Ask Dr. Z

Ask Dr. Z Knowledge Base houses over 7,000 coding questions and answers dating back to 2010.

Ask Dr. Z Disclaimer

No bladder aspiration performed. can 52 be added.

I have a report that states a suprapubic catheter was placed. I asked if the bladder was aspirated and the doctor states We use imaging (US visualization of needle and wire and contrast administration into bladder) to confirm our needle and wires, not aspiration as is the method of confirmation for non-image guided SP tube placement. I suspect that "aspiration" requirement applies to non-image guided SP tube placement.. Can mod 52 be added tu

Aortic root replacement, cut down and LAA

If the following procedures listed below were performed during the same operative session, would the LAA be considered bundled with the aortic root replacement? Also, how would you code this scenario? 1) Aortic root replacement with 27 mm freestyle with ascending aortic aneurysm repair with 26 mm tube graft. 2) Right femoral artery cutdown for arterial cannulation. 3) Ligation of left atrial appendage with Atriclip. 

Vein ablation and phlebectomy on the same leg at the same encounter

Under ultrasound guidance,right GSV was accessed at the level of the knee.The wire and inner dilator were removed and radiofrequency ablation catheter was advanced through the sheath into the vein and advanced towards the saphenofemoral junction the tip was positioned greater than 3cm distal to the junction within the vein.Tumescent anesthesia was then injected. The patient was then placed in Trendelenburg position.Radiofrequency ablation was performed along the length of the vein. After completion,all instruments were removed and direct pressure held until hemostasis.I interrogated the thigh and showed the saphenous vein appeared ablated while the deep veins appeared patent.I then proceeded with phlebectomy at previously marked varicose vein sites.Tumescent anesthesia was injected.Then a stab incision was made with Beaver blade. Using surgical hook, the vein was brought out through the incision. Then using mosquito forceps and gentle traction,phlebectomy was performed.16 separate incision sites along the leg. He submitted CPT 37765 and 36475, is that correct

thrombectomy at time of AVF creation

"A patient underwent creation of a brachiocephalic AVF. After construction, thrill in the fistula was noted to be weak. The anastomosis was taken down and fresh thrombus was seen at the anastomotic site. This was removed and flushed away with heparinized saline. Then thrombectomy of the brachial artery was performed with a Fogarty catheter. The artery was flushed. A Fogarty catheter was passed into the cephalic vein and a small amount of thrombus was extracted. The vein was flushed. The anastomosis was redone." How would this procedure be coded? Would the thrombectomy be considered part of the AVF creation, or is it separately reportable?

RF Denervation Dorsal Rami plus Medial Branch

Right lumbar medial branch RF denervation at L3, L4 medial branch and L5 Dorsal Rami. RF cannulas are positioned directly to the superior and medial aspect of the transverse process, and also at the right sacral alar notch. RF lesions are created at both of these sites. I believe this should be coded with 64635-RT for the L3,L4 medial branch; plus 64640 for the Dorsal Rami because it is a lateral nerve and not a medial branch or facet joint nerve. Auditor maintains that this represents two levels of medial branch denervation and 64635, 64636 should be coded. Who is correct?

CPT code for Innominate to left common carotid artery bypass with 8 mm dagr

CPT code for innominate to left common carotid artery bypass with 8 mm Dacron graft and 8 mm Dacron graft cannulation of innominate artery. These two procedures were done with aortic valve replacement (David procedure): 33864. Can't find codes. 

ICD pocket debridement

Patient with CRT-P came in with pocket infection. Opened pocket and just did debridement of pocket with tissue cultures sent to lab. Placed original device back in pocket and closed. What would be the correct billing code for this procedure?

