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36572 and 36573

Is it a requirement for images to be archived in order to report codes 36572 and 36573? Our organization occasionally performs bedside PICC insertions with ultrasound guidance; however, the images are not stored.

coronary intervention by wire manipulation

"I then proceeded with interventional therapy that consisted of just wire manipulation past the RI/ostial occlusion. The wire traversed through the RI thrombotic occlusion and just with passage of the wire, we reestablished brisk TIMI 3 flow. We required no balloon angioplasty or thrombectomy." Patient came in with chest pain but did not meet criteria for a STEMI, but rather a non-STEMI. How would I code this intervention done with just the wire?

Percutaneous access in radilogy for PCNL

I have questions pertaining to 50395 and the codes replacing it in 2019. Our patients are brought to the IR suite and the radiologist places new access (usually a long 6 French sheath) into the distal ureter or bladder prior to going to the OR for PCNL. In the past we have not used 50395 since the description specifically states “with dilation”, which we aren’t doing. We were instructed to use 50433 since we aren’t dilating the tract to 24 French. In some of your responses I see that you’re separating 50395 as the intro and 74485 as the dilation. Should we be using 50395 for this access, and is there a radiology S&I code to use with it? Also, what do you suggest for 2019? Are 50436 and 50437 meant to be used by radiology in the scenario I described? Both new CPT descriptions seem to focus on dilation of an existing tract. We’re looking for some help understanding these new codes.

Sclerotherapy

In the AMA 2018 professional CPT Codebook it states on pg. 247 (top green wording) that 36470/36471 is for "injection(s) of a sclerosant for sclerotherapy of telangiectasia", but in the description of 36470/36471 it contradicts that by saying "other than telangiectasia", so of course I am confused. What is the correct code for compounded (tessari method) injections of polidocanol into diffuse spider telangiectasias? I originally submitted 36468, but insurance is denying for cosmetic. The physician is yelling at me saying it's not cosmetic. Can you shed some light on this?

TYRX Antibotic pocket- is pocket revision billable with new lead

The V lead only is being replaced. Old lead is capped; new lead is placed. The generator is placed in a TYRX antibiotic pocket. The pocket is made a bit bigger down below and above to accommodate the TYRX device. Would pocket revision - 33222 be billable with the new lead - 33216 in this situation? Code correct shows 33222 is bundled but a modifier is allowed.

93458 with return for 93454

Left heart cath documented along with 92941 and 75630 with verified PAD, later same day return due to chest pain and did 93454 to make sure nothing else was wrong. Can we charge both 93458 and 93454-59 same day for separate sessions? 

Active fixation lead vs temporary pm lead insertion

The provider places an active fixation lead via the RIJ. The lead is placed in the RV apex and then attached to a single chamber external PPM. All sensing, impedance, and thresholds are stable. I'm wanting clarification if I should report code 33207 or 33210?

Mitraclip with IVC filter placement same access site

"The MitraClip device was at this point positioned into a 2P2 configuration and deployed under TEE guidance. There was significant reduction of the LA pressure as well as significant reduction of the mitral valve regurgitation. After confirming the position, the clip was completely deployed. The delivery system was removed. A mobile thrombus was present in the right ventricle prior to the MitraClip deployment and went into the inferior vena cava, and in view of the presence now of the iatrogenic atrial septal defect, it was decided to implant an inferior vena cava filter prior to removing the wires from the right femoral vein, and a Bard IVC filter under fluoroscopic guidance was indeed deployed successfully and position verified by inferior vena cava angiogram." We are having a debate about the IVC filter placement. 33418 for Mitraclip, 36010, 37191. I don't feel 36010 is appropriate, as same access site was used.

Contrast injection of peritoneal Pleurx catheter

Patient has peritoneal Pleurx catheter placed for drainage of ascites. How do we code diagnostic contrast injection to check malfunctioning catheter?

Sclerotherapy of fluid collection with Drainage from existing drain

"Patient has a cystic pelvic mass that needs frequent draining, and drain is already in place. When patient comes to the radiology suite, contrast is injected under fluoro, and multiple images are taken and stored in PACS. The cystic mass is completely drained by approximately 470 mL of yellow fluid via the existing drain, then 35 mL of Betadine was injected through the drain tube to perform sclerosis. The tube was capped for one hour, then the Betadine was drained. The drain was left in place." In addition to the 49185 sclerotherapy procedure, are we able to code for the drainage procedure that proceeded the sclerotherapy since the drain was already in place and a new drain was not placed? Can we report codes 49406 and 49185-59, or should we only report code 49185 for this scenario with the drainage procedure being included?

Lumbar Drain

Can you assist with the CPT code for the lumbar drain in the L3-L4 interspace? Code 62272 doesn't seem appropriate, as that's CSF, nor does 10030. "Evidence of a postoperative fluid collection in the subcutaneous space, which was possibly a pseudomeningocele. She is indicated for aspiration of the fluid for evaluation for infection as well as for placement of the lumbar drain placement. A large bore needle was inserted under prior guidance at first into the L2-3 interspace. Although the needle was in spinal canal, there is no evidence of CSF. The needle was removed and is once again reintroduced into the L3-4 interspace while the patient was placed in reverse and MR and was inserted into the spinal canal while the patient Valsalva. Clear CSF fluid was seen. The lumbar drain catheter was then inserted. The needle was removed and the catheter was secured at roughly 15 cm to the skin. Fluoroscopy was safe shows insertion of the lumbar drain at the L3-4 interspace with rostral progression and no evidence of kinking."

Lingual Vein

I have a pediatric congenital case where the pulmonary arteries were looked at, and in the body of the report it has an angiography of the lingual vein with findings documented as: "There is a stenosis that has a 10 mmHg gradient into this branch with a narrowing measuring 3.8 mm proximally and 5.1 mm distally." What CPT code would be used to report the angiography for the lingual vein?

PTA with 37212 Thrombolytic Infusion

"With a NaviCross catheter and a stiff angled Glidewire, access was ultimately gained to the inferior vena cava, confirmed by injection in the inferior vena cava. The wire was then exchanged through the catheter for a Storq wire. The catheter was then withdrawn. A 7 mm percutaneous transluminal balloon angioplasty was performed to the level of the inferior vena cava, all the way to the level of the femoral vein, through the external iliac vein and common iliac veins via inflations to 10 atmospheres at 30 seconds x4. Venous balloon angioplasty was performed in order to expose more fibrin receptors in this chronic DVT setting for improved thrombolysis." I want to verify that the angioplasty cannot be coded. It was not done specifically for maceration, which is not allowed, but the reason for it does not seem justified for coding either.

Chest Tube and tPA Infusion

Question regarding chest tube and tPA infusion. After a sheathed needle was placed and fluid aspirated, chest tube was placed and 6 mg of tPA was infused into the loculated pleural effusion to facilitate drainage. Can we report code 32561 with chest tube placement? 

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