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Tortuous Coronary Graft

What would be the proper diagnosis code for a tortuous coronary graft? Would I77.1 be considered? "RIMA graft to 2nd marginal. Graft is angiographically normal, but the vessel has significant tortuosity."

Occlusion Vs Thrombosis

I have a case where the physician is performing a thrombectomy (37184) with a Penumbra catheter as well as an atherectomy/balloon angioplasty (37229) in the right anterior tibial artery. Anterior tibial stenosis is documented as well as an "occlusion" in the same artery. Is it okay to capture the thrombectomy even though he is only naming it an occlusion?

CPT 93295, 93296 in skilled nursing facility

If a patient is in a skilled nursing facility, what codes get billed to the SNF vs. Medicare, 93295 and 93296?

congenital vs. non-congenital cath codes

It is my understanding that certain cardiac conditions, such as ASD and VSD, can technically be congenital or acquired. The ICD-10-CM classification assumes these conditions to be congenital (when not otherwise specified, of course). The CPT codebook does not include ASD and VSD in its list of diseases for which only the non-congenital cath codes may be assigned. When a patient with a known ASD or VSD undergoes a cardiac cath, and the physician has not indicated whether the disease is congenital or acquired, can we automatically code from the congenital family of cath CPTs? Do we need to query the physician? (All of our cath lab patients are adults.)

50432, 50080

When a urologist places a nephrostomy tube (50432) prior to a percutaneous nephrostolithotomy (50080), can both codes be coded? If the tube is taken out at the end of the procedure, is it appropriate to append a -52 modifier?

Temporary Uterine Artery Balloon Occlusion

Preop uterine myomectomy in OR, but had balloons placed in IR suite prior to procedure. Physician placed bilateral temporary uterine artery balloons. Balloons were removed after myomectomy. Is there a code for placement of temporary uterine artery balloon placement?

93571-52

Can you advise of the percentage reduction in physician work given an iFR /DFR is less time/less intensive than FFR? Also how it is documented correctly?

Is this coded 64400x 2 or 64400 x 3?

Is this injection coded with 64400 x 2 or 64400 x 3? Do we code per branch or nerve? "The supraorbital, supratrochlear, and auriculo-temporal nerve regions were identified by manual palpation. The overlying skin was prepped with an alcohol pad. At this point, after negative aspiration, a total 1.5 mL volume of treatment injectate, consisting of 0.75 mL of 1% lidocaine and 0.75 mL of 0.25% Bupivacaine, was injected easily at each area. Needles were withdrawn, and the patient was monitored for 15 minutes with no ill effects."

Is an "evolving STEMI considered acute?

Patient presented to ER with CP @ 21:19PM; first troponins were negative. Patient left AMI before second troponin results came back. ER staff called patient to return to the hospital. Patient returned next morning at 7:53 with CP, jaw pain, sweating. EKG showed ST elevation V3 and aVF, ST depression V2 and aVL. Patient taken to cath lab emergently. Would 92941 be appropriate in this scenario?

Intravascular lithotripsy performed on external iliac artery and SFA

The provider performed intravascular lithotripsy of left superficial femoral artery, left common femoral artery, and left external iliac artery. Do we code C9764 x 2?

33285 and 33286 via new channel and different plane

If the old implantable cardiac monitor is removed, and the insertion tool is used to form a new channel and insert the new monitor in a slightly different plane (but using the same incision), can codes 33285 and 33286 both be reported? I know previous guidance states if performed via same incision then we only report insertion, but I want to confirm about the "new channel" and "different plane".

PM Lead Removal with PVI RFA & LAA Exclusion

"PROCEDURE: Infected cardiac pacemaker lead removal, pulmonary vein isolation, left atrial appendage exclusion. FINDINGS: Two leads fully removed via right atriotomy and opening of the innominate vein + SVC junction. Dr. T of Electrophysiology inspected all parts of the extracted leads. The innominate/SVC was then repaired, and right atrium was closed with suture. (CPT 33243???) // Bilateral pulmonary vein isolation with RFA AtriCure. Left atrial appendage excised and closed. Next, bilateral pulmonary vein isolation with RFA AtriCure was performed with three burns on each side until evidence of transmural lesions. The left atrial appendage was then clamped, resected, and oversewn with 4-0 prolene suture. A small residual appendage remained, however, was felt to be too close to the circumflex artery for further resection." Can PVI RFA and LAA reconstruction can be coded separately? Because EP was there, would this be 93656, or would 33256 be appropriate due to sternotomy? (The add-on codes are not applicable to 33243.) Or, is this bundled into 33243?