Thoracotomy drainage lung parenchymal&pleural abscess

What is the code for the procedure above? and here is the note. Thank you in advance, I performed a standard posterolateral left thoracotomy, shingling the rib in about the fifth intercostal space. The lower lobe was very inflamed and matted down and the upper lobe was relatively adherent as well. With difficulty, I was able to mobilize the lower and upper lobes. There appeared to be 2 abscesses of the lower lobe that are perforated into the pleural space and there were multiple collections of thick yellow pus. There was approximately 1200 mL or more of purulence in a rather small hemithorax. I was able to mobilize the lung and wash the entire space out. The chest wall was rather raw as anticipated and oozy, so we did give him DDAVP. We irrigated with multiple liters of saline. I did obtain cultures. I placed a posterior right angled 28 at the base of the thorax and a more anterior access tube to the apex of 28.

What cpt code would be used for an aorto to aorta bypass?

We dissected free the 2 iliacs infrarenal aorta double loop on the inferior mesenteric artery with Silastic tubing. Dissection was carried out by opening the retroperitoneum releasing the superior mesenteric vein even above that we had to open above the superior mesenteric vein. The right renal artery was identified and it was the size of the aorta. With good pulses. The renal vein was identified crossing above the renal artery but there was no pulse at this level. We had to go suprarenal dissected aorta free above the renal in between the SMA and the right renal artery. The left renal is absent due to previous nephrectomy. The opening of the aorta was approximately 2 cm. A 14 mm dacryon woven graft was used and it was cut in a diamond shape to match the arteriotomy. Using 3-0 Prolene in continue running double-armed technique starting at the heel of the graft we run our anastomosis on the left side first and then at the right one we met at the upper left we tied up.

Multiple attempted, unsuccessful line placements

My provider attempted to place a central line in four different vessels with US/fluoro, but was unsuccessful. The op note states, in summary, "Inability to thread wire through vein once vein accessed. Attempted at right subclavian, right IJ, left subclavian, and left IJ." Ultimately, the provider was unable to place a central line and abandoned the procedure. Do I code each attempt with a -53 modifier?

Modifiers LT/RT on Dialysis circuit codes

Is it correct to add -LT/-RT site modifiers on dialysis circuit codes 36901-36909 or creation/revision of the graft/shunt codes 36800-36861?

Type III endoleak

OP NOTE:Incision in the upper extremity was made and dissection was carried down to expose the brachial artery. Proximal distal control was obtained with vessel loops in Potts fashion. Patient was heparinized with 8000 units of IV heparin, ACT was maintained approximately at 250. Access was initially obtained with a micropuncture sheath a bench the upsized to an 8 French 65 cm sheath placed a into the abdominal aorta just proximal to the previous endograft. Using and Glide Advantage wire and angled glide catheter access was obtained through the previous iliac branch device into the right hypogastric limb. Over this wire We tract a 16 mm XXL balloon and this was insufflated at the location of the noted type 3 endoleak on prior CT scan. Upon insufflating the balloon we noticed that the previously placed ABX post dilated to achieve a good seal within the bell-bottom limb within the right common iliac artery. The balloon was insufflated proximal and distal to this location w/ complete resolution of the endoleak.How would this be coded?Only cath placement?

93463

Is CPT code 93463 billable for the physician side? A doctor had performed a dobutamine challenge for aortic stenosis assessment during a heart cath. In his documentation, he stated the resting peak and mean gradients along with his findings. Hospital/facility side is saying it's only a technical charge whether he administered it or not. Please advise.

Synovial Cyst Rupture and Epidural Injections

Patient with lumbar radiculopathy. MRI shows severe facet arthropathy at L5-S1 with a new 7 mm synovial cyst protruding from the left facet joint into the left lateral recess compressing the left S1 nerve root. The synovial cyst at L5-S1 was reached and injected but despite multiple attempts the cyst would not rupture. Subsequently the physician performed bilateral transformational injections at L5-S1. Findings:Successful left S1 selective nerve block and bilateral L5-S1 transforaminal injections.2. Severely arthritic left L5-S1 facet joint difficult to enter. After numerous attempts, the needle could be placed barely in the back of the joint but could not be buried. Contrast injection does fill the synovial cyst but despite multiple pressure injections of the joint, the cyst could not be ruptured. There was preferential flow of contrast out of the back of the joint. Is it correct to code both epidural injection (CPT 64483/50) and 64999 for the synovial cyst? The rupture was not successful but it was a complete procedure. If not what would be correct to code?

