Ask Dr. Z

Indication: Post TAVR "with subsequent left femoral pseudoaneurysm which was repaired earlier in the operating room today. While in recovery room, unfortunately, his blood pressure spiked to over 200 and he had episodes of violent coughing. Afterwards nursing staff noted progressive swelling of left groin. Ultrasound performed on my request urgently showed recurrent pseudoaneurysm. I decided to take him urgently back to the operating room for surgical repair........." The physician billed 35141-78 for the return visit. There is an MUE of 1 and an MAI of 2 meaning there are no appeal rights. Is there a code to better capture the additional work or do we bundle it with the original procedure? We considered adding -22 to the original procedure, but are unsure if it is applicable since the work wasn't performed in the same session. Please advise.