Ask Dr. Z

Via right femoral access the doctor did an abdominal aortogram with bilateral renal and bilateral iliac runoffs. Then he placed the catheter in the right renal artery and did an angiogram. How do you code for the iliac runoff study? Is the aortogram included in code 36251? Can I use code 75630 with 36251? I code for the physician.

We have a thrombolysis case where the physician dictates final day on a progress note. Here is the only documentation provided aside from E/M details. Is this enough to report code 37214? "PA pressure measured through Ekos catheters was 44/37. Impression and Plan: Patient with improving clinical picture status post 24 hours of US assisted thrombolysis. Clinically her symptoms have resolved. Her troponins are down from 3.9 to 1.2, and her BNP is only minimally elevated. Therefore, TPA infusion discontinued and sheath removed. Plan will be to immediately anticoagulate patient with heparin and to convert to oral anti coagulation as soon as possible."

Can you please provide assistance for the procedures listed below at your earliest convenience! Procedure 1 - 2-6-18 *CESSATION/REMOVAL OF THROMBOLYSIS CATHETER - 37211 CHARGED ON 2-5-18 *STAGED RELOOK ANGIO *MECHANICAL THROMBECTOMY OF PRIMARY ARTERIAL THROMBOSIS OF LEFT COMMON FEMORAL, SFA, AND PROFUNDA ARTERIES *BALLOON ANGIOPLASTY OF COMMON FEMORAL, SFA, AND PROFUNDA PROCEDURE 2 - SAME DAY OF SERVICE 2-6-18 - PATIENT BROUGHT BACK EMERGENTLY POST FIRST PROCEDURE *LEFT LOWER EXT. ANGIO *CATH PLACEMENT IN LEFT POPLITEAL ARTERY FROM CONTRALATERAL FEMORAL ACCESS *MECHANICAL THROMBECTOMY OF PROFUNDA *MECHANICAL THROMBECTOMY AND ANGIOPLASTY OF ANTERIOR TIBIAL *MECHANICAL THROMBECTOMY OF PERONEAL *MECHANICAL THROMBECTOMY AND ANGIOPLASTY OF POSTERIOR TIBIAL *PLACEMENT OF THROMBOLSIS CATHETER. Dr. Z IR states that 37211 and 37214 are not allowed on the same date of service. Are any special modifiers allowed? Current tentative code set: Procedure 1 - (37214?), 37184, 37224 Procedure 2 - (37211?), 75710-LT, 37186, 37228, 37232

In our practice it's common to have one of our cardiologists perform the heart catheterization and the interventional cardiologist perform the intervention (like a stent) for the same patient, same procedure. Both cardiologists dictate their own OP report while referring to the other's work. Example: "See Dr. A's report for diagnostic cath details" or "See Dr. B's report for PCI". We have no trouble getting our claim processed when the intervention is a stand-alone code, but our claims for add-on codes like an FFR are being rejected. Is there a way to report the diagnostic cath on the interventional claim that acknowledges that a diagnostic cath was performed along with the FFR but by another physician at the same time?

37785, Ligation, division, and/or excision of varicose vein clusters. Does the documentation need to state "varicose vein clusters"? Our physician is removing large varicose veins through separate incisions and then suturing those incisions.

When a patient has a cardiac cath performed via radial access, I've been told intra arterial injections are being administered to "prevent" vasospasm while the catheter is being manipulated and moved throughout the cardiac cath procedure. These injections are not given when access is gained via the groin. These claims are hitting a CCI edit with the cardiac cath codes and CPT 96373. In my opinion, this would be included as part of the cardiac cath procedure and adding a 59 modifier would not be appropriate. What are your thoughts? Thank you.

We have scenario in which a patient had a therapeutic injection of Depo-Medrol for shoulder pain (20610) at the same time that Omnipaque, Omniscan, lidocaine, and ropivacaine were injected via a 22 gauge needle inserted into the glenohumeral articulation to perform a diagnostic arthrogram and post arthrogram MRI. Is it appropriate to report code 20610 along with 23350? All meds were injected via one needle. 

The patient has hepatocellular carcinoma (HCC). The procedure performed is a Pexa-Vec (oncolytic immunotherapy drug) ct-guided injection into the liver. What is the CPT code for the injection procedure?

We are trying to code a case where the physician states he stented a 100% subtotal occlusion of the RCA. No thrombus is mentioned. Would this be coded as a CTO?