Follow up on Holter question ID: 8872

Code 93225 is a code that does not have a physician component. Can this code be billed without the device being returned for scanning and analysis?

How to obtain proper reimbursement for unlisted procedures 37799?

I verify with the surgeon a comparison code and we send letters to the insurance companies. I have also suggested management involvement on a contracting level. However there are payers out there that deny unlisted procedures as investigational. I don't understand that, as some of the procedures have been performed for years. Some examples of unlisted procedures that come to mind are stab phlebectomy of varicose veins less than 10 incisions, median arcuate ligament release, and bypass revisions that don't have a code in CPT like revision of arterial bypass that are not lower extremity or hemodialysis grafts. What do you suggest?

Correct coding for a "Florida sleeve " for aortic root dilation & AV insuff

Our doctor's short description of what was done is: "Transesophageal echocardiography; total cardiopulmonary bypass; Florida sleeve aortic root reconstruction using 30 mm Dacron Hemashield graft and reduction aortoplasty of aortic root above the midportion of the noncoronary cusp." We are back and forth between 33864 and 33860-22. Since the Florida Sleeve procedure is new to our facility, I'm asking what the most appropriate code would be. Since the surgery was similar yet a different procedure with the root than the "David Procedure".

Coding for 93623

Is the following documentation sufficient to report code 93623? Would you please explain why or why not? "Bidirectional block was demonstrated in and out of all four pulmonary veins post ablation. Adenosine was administered in 9 mg boluses to check for dormant pulmonary vein reconnections, and additional ablation was administered as needed to eradicate these connections."

93623 Post Ablation

I believe 93653, 93655, and 93609 are documented here, but I wonder about 93621 and 93623? Is the coronary sinus location for 93621 and key word 'induced' enough to support 93623? "We first mapped and ablated the left slow pathway, mapping the retrograde sequence during atypical AVNRT with retrograde left slow pathway. After ablating this pathway, the sequence in the coronary sinus showed only retrograde right slow pathway activation. The right slow pathway was then ablated. Junctional beats were seen both with left and right slow pathway ablation. After this, no sustained tachycardias were inducible with and without the use of isoproterenol. After waiting period of about 30 minutes, repeat testing was done, and no tachycardia was inducible. The patient was recovered from sedation. Catheters were removed. There were no recognized complications."

Update on convergent or hybrid cardiac ablation?

A question about how to code for hybrid approach EP ablations was asked back in 2017 (question ID 8968). Recommendation was to use an unlisted code for this investigational procedure, and to check with specific payers. Also, use 93656 for A-fib ablation if done at separate encounters. Are there any more current recommendations on how to code these procedures now (2019/2020) from Dr. Z?

Large French cath placement with Impella joint case

The vascular surgeon was called into the cardiology case for a placement of the Impella (33990), requiring placement of a 14 French for the cardiologist to be able to place the Impella in a high risk patient. Code 34713 is only allowable with TAVR, EVAR, FEVAR, and TEVAR procedures. It would not be an allowable separately reportable service for the vascular surgeon, or as an add-on to the Impella. Would they both share code 33990 with either an -81 or -82 modifier for the vascular surgeon for the placement of the 14 French sheath, or would the vascular surgeon not be able to bill for the Impella at all?

Drainage of pseudoaneurysm and injection of thrombin?

