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Lower Venous Intervention/Cath Placement

Bilateral venogram was performed (75822). Stent was placed in vein in the left lower extremity (37238). Can a catheter placement be billed when intervention is done (36010-36012)? If so, for both the right and left extremity? Access site is bilateral common femoral veins.

Additional Non-Coronary IVUS

Please help us understand when it is appropriate to use the additional non-coronary IVUS. Our physician placed a subclavian stent for known occlusion of the carotid and subclavian arteries with evidence of retrograde flow into the vertebral artery. The patient has been experiencing right arm claudication as well as subclavian steal symptoms. After the stenting procedure the physician states, "An IVUS catheter was then advanced over the Grand Slam wire and used to perform IVUS imaging of the right subclavian and innominate arteries. The IVUS images revealed excellent stent deployment with adequate stent apposition and no evidence for significant residual disease. There was no evidence for disease in the innominate artery." Can we code IVUS for both the subclavian and innominate arteries (37252 and 37253)? Could you explain why or why not?

LVOT Angiogram

Would an angiogram of the left ventricular outflow tract be reported with code 93565?

Needle and Catheter Aspiration Pleura

Patient had a microwave ablation on the left lung. Post ablation showed a posterior pneumothorax that was drained by a needle and an anterior-lateral pneumothorax drained with catheter placement. Is the pleural space considered one surgical field and code for the catheter placement (32557) along with the ablation? Or do we code for both the needle aspiration (32555-59) and the catheter placement?

Central Shunt Stent

Looking for codes for a stent and angioplasty to the central shunt as follows: "Using a 5 French long flexor sheath into the right femoral artery, stent was inserted in the right-sided shunt. The stent was deployed in the junction of the right BT shunt and the right pericardial tube. The stented region was ballooned again. Post stenting, angiography demonstrated patency of the shunts and the LLPA. Left lower branch of the LPA was ballooned as well. Shuntogram of the left BT shunt and right-sided shunt were performed prior to the revascularization." Struggling to find codes applicable to the shunt work. 

Mediports Without Tunnels

What CPT code should be reported in this situation? My doctors are inserting Mediports without creating tunnels, therefore, CPT code 36561 that describes creation of a tunneled Mediport insertion does not qualify in these instances. If you bill as a non-tunneled CVC with CPT code 36556, it would not capture the RVUs for the pocket created for the port placements. What are your thoughts?

93463

Can you please clarify what documentation is needed to support reporting code 93463 with a left heart catheterization? Our provider includes the statement, "Intra-arterial administration of verapamil 2.5 mg and nitroglycerin 200 mcg with an appropriate hemodynamic response," at the end of his heart catheterization dictation. Is this enough to report code 93463?

Aspire Mechanical Thrombectomy Platform

The Aspire mechanical thrombectomy platform was used in our cath lab to perform a coronary artery thrombectomy. Was I correct in reporting code 92973 for this procedure? My research indicated that I should use this code. Will you please confirm?

50432 vs. 50435 for dislodged Nephrostomy caths

We occasionally have patients who have had nephrostomy catheters placed. The catheter becomes dislodged at home, and they return to have it replaced. Upon arrival, there isn't a catheter present. The nephrostomy tract is still open, and a catheter is easily reinserted. Do you consider this a nephrostomy placement (50432) or an exchange (50435)?

Jejunostomy to Gastrojejunostomy

Patient with a failing jejunal feeding tube with significant bruising around the J-tube came in for a jejunostomy tube exchange (45451), but after discussion with the gastroenterologist it was decided to place a double lumen gastrojejunostomy (49452) tube. The gastrostomy lumen will be used for aspiration, and jejunostomy port will be used for feeding. What should be charged for jejunostomy to gastrojejunostomy conversion?

93286 and 93287 performed by reps

Our physicians are documenting in their op reports that pre and post reprogramming of the PM/ICDs is being performed before and after certain procedures such as ablations/cardioversions, so we assumed this was being done by the physician. However, we have found out that these reprogrammings are being performed by the Medtronic reps even though our physician is signing the device reprogramming form showing what changes were made to the device. I assume we cannot bill this under the physician or on our facility claim, as this is being done by an outside rep...is that correct?

Venous Angioplasty

For venous studies that require angioplasty, does the doctor have to dictate the actual percentage of stenosis, or would "significant occlusion" or such suffice? If percentage is needed to code angioplasty, how much is needed?

