Ask Dr. Z

I have an EP provider who wants to report code 37248 when they perform Dotter dilation during a pacemaker or ICD lead insertion. Here is an example of the documentation: "I was able to visualize a fair caliber right internal jugular vein. Using Seldinger technique, I was able to access this vein and place a 0.038 guidewire. The guidewire would not fully advance down into the SVC. I exchanged this for a catheter, and right internal jugular venogram did demonstrate a high-grade stenotic occlusion. Using the 501J catheter and a 0.038 guidewire, I was able to manipulate across this high-grade stenosis. Using Dotter dilation, I was able to advance up to a long #10 French introducer sheath to achieve access to the right heart. Through the #10 French sheath, I then placed the right ventricular lead." My understanding is that the Dotter dilation creates a small channel for the lead, and this would not be coded separately. The provider disagrees and wants this coded as a venoplasty with 37248.