Place of service is 11 (Office). Access to AV fistula and fistulography identified 80% stenosis at the arterial anastomosis and a large pseudoaneurysm receives blood flow from the brachial artery proximal to the arterial anastomosis. Incision was made and Yueh needle catheter was placed directly into the pseudoaneurysm to drain. Balloon was used to cover leakage point and to also treat the stenosis at the arterial anastomosis. It was completely drained but pseudoaneurysm immediately refilled. Decision was then made to treat with thrombin. 600 units followed by 200 units were injected. And another access to pseudoaneurysm was made and 200 units of thrombin were injected. Pseudoaneurysm was successfully thrombosed. Would the CPT codes be 36902, fistulagram and angioplasty, 10160 drainage and 36002 thrombin injection extremity?

DFR during heart cath

We have been seeing some of our heart doctors say they are doing a DFR during heart cath. I have seen the FFR but have not been able to find enough information to get a code for the DFR procedure. Physician says EX: "We then did Comet wire interrogation of the LAD and left main Distal to the LAD lesion the DFR was 0.85, significant. Next EX: Diagnostic cath was done then a DFR determination RCA with Mach1 6 French FR4, unfractured heparin weight adjusted." Some coders are using the 93571 FFR, but Im not sure there is enough documentation for this. Do you have any information on the DFR procedure? 

KX modifier on device codes

I am getting a denial back from our billing office stating that the required modifier on C1785 is missing. The primary diagnosis was I48.1, and CPT 33208 was coded with a -KX modifier appended. Is the -KX or -SC modifier also required on the device codes?

76376 vs 93613

Hello - need some assistance with the following, please! ESRD w/ hx of access complications/occluded SVC. Sharp recanalization of SVC attempted w/ EP Carto mapping. Sheaths placed in LCF, RCF, R brachial, L brachial veins, and L brachioceph fistula. EP Carto mapping of R atrium and L brachioceph vein to ID access points for recanalization. Deployed Amplatzer plug in L brachioceph, attempted sharp recan from RCF w/ plug as target, unsuccessful. What to code?? Cath placements, US guidance (all documented appropriately)? EP mapping code is add-on, with no appropriate primary - is 76376 possible in lieu of 93613 to capture mapping? Thank you!

Fluoroscopic guided bilateral pedicle marker using Hilal marking coils

Could you tell me if C9728 would be the appropriate charge for the scenario below? Due to the fact they are placing coils, the attending feels 76000 would be the correct charge. "Using fluoroscopic guidance, a 20 gauge spinal needle was advanced toward the left T12 pedicle. Three 3 mm Hilal marking coils were placed overlying the pedicle. Placement was confirmed with fluoroscopy. The procedure was repeated at the right T12 pedicle, and again coils were placed overlying, then confirmed with fluoroscopy."

His Bundle Recording

I'm confused about what exactly is needed to bill 93600. Is just notating an HV interval enough?

When is it ok to bill for non-pv triggers post PVI ablation?

"We isolated all pulmonary veins using wide area circumferential ablation. The right carina was ablated. External cardioversion was not performed. Pulmonary venous conduction block was demonstrated using entrance block (adenosine) and exit blocked (pacing). Posterior wall isolation was not performed, but an anterior roofline was ablated." Are codes 93656 and 93657 correct?

Coding for 93566 vs. 93566, 93567, 93568

"HX: 1-day-old with HLHS on prosteaglandins. Cath and placement of flow restrictors in bilateral PAs, stent PDA, atrial septostomy in order to allow growth before Norwood proc. PROC: antegrade RHC using 5 French end-hole wedge catheter was performed & DSAO & RV pressures obtained & baseline oximetry. Power injection performed in RV. Measurements were made in RPA & LPA. ANGIO: Power injection performed in RV w/berman catheter and contrast shows no catheter related TR. The RV is moderately hypertrophied w/adequate systolic function. There is no angiographic obstruction of main PA. There is a large duct which is opacified & the descending aorta. There is retrograde faint opacification of ascending aorta. Both branch PA's appear of normal caliber. There is normal distal arborization." Would you code 93566 since injecting RV, or 93556, 93567, and 93568 based on angio description?

CTO 92943 Clarification use Mod 52 or 53

For physician billing, if the intent of procedure is CTO but only angioplasty is performed, is a modifier -52/53 required? Or since 1 of the 3 components is performed would no modifier be required?