Follow up to Question ID: 10093 re: 93456 & 93505 CCI Edits

You recommended code 93505 only for routine heart transplant rejection surveillance. However, per NCCI edits, the "more comprehensive" column 1 code (93456) is eligible for payment, while the "component" column 2 (93505) is denied unless clinically appropriate with modifier -59. So shouldn't we report 93456 only instead of 93505? Furthermore, the recent OIG workplan only disallows the use of modifier -59 to the RHC code when it's a component of (secondary to) the column 1 code 93505. Not the other way around. Hence, shouldn't we be exploring the possibility of 93456 only or 93456 and 93505-59 in this scenario, instead of 93505 only?

92943 and 92944?

Patient scheduled for CTO of the RCA. After several unsuccessful attempts to access the RCA, the physician eventually needed to angioplasty the right PDA. Once the RDPA was ballooned, he was able to stent the RCA. Would add-on code 92944 apply here? Or would this be considered bundled into the CTO procedure (similar to roadmapping, per se)?

Multiple Breast Biopsies/FNAs

In the left breast, an ultrasound-guided core of one lesion and four fine needle aspirations of four different lesions were done in a single encounter... how would you code? How about two cores and two fine needle aspirations in a single encounter (all separate lesions in the same breast, single encounter)? How many times can code 76942 be applied?

GJ Tube Placement

What is the proper coding for the initial GJ tube placement under fluoroscopy?

3D 76376

Can you tell what statement would be good documentation for a radiologist to state if using 3D? I cannot find documentation that states what specifically needs to be documented. I have some providers that state 3D MIP images, MIP reformations, 3D postprocessing including MIP images, MIP reconstructions, 3D reconstructions. Do any these qualify for documentation for the 76376?

Acute Marginal Branch

Please clarify intervention on the acute marginal branch. Is the acute marginal considered a branch of the right coronary? Should we report codes 92928-RC and 92929-RC for the following intervention? "We successfully advanced a 2.5 x 22 mm Resolute drug-eluting stent over the ATW Marker wire and positioned it across the mid RCA stenosis where it was deployed using up to 16 ATM. We then advanced a 2.25 x 12 mm Resolute drug-eluting stent across the proximal acute marginal branch stenosis where it was deployed using up to 15 ATM. The stent balloon was pulled back slightly and used to post-dilate the area of overlap between the deployed stents."

Sclerotherapy reticular veins

What would you code for sclerotherapy reticular veins and why?

Intercostal Artery Fiducial Marker

Can you please tell me if unlisted spine 28999 or 37799 should be reported for the following procedure? "IMPRESSION: Spinal dural arteriovenous fistula arising from the right T5 intercostal artery at the right T5 neural foramen. There is also an anterior spinal artery arising from the right T5 intercostal artery. To assist with surgery, platinum fiducial marker was placed in the left T5 intercostal artery."

CT guided cryoablation and microwave ablation of lung

Would you code CT-guided cryoablation and microwave ablation of right lung 0340T, 32998-RT, and 77013 same session?

Aspiration of Fluid Collection

I work for a hospital. Our physician performed a CT-guided aspiration of a midline paraspinal collection for diagnostic purposes. The physician describes the collection as a postprocedural hematoma of the subcutaneous tissue. The physician manually aspirated 15 cc of yellow material with a 5 French Yueh centesis catheter needle, which was submitted for culture and sensitivity. Would the appropriate code for this procedure be 10022 or 10160 (both with 77012 for CT guidance)?

Venous stenting

My provider is doing placement of a vascular reconstruction device in the right transverse sigmoid sinus junction with cerebral angiogram and venous sinus manometry for pseudotumor cerebri syndrome. The following are the codes that we are billing: 61635, 36224, 36012, 75898, 75894, and 75870. I'm trying to verify if this coding is correct.

CODA balloon insertion for emergent AAA rupture patient transfer

A 90-year-old patient presented with abdominal pain in the ER. CT was performed, which showed a rupture AAA. The Cath Lab call team was requested. Once the team arrived, the patient was sent to the cath lab. Ultrasound vascular guidance fluoroscopy was used, then the physician inserted a CODA balloon to stop the bleeding and stabilize the patient for transfer to another facility, with the surgery team awaiting the patient's arrival." I am not aware of a CPT code specific for a CODA balloon insertion. Would it be acceptable for the cath lab to code catheter (balloon) placement (36200) and unlisted procedure? Or perhaps balloon embolization to stop a hemorrhage?

75625 vs. 75630

For the example that follows, which fits best: 75630 or 75625? "Aortogram was obtained in multiple views. There was a high-grade lesion of the proximal right common iliac artery. The right internal and external iliac arteries were patent. The external iliac artery was a little large than the 6 French sheath. The left common iliac artery stent was patent. The stent originated 2 cm distal to the aortic bifurcation. The left external and iliac arteries were patent. The catheter, wire, and sheath were removed. A figure of eight 6-0 prolene was used to close the access site."

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