How would you code placement of a tunneled port via the hepatic vein? Would the same port placement codes (36561, 77001, 76937) be correct? 

"Patient presents with AAA as well as bilateral common iliac artery aneurysms that involve bilateral common iliac artery bifurcations. The patient's bilateral common iliac aneurysms are not amenable to standard endo-grafting and will require the use of a Gore iliac branched endoprosthesis to obtain a seal, as well as to maintain preservation of flow into the internal iliac arteries. Our physician did EVAR with an aortic endoprosthesis with two docking limbs, distal extension into external iliac artery of endoprosthesis on right side, distal extension of endoprosthesis, internal iliac on right side, distal extension into external iliac of endoprosthesis on left side, and distal extension into internal iliac with distal endoprosthesis extension on left side." This is the first time we have done this with four extensions. What is the best way to code these?

Prior to the McKesson reports, cath reports would describe the catheter crossing the aortic value, which meant you were in the left ventricle and performing a left heart catheterization. Reports no longer have this verbiage however. So my question is, if the report indicates LV pressures were taken, does this constitute a left heart catheterization? LV gram would constitute a left heart catheterization, but this is not always performed. Any help in determining if a left heart cath is done is very much appreciated.

During EOL generator change, a pocket revision procedure is noted in the operative report to reduce perioperative infection risk. Is debridement code 11042 for 14 sq cm appropriate to report? "A 10 blade was used to make an incision approximately 3 inches in length over the pre-existing scar. Blunt and sharp surgical dissection was carried down to the endothelialized capsule, which was incised. The pulse generator was removed from the capsule. Leads were removed from the head of the device. Chronic threshold testing and lead evaluation demonstrated all three leads to be adequate for utilization. A complete capsulectomy with excision of all devitalized tissue was performed at this time, with removal of approximately 14 cm tissue at this time. Hemostasis was assured with electrocoagulation. The pocket was copiously irrigated with Bacitracin solution. A new CRT-D pulse generator was brought on the field."

Would we code both or just the most extensive (the chest tube) for the below example? I'm thinking since it was two separate diagnoses (the chest tube is for the pneumothorax that developed and the thoracentesis is for the effusion) that we can code both (even if they are in the same place, it's technically now separate issues)... what are your thoughts? "A small 6 gauge catheter was placed into loculated pleural effusion with subsequent fluid drained. Small pneumothorax was identified directly after draining the loculated effusion. A small 6 French chest tube was placed with interval improvement of the pneumothorax."

"Sternotomy were performed. ICD was excised from left deltopectoral pocket and placed outside the body. ICD leads were cut at the level of the innominate vein in the deltopectoral pocket. Right subclavicular incision was reopened and Hemashield graft exposed. As soon as cardiopulmonary bypass was initiated, the Impella 5.0 was pulled out, and Hemashield graft was stapled off. The donor heart came to the field. The interatrial septum was inspected; there was no PFO. The LAA of the donor heart had been opened on procurement and had been closed. The heart was then implanted in the usual fashion." Are codes 33945, 33944, 33241, 33243, and 33992 correct? Impella was inserted two days prior via Hemashield conduit. If code 33992 is not correct, how would this be coded? I'm not sure of the documentation requirements for 33944.

"Occlusion of midportion of SFA with reconstitution to the below-knee popliteal artery.4-0 spider wire was deployed into the distal popliteal artery. Area was predilated. Atherectomy was performed in the occluded area.Multiple cuts were performed in multiple areas.2 balloons were inflated to nominal pressure per protocol. Excellent results were obtained.Spider wire had embolic debris contained within.This was removed in the usual manner. A runnoff was performed following removal of spider wire and was found to be unchanged compared to pre-intervention." Provider is asking to bill the angio due to tibials being imaged post atherectomy to evaluate embolic debris, stating a different territory is selected, spider wire removed, and catheter remains in place, and that it is independent of the procedure performed proximally in a different territory. Is this considered a true diagnostic angiogram? We feel it is not separately billable (pre-procedure aorta/leg runoff was done and is being captured). Please kindly advise on allowance to bill post procedure angio in this case.