Atherectomy of Non-coronary Arteries

How many times can code 37225 be billed if two femoral arteries are treated?

Diagnostic LP with chemotherapy

Is it appropriate to bill code 62270 (diagnostic lumbar puncture) with 96450 (intrathethcal chemotherapy) if the CSF is sent to pathology for diagnostic testing? Documentation EX: "A 3.5 20 gauge spinal needle was advanced with the stylet in place using an oblique approach at the level of L3-L4. 5 mL of clear CSF was removed and divided across 4 collection tubes. Intrathecal chemotherapy (methotrexate) was administered as per hematology/oncology order."

Segmental liver artery catheterizations

I'm wanting clarification regarding liver segmental artery catheterizations. In the dictation, it sounds like the physician accessed a single artery versus two segments. Here is a sample of his wording: “with the catheter in position within the 5/8 hepatic artery,” “with the catheter in position within the 6/7 hepatic artery,” and “the microcatheter was advanced into the segment 4A/4B hepatic artery.” I coded this 36247 and 36248 x 2. Please advise.

Diagnosis for cardiac monitors

My educators and I are having a discussion. Maybe you can help us on this. "Event monitor was placed. There were 7 events including baseline. Events showed sinus rhythm, sinus bradycardia, and sinus tachycardia. Symptoms includes shortness of breath, dizziness, and racing heart. Conclusion reads: Event monitor with 6 events recorded, symptoms were reported for sinus rhythm, sinus tachycardia." Would R00.0 be an appropriate diagnosis, or would the indications be a better choice since there really isn't an abnormal finding? My thought is that the sinus "rhythms" are just the rhythm the patient was in at the time they had their "symptoms." Sinus tachycardia isn't an abnormality to code here is it?

Code 76376

Is the following documentation sufficient to report code 76376, or does it need to state acquisition scanner? "With a 5 French vertebral catheter, the right internal carotid artery, left internal carotid artery, and left vertebral artery were selected in turn. Standard angiographic runs were performed from each location; rotational acquisitions with 3D reconstructions were performed from the left vertebral artery. The images were reviewed."

93619 or 93620?

Is this reported with code 93619 or 93620? "Indication: Persistent atrial flutter with symptoms of congestive heart failure and slow ventricular response. An octapolar catheters and placed in the coronary sinus and quadripolar catheters were placed in the RV and His bundle region. A 20 pole catheter was then placed around the tricuspid annulus and baseline measurements were made revealing an AA interval of 280 ms, and R-R interval 950 ms and HV of 52. Pacing was performed from the coronary sinus and demonstrated a PPI minus TCL interval of approximately 55 ms. Pacing from the right atrium however demonstrated PPI minus TCL of over 200 ms suggesting this was not typical CTI flutter. The cardioversion was then performed to restore sinus rhythm and with further pacing maneuvers, we were able to demonstrate the continued presence of both clockwise and counterclockwise block. Significantly, the patient developed AV Wenkebach at cycle length 710 ms in sinus node recovery times were performed at 500 ms resulting in an SNRT of 3090 ms with a corrected CNS RT of over 1700 ms which was blatantly abnormal."

Geniculate nerve ablation with Coolief system

We have a physician using the Coolief system to perform geniculate nerve ablation. Procedure: Ultrasound-guided nerve ablation of the following nerves: Superior lateral geniculate branch from the vastus lateralis, Superior medial geniculate branch from the vastus medialis, Inferior medial geniculate branch from the saphenous nerve Ultrasound confirmed that needles were 50% depth of the femur and tibia and at the correct anatomic locations for all 3 needles. Motor stimulation was tested at 2.0 V with no leg movement. An additional 2 mL of 1% lidocaine without epinephrine was slowly injected at each of the 3 previously mentioned locations. Then a thermo-radiofrequency ablation of each of the geniculate nerves was done at 80°C for 2 minutes and 30 seconds each. The needles were then withdrawn. Is it appropriate to report 64640 or should it be an unlisted 64999? In addition, can we report our code per nerve or is each knee 1 treatment area, so 1 CPT?

