Ask Dr. Z

I'm not sure what I can bill here. I know thrombectomy isn't separately billable, and the dottering was done with a wire, so I'm thinking that isn't either. It seems to me the physician should be able to bill something for the work. Acute MI is documented in report. Interventions: "Given bolus and started on infusion of angiomax. Prowater wire advanced beyond PLB occlusion, but distal vessel very small and tortuous. Two aspirations with Pronto thrombectomy catheter, restoring TIMI-1 to TIMI-2 flow. Wire then pulled back and advanced to distal PDA occlusion. Vessel very tortuous and occlusion very distal, so no thrombectomy. Floppy wire then used to dotter the PLB occlusion again, restoring TIMI-2 flow. Elected not to do PTCA or stenting, given how distal both occlusions were and how small the vessels were at that point. Considered integrilin, but small hematoma at right groin (patient practically jumped off table with lidocaine at beginning of case) and concerns about bleeding risk (with effient on board as well). Angio-seal deployed right FA."