation; however, it was unsuccessful. Would it be appropriate to code for the balloon angioplasty in this setting?

Patient taken emergently to the OR for bleeding from left neck. Right transfemoral access with left carotid angiogram. Stent-assisted angioplasty using Viabahn stent graft of the internal carotid artery. Deployment of stent graft abated all bleeding. Would this be billed with unlisted code 37799?

If my provider performs a fistulogram and angioplasty in the peripheral segment (venous anastamosis), then also obtains femoral access due to 100% occlusion of the innominate vein and performs angioplasty, am I correct in assigning 36902 without modidifer -52, 36012, and 37248? And what about if he does a complete fistulogram via AVF and finds patient to have total occlusion of subclavian, gains access through femoral, and performs angioplasty of subclavian? In these instances are we okay to report catheter placement with intervention code via remote access as well as 36901 or 36902 without modifier -52?

Successful PCI of LAD and diagonal, initially treated with main branch stenting (3.0 x 30 mm in LAD, post-dilated to 3.25 mm) and provisional balloon angioplasty of diagonal however the diagonal branch did require stenting after this. Therefore, reverse mini-crush technique used with 2.5 x 15 mm DES placed to diagonal, crushed, final kissing inflation with 0% residual and TIMI 3 flow in both branches There is a bifurcation lesions-successful-crush technique. Would 92928-LT and 92929-LT be appropriate here for the intervention? I've not seen a crush technique before.

I see conflicting info on submitting 61645 and 37215 (with DEP) together. In some of these Q+A's on this site it says bill both, but #47 instruction states this: 47) Cerebral artery thrombectomy code 61645 bundles ipsilateral catheter placement, diagnostic imaging, thrombolysis, intracerebral balloon angioplasty, and/or stent placement, vasospasm therapy, and follow-up imaging." I just would like to know what is correct. I know some of the advice was older, but I'm wondering what your take on this is now?

Procedure performed 1. Right femoral and left femoral arterial access 2. Left femoral venous access 3. Temporary pacemaker placement and removal 4. Aortic valvuloplasty with a 20 mm balloon 5. With a transcatheter aortic valve replacement 23 mm sapien 3 valve 6. Balloon angioplasty of the right common femoral artery 7. Art Line.

Would the professional CPT code for this case only be 33361, as the other elements are included in the procedure?

"Our physician performed a balloon angioplasty of a right-sided axillary-femoral artery bypass at both the proximal axillary and the distal profunda femoral ends of the bypass. Using an abdominal incision, we maneuvered to the proximal axillary end, performed angiogram and angioplasty, and then repeated the process at the distal profunda end." Is the selective catheter movement to the proximal axillary end of the bypass billable? We used two balloons to treat the stenosis at both ends of the graft; are both angioplasties billable?

How should intravascular lithotripsy for peripheral vascular disease be reported? Description of procedure from report: "We confirmed placement of a 0.014 Quick-Cross and confirmed that we were in the dorsalis pedis artery beyond the occlusion. We then used the shock wave lithotripsy catheter to break the calcium in the dorsalis pedis vessel as well as anterior tibial artery using serial pulses. Contrast injection confirmed luminal gain, and this was then touched up with balloon angioplasty. We placed a 3.5 x 4 mm balloon in the dorsalis pedis and brought it up for prolonged inflation."

"Acute RLE ischemia after percutaneous neuro-intervention via RT CFA access closure with Star device. RT CFA incision and dissection of the CFA, SFA and PFA. CFA arteriotomy revealed fresh thrombus that was removed and demonstrated a large posterior wall dissection flap. Arteriotomy extended distally and found the Star device had been deployed intra-arterially and had tacked down the origin of the RT SFA over the origin of PFA completely occluding both origins. The majority of the origin of the SFA was excised off the CFA in order to explant the Star device. Primary repair of the SFA with a patch and CFA and Star device associated dissection flaps with tacking sutures and bovine pericardial patch angioplasty. Thrombectomy of RT EIA, CFA and PFA. SFA was then end-to-side anastomosed to CFA patch using sutures. Below-knee RT popliteal artery cutdown and arteriotomy with thrombectomy of RT SFA, popliteal, tibial, and peroneal arteries. 4 compartment fasciotomy of calf." I reported codes 35226-22, 34203, and 27602. Is this correct?

What would be the appropriate CPT for a transcarotid TAVR? And is the common carotid angioplasty bundled?

Physician is billing 37246 for angioplasty of Impra tube graft/native LPA anastomosis (wouldn't this be 92997?), which was unsuccessful, and they were not sure they were even in the Impra tube graft. Same day patientt was transferred to OR for LPA stent. Since angioplasty is bundled into stent placement, can I only bill the 37236 for the LPA stent, or am I able to bill the angioplasty since this was done at different settings?

Our hospital-based IR doctor is going to be doing everlinQ vascular procedures. I found HCPCS code C9755, but I think this is for the facility or ASC only. Do you have any coding guidance for the physician (pro) side of billing for this new technology? I'm thinking unlisted code 37799 for the creation of the percutaneous fistula. Are we to bill everything else separately, like US guidance, angioplasty, etc.?

Procedure performed: open AV graft thrombectomy with angioplasty of the AV graft (peripheral dialysis segment). Would this be coded with 36831 (open thrombectomy) or 36833 (revision/thrombectomy)? Would angioplasty and/or stenting be considered a "revision"?

Partial note with cut out parts: "The plantar arch did not connect on the tip due to low flow. Subsequently, it was decided to proceed with a posterior tibial retrograde pedal access. The posterior tibial artery was accessed. There was a very small area to access the artery, as the artery quickly was 100% occluded thereafter. (Several wires were attempted)...using the Confianza Pro and the Quick-Cross the distal cap was finally crossed. Advanced to mid level PTA. The wire was withdrawn, and an angiogram revealed that the position was intraluminal. Next, a long Runthrough wire was advanced through the retrograde access and was snared antegradely and brought back out through the sheath in the left groin. A hemostat was applied to the wire at the right foot so as to secure it. A 2.0 mm x 40 mm balloon was advanced into the posterior tibial artery using the access in the left groin. Successful angioplasty was then performed." Can we bill the catheter access and angiography on plantar arch beyond the post tibial? Is there a code for snaring a wire to do the procedure?