"A venogram of the left subclavian and axillary vein was performed, which demonstrated a small vessel with the question of possible downstream collateralization. Using sharp and blunt dissection, a pocket was created on top of the pectoralis muscle. Access was obtained in the left axillary vein using the modified Seldinger technique under fluoroscopy and ultrasound guidance. A 5 sheath was placed over a Glide wire, and then a selective venogram was performed in the subclavian vein. This demostrated a complete occlusion and thrombosis of the mid subclavian vein with significant collaterals. The wire could not be passed through this obstruction. At this point, the wound was closed in a 3-layer fashion with absorbable suture. A venogram of the right axillary and subclavian vein was done. Found to be patent. A pocket was fashioned and continued with the placement the dual chamber ICD." Can we report the attempted left axillary access selective venogram of subclavian vein with code 36005-XS?

"Patient's previous PEG tube was removed due to fistula drainage. After gastric drainage, patient returned for new gastrostomy tube placement via the fistula. Patient was placed on the gastrostomy table, and fluoroscopy was used during the procedure. The skin around the G-tube site was prepped and draped. Using fluoroscopy, the track was recannulated, and a new 20 French gastrostomy tube was advanced into the stomach via the fistula access. A balloon was inflated, and contrast and air were injected through the tube to confirm final position. Tube was secure and bandaged." Would this be considered a new PEG tube with 49440 since fluoroscopy was used, or would this be 49450 just for the replacement of PEG tube since they aren't generating a new access?

When my surgeons remove an Impella, they expose the femoral artery to remove it and then suture the artery. Due to NCCI edits, would this be bundled into the removal code? When would it be appropriate to report the repair code with an Impella removal?

Our EP physician had a failed attempt at placing an LV lead with existing ICD and also a failed attempt at His placement of the lead. The CT surgeon finally placed an epicardial lead by thoracotomy. Can the EP physician charge for codes 33224-53 and 33216-53?

Patient with chronic abscess cavity in post coccygeal resection bed with chronic drainage catheter in place. Patient was placed on fluoro table in prone position. Contrast was injected through the drain, then flushed with sterile saline. Drain and surrounding skin were prepped. Drain was advanced back into appropriate position and again flushed with sterile saline and placed back to bulb drainage. Findings: Coccygeal abscess cavity fills and drains via drain; however, it had pulled back slightly. A plug was cleared from the drain, improving drainage, then was repositioned back to where it had been previously to improve function. Cavity was fully evacuated." We are finding no CPT code for imaging, flushing, repositioning coccygeal abscess drain, so we assigned code 20999 after eliminating codes 49423, 49424 (out of category), and 10030. How would you code this, and what's your rationale?

Under what circumstances can codes 76885 and 76886 be billed during the same encounter (e.g., can they be billed separately when both static and dynamic tests are performed, and findings for static test and dynamic test are reported in separate paragraphs)? Under what circumstances can code 73562 or 73564 be billed with 77073 during the same encounter? Would it be appropriate to report three views of the knee if three views of the knee are taken and one additional view is reported for “scanogram”? Diagnoses are knee pain and/or arthroplasty follow-up.

How do you code bilateral femoral arterial primary mechanical thrombectomies when performed via the SAME access site? Would this be code 37184-50 (since two separate vascular families), or would it be considered 37184 and 37185 since performed via the SAME access site? The CPT Codebook seems to indicate in order to report this performed bilaterally there must be a separate access site. Can you please clarify if there must be separate access sites in order to report 37184-50 for a bilateral arterial mechanical thrombectomy via the SAME access site?

In the 2018 Professional Edition of the CPT Codebook, it states that code 34808 can be billed with 34701, 34702, 34707, 34708, 34709, 34710, 34813, 34841, 38482, 34843, and 34844. However it doesn't say 34705 or 34706. With the old codes you could bill 34808 with the bifurcated grafts. Is this a typo? Or is it included in the treatment zone now? I checked NCCI and there are no edits for 34705 and 34808.

I know you answered a similar question in 2012, but I'm wondering if the recommendation is still the same. We performed an EVAR in which the SMA was also stented. A few weeks later the patient returned to us for evaluation of a possible endoleak and evaluation of what appeared to be a stent fragment in her left external iliac artery. A diagnostic study was performed, and it was determined that her SMA stent had fractured and migrated to her left external iliac artery. The stent was balloon dilated in place in the external iliac. The stent was not otherwise manipulated, and no other interventions were performed. How would you bill for the balloon dilation of the stent?

"Utilizing fluoroscopic guidance, a 20 gauge Touhy needle was placed into the left paracentral posterior epidural region at the L4-5 level. Needle localization was confirmed with contrast injection in multiple views and negative aspiration. 4 mg of dexamethasone and 1.5 mL 0.75% Sensorcaine were injected into the epidural region." Is this transforaminal approach or midline? Please advise. 