CPT 61645

Is 61645 used for both mechanical and aspiration thrombectomy? If not what code do we use for aspiration thrombectomy, unlisted?

Subsequent Thrombolysis 37213

On the second day of thrombolysis, the patient is transferred to the suite for a relook angiogram--CPT 37213. Six hours later on the same date of service, the patient is returned to the suite for another relook, without intervention performed. Is CPT 37213 allowed to be billed again?

non/delayed healing wound

The patient has peripheral artery stenosis with non-healing wound. May the non-healing wound be coded (ICD-10-CM) as an ulcer?

Takedown of infected axillary-fem-fem bypass; axillary only

"A patient has an infected left axillary-fem-fem bypass. The surgeon creates a right axillary PTFE graft and attaches it to the existing fem-fem bypass, thereby creating a new axillary-fem-fem bypass. Surgeon then proceeds to take down the left axillary bypass, which is infected. But, only the axillary graft is removed." Surgeon wants to report 35654 for new PTFE axil-fem-fem and 35907 for removal of axillary graft. Is this appropriate since the fem-fem portion was not removed, only a new anastomosis from the axillary to the right femoral graft was added?

Hemodynamic Stress Echo

Is there a specific CPT code or add-on code that should be used when a "hemodynamic" stress echo has been performed? This test is more involved than a conventional stress echo.

Trauma Patient Vessel Repair

"Trauma patient had injury to an upper extremity. Axillary artery was repaired with harvested GSV interposition. Cephalic vein in same extremity was injured and bleeding, so vein was sutured."  I came up with 35236 for repair of axillary artery with vein graft and 35206 for suture repair of cephalic vein. There is an edit against 35236 when coded with 35206, so I am looking at 35236-XS (59), 35206-51 (billing pro-fee and 35236 has higher wRVU). Can I not code for both even though two separate vessels repaired in two different ways?

Follow-up Ultrasound (76970 - deletion)

For venous ablation procedures, the plan of care often includes a duplex ultrasound to diagnose (93970/1) the venous insufficiency, then the procedure (e.g., 36475), and then a follow-up ultrasound at a later date. With the deletion of 76970, what would the recommended code be for this follow-up? It was my understanding that the duplex ultrasound codes are used for diagnosing the condition.

Aorto-pulmonary Collateral Imaging without Heart Cath

How would you handle selection and imaging of aorto-pulmonary collaterals when no heart cath or intervention performed?

Hello~ would this be an unlisted code?

"Cryoablation of recurrent painful left lower rectus intramuscular endometrioma. 2) Post ablation contrast-enhanced CT scan demonstrated adequate coverage of the ablation zone." Would this be reported with an unlisted code?

central or peripheral circuit?

Focal area of stenosis in patient's fistula in the chest at the junction of the cephalic vein and subclavian vein responding to 8 mm balloon dilatation. Is this the central or peripheral circuit?

Indiana Pouch

How would you code a retrograde Indiana pouch drain exchange? I only find information for ileal conduit, which is not the same.

AVF, lligation followed by AVG same session

"Patient had a left brachiocephalic AVF created. After completion there were multiple leaks at the suture line. The anastomosis had to be taken down, and attempts to redo the suture line led to disintegration of the vein making it unusable. The cephalic vein was ligated with silk tie. Then a left brachial-axillary AVG was created." Can both the AVF and AVG be coded? How about the ligation?

Access of an EVD with aspiration and injection

Would I use 61070 or 61026 for the following? "Proximal EVD port accessed and cleaned with betadine. 3 cc of serosanguinous CSF fluid aspirated gently from EVD at proximal site. 4 mg of Cardene administered intrathecally slowly over one minute without any complications or fluctuations in hemodynamics and 2 cc of sterile NS flushed slowly behind. ICP post-administration was 13 with an adequate waveform and EVD clamped successfully for 30 minutes without complications."