Can you code 92997/92998 and 37236/37237 same session/same vessel?

Can you please clarify whether it would appropriate to code both pulmonary angioplasty codes (92997, 92998) and arterial vascular stent placement codes 37236, 37237 for pulmonary artery stent placement at the same session and in the same vessel? MD performed right heart catheterization, pulmonary artery angiography, LPA/RPA angioplasty – due to LPA,RPA narrowing bilateral stents were deployed. Of note the intent was not initially for stent placement but to determine why there was pulmonary stenosis. Please see reference below from Dr Z’s Medical Coding Series -Interventional Radiology coding Reference. Pg 278 #17. Separate cardiac codes for pulmonary artery angioplasty (92997,92998). Use established arterial vascular stent placement codes 37236/37237 for pulmonary artery stent placement(s). These procedures included catheter placements at the time of cardiac catherization.

What code would you use for the palcement of an Alfapump?

Would you use 49419 for the following?
Sequana Medical’s alfapump is a fully-implanted, programmable, wireless, CE-marked system that automatically pumps ascites from the peritoneal cavity into the bladder, where the body eliminates the ascites naturally through urination. The potential of the alfapump to address the unmet medical need in patients with recurrent or refractory ascites has been demonstrated in multiple clinical studies showing a significant reduction in the need for large volume paracentesis, which is paracentesis where at least 5 litres of fluid is removed (i.e., the current standard of care), and a significant improvement in patients’ quality of life."

Code 0296T - External electrocardiographic recording

We receive many denials on code 0296T. Can you provide any guidance or suggestion for resources on required documentation and billing guidelines for this procedure both alone and in conjunction with other codes such as 93458, 92928, stress test codes, and ECG with pacemaker interrogation?

37226 or 37236?

Can we please pick your brain? Would the below procedure qualify as occlusive, or should it be used with 37236? "The left external iliac artery is patent with minimal atherosclerotic disease. The SFA is patent for about a centimeter, and there is a total occlusion of the SFA along about 8 cm length and appeared there is reconstitution via collaterals. There is some filling defect in the proximal aspect of the reconstituted SFA, which is now about mid femoral level consistent with thrombus and probably the cause of embolic debris. The popliteal artery is patent with minor irregularities, but no evidence of aneurysm or stenosis." Physician "felt that recannulization of the SFA was indicated because of the concern of embolization and thrombus that a stent was indicated". Stent was placed in this area.

Percutaneous Fem-Fem Bypass for femoral occlusions.

Is code 35661 for open proc or can it be used for percutaneous bypass? "The interventional radiologist performs percutaneous accesses in RT internal jugular and LT SFV then performs small suprapubic incision and performs a needle access in each femoral vein through the incision. He places Ensnares through each percutaneous access (RT IJV/LT SFV) then performs through and through access from the lright internal jugular to the left femoral vein through the subcutaneous tissues in the suprapubic area. That area is dilated with balloons, the distance is measured with marking catheter. Long sheath placed the RT IJV through suprapubic soft tissues into the LT femoral vein. Through this sheath, percutaneous bypass was created using 8mmx15cm Viabahn stent. Two additional 8mmx10cm Viabahn stents were deployed to cover the complete segment between the two femoral veins with balloon dilitation. Successful percutaneous LT fem vein-RT fem vein bypass creation." Should this be an unlisted code (37799)?

Venous angioplasty of both lower & upper extremities with two puncture site

Please help code Percutaneous balloon angioplasty was performed using a 12 mm x 20 mm angioplasty balloon catheter. The right and left external iliac veins, the right and left common iliac veins, the right and left brachiocephalic veins, and the right and left subclavian veins were dilated with the angioplasty balloon catheter. Vein accessed sites: Lt GSV, Rt CFV .