According to one of our vascular surgeons, all but one EVAR device utilized by our surgeons have an attached sheath. He is questioning whether code 34713 should only be billed with the GORE device. He states the others are sheathless. Example: "Endurant II was used for the following. I obtained bilateral common femoral artery sheath access initially by advancing wires and catheters, initially placing 6 French sheath and then deploying a Perclose device at the 12 o'clock position in each common femoral artery. The suture is left loose to be secured at the completion of the procedure to utilize the pre-close technique. Anticoagulation is achieved with heparin. I then advanced a larger sheath upsizing to a 16 French on the right and a 12 French on the left. Main body aortic extension using the 36 device is advanced and deployed proximally preserving the renal arteries. I then ballooned this out with a large balloon and then utilized for the endoanchors to fixate this more actively given his history of endoleak." Can code 34713 be billed for this case?

US-guided biopsy of anterior abdominal wall, superficial fat biopsy. I reported codes 76942 and 20206; however, it has been kicked back multiple times (even after I forwarded three examples from you), and now coding management has sent this: "The code descriptor of 20206 specifies muscle biopsy. The tissue biopsied in this case was superficial fat of the abdominal wall. There is no specific CPT code for this procedure, therefore code 22999 (unlisted procedure, abdominal musculoskeletal system) is the correct code." Am I off base here? I have been using 20206 for these for a long time. Is there anything else I might offer them as explanation? 

I am confirming what I think I know to be true, but making sure I did not misunderstand anything. When billing 76937-26 for ultrasound access, the provider needs to document vessel patency, real-time visualization of needle access, where the images are stored (meaning the images must be stored), and findings of the service. Can this be documented in the procedure note for the services vessel access is being done for? There is a question in my organization as to whether the images do have to be stored.

Are the angiographies billable with these two procedures? "(A) Y90 WORK UP: Selective arteriography of the celiac, SMA and replaced RT hepatic artery with a large tumor blush in RT hepatic lobe corresponding to tumor seen on recent MRI, fed by branches of replaced RT hepatic artery. 3D cone beam CT from replaced RT hepatic artery show the large RT hepatic lobe mass seen on prior CT. Infusion of MAA into RT hepatic artery was performed. (B) IMPLANTATION: TACE X 2 with follow-up MRIs showing bilobar treatment changes with new/enlarging residual viable tumor in LT hepatic lobe and segment 7/8. Selective celiac arteriogram: truncation of PHA with vessels that supply the tumor in LT hepatic lobe arising from LT gastric artery; selective CHA/cystic arteriograms: small vessels arise from cystic artery which takes off from proximal GDA; and selective LT gastric arteriogram: accessory LT hepatic artery with multiple small vessels supplying the known lesions in hepatic segment 2/3. Radioembolization of the parasitized vessels arising from his cystic artery and small branches supplying the gastric fundus was performed."

Would this be coded as unlisted or kyphoplasty? "The patient was prepped and draped under sterile fashion in a prone position. 90% of the L5 vertebral body was destroyed using a left parapedicular approach. A 9 gauge trocar needle was placed into the anterior vertebral body of the L5 tumor. Radiofrequency ablation was performed until complete roll-off at 60 Celsius temperature to achieve cytotoxicity, which took approximately 20 minutes. Thereafter, vertebral height augmentation was performed with balloon at 350 psi. 5 cc of methyl methacrylate was injected into the disk space. A 9 gauge trocar needle was placed into the right sacral iliac ala where there is a lytic lesion. Initially radiofrequency ablation to 60 Celsius and complete roll-off with impedance was performed for cytotoxic treatment. Thereafter, 4 cc of methyl methacrylate was injected into the right sacral ala for stabilization as well as palliation."

How would you bill for crisscross infusion catheters placed in a fistula? Fistulogram showed thrombus within AV fistula with total occlusion. Successful crisscross placement of 5 French sheath and 10 cm infusion catheter within the venous limb directed peripherally and 6 French with 10 cm infusion catheter within the arterial limb directed centrally.

"The cephalic arch stenosis was treated with angioplasty using a standard balloon, size 8 x 8. The post intervention stenosis was 50%. The residual stenosis was treated with angioplasty using a standard balloon, size 9 x 4, resulting in less than 10% stenosis. Next, a 5 French berenstein catheter was used to advance the wire through the supraclavicular collateral vein. The stenosis in this collateral vein was treated with angioplasty using a standard balloon, size 8 x 8, resulting in less than 10% stenosis." Should we report codes 36902 and 37248?