Fasciotomy Closure

Doctor performs a four compartment fasciotomy through two incisions and is left open. A few days later the incisions are closed. We are billing 13160 for the closure. However, since there are two incisions, would you bill with two units? Or since it was one surgery would you bill as one unit? What if the surgery extends multiple body areas such as an ax-fem-fem? Would you bill one unit as it was one surgery or multiple units as it was multiple body areas?

Can I code endarterectomy with a bypass?

Is it allowable to code a right common femoral endarterectomy, right common femoral to left common femoral bypass, and a right external iliac angioplasty? If so what are the codes?

Billing for the drugs used during a surgical procedure?

When the place of service is an office (POS 11), can all drugs that are injected or administered by IV be coded in addition to the surgery? I am clear drug administration service codes can't be coded in addition to the surgery, but can at least the HCPCS for drug get coded such as the drugs used for pain and prophylactic antibiotic use? Example: Could Dilaudid and Ancef be additionally coded with a tunneled dialysis catheter replacement?

hypothermic arrest 33866

Is hypothermic arrest another technique to achieve total circ arrest and/or cerebral perfusion? The report states: "Hypothermic circulatory arrest, blood flow was discontinued and hypothermic arrest instituted. The cross-clamp was removed." Does this meet the requirement of either total circulatory arrest OR isolated cerebral perfusion? Would 33866 be billable by this documentation?

multiple abscess drains

If more than one abscess drain is placed within a large, loculated abscess, can you code 49406 and 49406-XS, or can you just code for one abscess drainage?

RHC with Biopsy

Routine surveillance endomycardial biopsy and right heart catheterization for diuretic management. Would you code the right heart cath with the biopsy?

RT & LT HEART CATH WITH SELECTIVE ANGIORAM WITH COIL EMBOLIZATION

I am a new pediatric cardiology coder. What CPT codes are used to code the following? "Right and left heart cath with selective angiogram with interventions: coil embolization of aortopulmonary collateral arising superiorly from the right subclavian artery."

93621 and 93622

We have EP doctors that would like to charge for 93621/2 with allowed ablation procedures. However, I do not feel like the documentation is appropriate enough to bill either 93621 nor 93622. Plz note below:

"All vascular access sites were prepped and draped in the usual sterile fashion and the Seldinger technique was used to catheterize right and left femoral vein with multipolar electrode catheters, which were placed in the appropriate intracardiac sites under fluoroscopic guidance. During the procedure right atrial pacing and sensing, His bundle sensing, RV pacing and sensing, and left atrial sensing and pacing, left ventricular sensing and pacing were performed."

I feel like this is not descriptive enough. Should the doctor(s) say where the catheters were placed and then what was performed from each location? For example: "A decapolar cath was inserted into the CS and left atrial (and or ventricular) pacing and recording performed." Please advise. 

Aortic coarctation gradient interrogation

When interrogation of the gradient in the coarctation of the aorta is performed (gradients measured and recorded), can we use code 93571-26-52 for professional coding, as we do for RFR? Documentation: "Next we proceeded with interrogation of the gradient in the coarctation of the aorta. We exchanged for a JR4 guide catheter and advanced the catheter over a Versacore into the descending aorta. Next, a BMW coronary guide wire followed by a ACIST NAVVUS microcatheter was equalized in the aorta. The JR4 guide catheter was pulled back into the ascending aorta-right subclavian artery juncture. Simultaneous gradients were measured and recorded. Finally, the microcatheter was then pulled back to the ascending aorta to confirm absence of drift."

0439T for professional claim

Should 0439T be submitted on professional claim since it has PC/TC indicator 0 associated with it?

93000

Our cardio docs perform in-office EKGs, and the scanned data sheet states the basic findings without a signature. They document their interpretation on the chart note itself on the same DOS, so would that support billing 93000? Or is it required that they either sign the findings on the data sheet or create a separate report in order to support the billing? 

Unroofing of coronary sinus

We have a patient with pulmonary atresia with intact ventricular septum, RV dependent coronary circulation, and coronary sinus ostial atresia with drainage into the left superior vena cava. Our MD ligated the left superior vena cava and unroofed the coronary sinus. What CPT code would you recommend for the coronary sinus unroofing? Repair of blood vessel code 35211 or unlisted?