Appropriate Use Criteria Modifiers

I was hoping you could expand on two of the HCPCS modifiers that relate to Appropriate Use Criteria (AUC). 1) Modifier QQ - ordering professional consulted a qualified clinical decision support mechanism. Considering that there are more specific modifiers that will be available for CY 2020 (MA through MH), will this modifier have any relevance next year? 2) Modifier MG - the order for this service does not have appropriate use criteria in the clinical support mechanism consulted by the ordering professional. Can you explain when this modifier might be appropriate?

Hip arthro inj and hip sterioid injection

We received charge for 20610 Rt Hip and 77002-26 same day as 27093 Rt Hip & 73525-26. Our question is about coding hip arthro injection and hip steroid injection & if it's just arthro injection is it the code with anesthesia or not?

FFRs and IVUS codes

How is everyone billing for FFRs and IVUS codes? We get a lot of denials for FFRs and IVUS codes. Are we applying a -59 modifier or not? Or just a -26 and branch modifier or not? These codes have me so confused.

62264 or 62321

Is the appropriate code for this procedure 62264 or 62321? "The patient was brought to the fluoroscopy suite, and monitors were applied. The patient was placed in the prone position on a carbon fiber fluoroscopy table. The skin was prepped, wiped, and draped in the usual sterile fashion. Lidocaine 1% was used for skin and subcutaneous anesthesia. A Coude needle under fluoroscopy in PA/lateral position was used to enter the caudal epidural space. No CSF, blood, or paresthesia was noted. Epidurography: 5 ml of Omnipaque 240 was injected to confirm the epidural placement of the needle with real time fluoroscopy. No intervenous or intrathecal diffusion was noted. Poor lumbar and sacral diffusion and filling defects corresponding with patient’s pain distribution were noticed. A catheter was advanced towards the L4-5 level. Following multiple gentle mechanical manipulations contrast was injected, which showed some improvement in the lumbar and sacral diffusion. Then a solution containing lidocaine mixed with betamethasone was injected without problem, needle removed."

LD and LM separate vessels for IVUS/IFR/FFR

There are times whe our cardiology docs will pull back into the LM to verify the adequacy of the test when there is a lesion in the LD. In this case, we would just charge for the LD study. However, if they need to look at the LM for stenoses or a lesion as well, can both the LM and LD or LC be coded in that instance? My thought was yes, but one of our physicians told me he was told not to bill separately. Could you please advise?

92997 for PTA of embolus?

A patient presents to IR with bilateral main pulmonary artery emboli. The provider performs PTA of both arteries in an effort to create a channel for perfusion, and then initiates TPA bilaterally. There is no underlying, chronic cause for the PE; this was an emergent event. Is the PTA billable with 92997/92998? I am getting hung up on if its a true stenosis or not, and if the PTA was only a means to place to TPA catheters.

35661 35558 groing to groin or ipsilateral?

The question below. A common femoral to SFA or even an SFA to distal SFA bypass. Ipsilaterally can be used for 35661, 35558? MUE is 1 which is making me doubt and that it should be right to left. Thanks for your clarification. Kim Question: Vascular surgeon does common femoral to superficial femoral artry bypass using 8 mm PTFE graft. CPT 35661 fem/fem graft per the coders' desk reference states right to left femoral bypass. Should I use unlisted code 37799 in this case? Or could I use code 35661 for the same extremity? Thank you for your advice. Question ID: 5119 Answer: Fairly uncommon bypass. Since it is a femoral (common) to femoral (superficial), I lean towards code 35661. There is no question that the vast majority will be CFA to CFA but there is nothing specific in CPT to the contrary. The work involved would be similar with two anastomoses. You can query your payer to see if they prefer unlisted. -Dr. Dunn

Need to ask Dr.Z?

Don't see the answer you're looking for in the knowledge base? No problem. You can ask Dr. Z directly!
Ask Dr. Z a question now!