1) Pacemaker generator change. 2) Placement of a new lead in the right ventricle. 3) Capping and abandonment of old lead.... When the existing right ventricular lead has been capped and abandoned and new lead is advanced into the right ventricular apex using a combination of straight and custom-formed stylettes onto new pacemaker generator (pulse generator was also changed), should this procedure be coded as 33212, 33216, and 33233? Or 33227 with 33212 and 33216? And is fluoroscopy always included in pacemaker procedure?

The new MI codes are throwing us off a little. If our doctor admits the patient with a NSTEMI (I21.4), but after taking the pt to the cath lab an in-stent thrombosis is found, should we code the I21.4, I21.A9 and the T82.867A or leave the NSTEMI code off since by definition the stent thrombosis meets the definition of the new MI code I21.A9? Also, if we know an MI is due to an in-stent thrombosis, would you recommend sequencing the I21.A9 or the T82.867A first? Thank you.

Are assistant surgeons and co- surgeons allowed for the new EVAR codes?

We are requesting your opinion on an accurate comparable code. We suggested code 33215; however, the provider prefers 33300 (at 10% work effort) due to prepping in case things didn’t go as planned. "Operative Note: Patient had a temporary lead perforate the RV. A permanent system was placed before the patient was transferred here. The patient was taken to the OR and placed under general anesthesia. I was prepared to perform placement of a percutaneous drain, moving to a subxiphoid pericardial window, moving to a full sternotomy to repair the defect directly if complications occurred. We began with exam of the heart under fluoro, then, with a good eye on the lead, we carefully pulled it back through the perforated site, into the heart, then into the SVC. Echo confirmed there was no effusion or evidence of bleeding, indicating that allowing the pericardial space to seal functioned successfully and there's no need to open the patient. I removed the lead back into the sheath, and the procedure was concluded. The lead was successfully removed without complications from the perforated RV."

Patient has a dual chamber ICD with a right ventricular lead fracture. Procedure performed was right ventricular lead replacement, fractured right ventricular lead capping, and replacement of dual chamber ICD with testing of ICD. What are your coding recommendations? 

A new AV fistula (brachial/cephalic) is created, and the cephalic is brought over and sewn end-to-side into brachial (I know this is 36821), but they then elevate the cephalic with sutures underneath to superficialize it during closing... would the procedure then become a transposition (36818)? 

Is angioplasty of the right common iliac billable when done for protection? Note states: "We now angioplastied the right common iliac artery with a 6 mm balloon for protection. We brought a wire and catheter into the aorta from the left side. We performed over-the-wire thrombectomy of the left common iliac artery, removing a moderate amount of old appearing debris. We performed two thrombectomies with audible inflow. We then stented the left common iliac artery into the aorta using a 7 x 38 mm iCAST covered stent. The right-sided balloon was deflated."

We need clarification after a TAVR is performed due to a disease. After which the surgery is performed, our team bill status post codes for the CT cardiac morphology instead of the disease that warranted the TAVR. Of course Medicare is denying the status post code TAVR. I would think if the physician has  "Severe Aortic Stenosis" under the impression/assessment that this ICD-10 code can be used. Please advise.

For G0288 surgical planning for vascular surgery of aorta, can the code also be billed for post-op follow-up treatment? My understanding is that the code is for surgical planning only, but the facility where I work is using it for follow-ups to TAVRs and AAA repairs where no surgery is planned. Is that allowed?

I need some clarification on how to use the new INR related codes for 2018 (93792, 93793). Are these codes used in conjunction with 85610 or would these codes replace 85610. Also, are these to be used for both office and in home INR monitoring? Any insight or information on these new codes would be greatly appreciated.

I have a case where the cardiologist put in a dual chamber pacemaker (33208-KX). The following day the patient had chest pain and palpitations, so the note says the patient will have revision of pacemaker and leads. I am not sure how to code this revision. Here is the revision report: "An incision was made inferior to clavicle. Dissection was carried down to myofascial plane and then continued caudally to form a pocket for the generator. The atrial lead was placed in the atrial appendage. Ventricular lead was placed in right ventricular septum. Suture was used to secure the new leads. The leads were pushed in about another 2-3 cm to provide more slack. Thresholds and impedance were excellent. New generator was securely attached to the leads and placed in pocket." Would this be just a revision (33215), or would you code this as removal and replacement of the entire system?