Post core mammogram

If a diagnostic mammo is performed, followed by a needle biopsy with clip placement, followed by a post core mammo on same DOS, is it appropriate to code for the post diagnostic mammo in addition to the diagnostic mammo (77065), thereby coding 77065 twice on the same DOS?

Ultrasound-guided therapeutic injection of symptomatic Varicose Veins

This is a new procedure to my office. "Two mL aliquots of Polidocanol 2.5% was injected into identified pathologic veins in three locations feeding area of previous ulcer bed. Successful ultrasound-guided therapeutic injection of three varicose veins supplying area of previous venous stasis ulcer." Is this reported with codes 36471 and 76942? Can I bill for the cost of the medication?

ICD IMPLANT FAILED LV LEAD PLACEMENT

"ICD lead advanced to RV apical septum. A paced-sense lead was advanced to the RA. Coronary sinus was cannulated. There was a very small posterolateral branch and a decent size lateral branch. Lateral branch had severe tortuosity at its proximal portion. There were not suitable other branches. I attempted to wire and advance an LV lead in the lateral branch, but this was not successful. I decided to abandon further attempts. A new dual chamber ICD pulse generator was connected to the lead and placed in the existing pocket."  Should only the successful procedure be coded with 33249? Should there be any coding in regards to the LV lead that was not placed?

Left VATS with pleurodesis with pleural tent

I am looking for a CPT code for a left VATS with pleurodesis with pleural tent for recurrent spontaneous pneumothorax with persistent air leak. After researching, I feel the procedure should be coded as 32650-22. There does not appear to be a CPT code for the pleural tent, and recommendations (sts.org) are to append a -22 modifier for the additional work. Your thoughts are greatly appreciated.

IFR wire or IVUS catheter won't cross lesion

Curious as to guidance when an IFR wire won't cross a lesion or when an IVUS catheter won't cross a lesion. Is it appropriate to use a modifier for the procedure or just charge for the supply?

Tunneled Cath Removal

Patient had a tunneled catheter placed and then removed a short time later. When they removed it, since the catheter hadn't been in very long, they were able to pull it out through the tract. There was no dissection. Would this be reported with code 36589-52, or would it be just an office visit/E&M code?

Canceled CT Liver Ablation due to imaging

How do you recommend we code the following scenario? "CT ablation of a liver lesion was ordered. The patient was brought to radiology, and CT of the abdomen without and with contrast was performed to localize the lesion. The procedure was canceled due to the imaging results (inoperable). The patient was under general anesthesia."

33405 Minimally invasive billing 77001 and 34812

My provider is doing a minimally invasive aortic valve replacement (25 mm CE Inspiris tissue valve) with an anterior mini thoracotomy. She accessed the right femoral artery and used fluoroscopic guidance. She wants to bill 34812 and 77001 (33405 is not a primary CPT for 34812 or 77001). Should I be using an unlisted CPT or just bill 33405? She stated mini-nonsternotomy approach to valve replacement. You need open femoral artery exposure and fluoro. It's my understanding that expose no matter how it's exposed is included. Is this correct in only billing 33405, or should I be using another CPT?

Scoloisis series

AP and lateral 2-view of c-pine, t-spine, l-spine. Each level AP and Lateral. Do we just count the view (72082) or each view per level (72084) even if it is the same type of views?

MR Cine Flow Study

Is there a separate CPT code that can be billed in addition to MR head and spine for MR cine flow study of the brain or spine? Can codes 76120 and 76125 be used? Which one, if any, will be appropriate to use for this study?

VNS - billing programing

MUCH confusion on the MD billing for programing - MD states he is programing and rep is in the OR. Example op note: "Next, the device was programmed by turning on the wand and programming the pulse generator for more than 3 parameters. After the impedance was checked, it was noted to be quite high initially and I removed and cleaned out the lead and reconnected this to the generator and got a good reading of under 1800 at this point in time. Next, this was correlated with the heart rate and the other parameters and a copy of this is saved in the chart. Once this was performed, the VNS was turned off."

93463 Documentation Requirements

Can you please clarify what the documentation requirements are to support code 93463?

LVAD speed change

"LVAD speed began at 9400 RPM. Right heart hemodynamics were performed, and LVAD speed changed to 9200 RPMs. Right heart hemodynamics were repeated." Can this be reported with code 93799 for the LVAD ramp study with 93451?

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