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Pulmonary artery pulmonary vein fistula with shunting
Date: Mar 12, 2012
Question:
Dr. Zielski,
Good afternoon it has been a while since I have sent you a question. I love the 2012 book by the way!
I have a question that I would like to ask as it is a rare situation that occurred and now I am trying to figure out how to code it.
A patient came to the ER hypoxic and not doing well, went to ICU and was there for several days. The patient was found to have a right pulmonary artery/pulmonary vein fistula and was shunting past the left atrium. The patient was not a surgical candidate and on high levels of oxygen.
This case was a combined effort with the Interventional Radiologist and the Interventional Cardiologist (just like Amir Motarjeme once told me that it would be)
where the Radiologist did the diagnostic and filming via low resolution CT and the Cardiologist managed the intervention (has does the ASD/PFO closures in the Cardiac Cath Lab and is very familiar with the device)
The fistula was closed with an amplazter septal occluder (not vascular plug as there was no "tunnel/tube").
The patient's oxygen saturations immediately increased. The patient was returned to ICU and walked out of the hospital on room air a few days later.
Now my fun begins. I was thinking of using the embolization codes of 37204/75894. The C code for the device is C1817.
There are no "procedure to device edits" per the Jan. CMS list for procedure 37204.
The patient was an inpatient but all of the charging of procedures are attached to CPT codes as per the chargemaster.
Thank you for your time and consideration.
Good afternoon it has been a while since I have sent you a question. I love the 2012 book by the way!
I have a question that I would like to ask as it is a rare situation that occurred and now I am trying to figure out how to code it.
A patient came to the ER hypoxic and not doing well, went to ICU and was there for several days. The patient was found to have a right pulmonary artery/pulmonary vein fistula and was shunting past the left atrium. The patient was not a surgical candidate and on high levels of oxygen.
This case was a combined effort with the Interventional Radiologist and the Interventional Cardiologist (just like Amir Motarjeme once told me that it would be)
where the Radiologist did the diagnostic and filming via low resolution CT and the Cardiologist managed the intervention (has does the ASD/PFO closures in the Cardiac Cath Lab and is very familiar with the device)
The fistula was closed with an amplazter septal occluder (not vascular plug as there was no "tunnel/tube").
The patient's oxygen saturations immediately increased. The patient was returned to ICU and walked out of the hospital on room air a few days later.
Now my fun begins. I was thinking of using the embolization codes of 37204/75894. The C code for the device is C1817.
There are no "procedure to device edits" per the Jan. CMS list for procedure 37204.
The patient was an inpatient but all of the charging of procedures are attached to CPT codes as per the chargemaster.
Thank you for your time and consideration.
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