Patient already had a CFA puncture for fem/pop angioplasty, and then the physician's documentation states: "At this point we prepped the patient's left foot and punctured the posterior tibial artery under US guidance. Again a wire and a catheter were inserted and angiography confirmed location. Following this 100 mcg of nitroglycerin was injected through the catheter every 15 minutes. We were able to advance a wire and a catheter through the TPT and into the popliteal artery. We then used a micro-snare and were able to snare the wire coming from the posterior tibial puncture from a catheter inserted from the common femoral puncture." I'm really at a loss on how to code what is documented above. Any help would be appreciated.

For the following example, would code 35741 be correct? "Patient had subtotaled popliteal artery just above his knee, about the place it looked like for entrapment. Skin incision made posteriorly across the fossa. We angled the skin incision. We opened across the fascia, went down, and found the artery. There was a lot of inflammation around the artery, and it looked like the artery was not going to be viable for an endarterectomy with patch angioplasty, so we closed the incision, flipped him over, and took the greater saphenous vein from his right groin. We oversewed the branches and cut the valves out so we were able to use this for the interposition. Incision was closed and stapled. We then turned him back over, prepped and draped, and opened the posterior incision behind his right knee. We gave 10000 units of heparin. ACT was just was 225. We gave another 10000. We then clamped the artery and did the proximal anastomosis. We had good flow through it. We cut it to appropriate length. We did the distal anastomosis, both with 6-0 Prolene, and closed." 

I am auditing a case where a physician performed thrombectomy of an AV graft through an open incision and graftotomy. He then shoots a diagnostic fistulogram (bundled) and identifies a hemodynamically significant stenosis in the venous outflow. He treats this stenosis through a percutaneous stent placement. Can I report code 36833 for the combined procedures in this case since there was an open incision and thrombectomy to start the case and edits prevent coding 36831 and 36903 together?

Would the following example be reported with codes 37252, 36200, and 34702? "The patient was intubated. She was prepped and draped. Under ultrasound guidance, the left common femoral was accessed. Two Perclose sutures were fired, and we placed a 7 French sheath. We did an angiogram. We placed an 18 French sheath. We did an angiogram, which revealed lobar renal arteries. We then advanced a 12 x 10 C-tag device and deployed it below the renal arteries. We then ballooned the middle and distal zones with a Q50 balloon. Completion angiogram showed excellent result exclusion of the aortic disease to ulcerations of the aorta. There was a small dissection noted in the left common iliac artery. We had a wire across the device across the native artery, so we went ahead and that by 8 x 56 _____ stent. Completion angiogram showed excellent result. The sheath was removed. The Perclose sutures were of admission, she had good pulses, which she did. She tolerated the procedure well."

For the following example, we are not sure about the correct CPT code for retrograde catheter placement? 36246? "The right groin and right foot were prepped and draped in the usual fashion. Under ultrasound guidance the distal anterior tibial artery at the level of the ankle was accessed with a micropuncture needle. Images were saved for further review of the medical records. A 2.9 French sheath was advanced into the artery and arteriogram was obtained to confirm the intraluminal placement of the sheath. Next 200 mcg of nitroglycerin were administered through the sheath. Next a Cook wire was advanced with the help of the 0.18 CXI catheter to the level of the occluded SFA. Next different wires were utilized including a 0.018 wire, then a 25 g CTO Cook wire and all these wires were unable to cross the lesion despite the support catheter. Next I tried a 0.018 Glidewire to try to obtain a subintimal plane and that also was not possible. We proceeded to pull wires and catheters the micro sheath and manual pressure was held for 10 minutes at the level of the ankle." 

I found a question from 2015, but I'm looking for current information regarding the coding of this procedure. For our procedures the patient has the prostate MRI done at another location and then we import that data into the UroNav unit the day of the procedure. At the time of the procedure the live ultrasound of the prostate is performed, and that exam is fused with the prior MRI to create a 3D rendering on screen that is used for the prostate biopsy. Multiple core biopsies of the prostate are then done with the guidance of the image appearing on the UroNav unit. Currently for this procedure we are using the codes 55700, 76942, and 76377. We are being told that we cannot use code 76377 because "there is no separate reimbursement for that code, as it is considered a packaged service". What is the correct billing for this entire procedure?