Ask Dr. Z

For a liver chemoembolization (37243) if the angiograms prior to the procedure are not diagnostic, can the catheter placements still be billed, or would this be considered roadmapping/guiding shots?

CPT 47550 with 47544 or 47554?

"Contrast injected through existing cholecystostomy and internal/external biliary catheter and cholecystogram was performed. This showed a distended gallbladder with gallstones, Amplatz wire was introduced through the biliary catheter. The catheter was then removed and exchanged for a 12 French peel-away sheath. Additional Amplatz wire was introduced. Spyglass scope was then introduced through the peel-away sheath. Multiple black gallstones were noted in the gallbladder. Lithotripsy was performed of multiple gallstones, followed by saline washout and suction of the fragments periodically, a Kumpe catheter was introduced through peel-away sheath. The gallbladder was flushed with saline with washout through peel-away sheath. Repeat cholangiogram to the Kumpe catheter demonstrated partially decompressed gallbladder with up to 60-70% decreased gallstone burden. A new internal-external 12 French Mac-loc biliary drain was then placed. A cholangiogram was performed demonstrating free flow of contrast into small bowel."

Would we report code 93583 with modifier -22 for (VOM) alcohol vein of Marshall ablation?

Would I report 36901 and 36907 or 36902? "The right arm was prepped using ChloraPrep. Under ultrasound guidance, the right brachial basilic vein transposition fistula was accessed in antegrade fashion near the arterial anastomosis. A fistulogram was performed in stations to the chest. This demonstrated a recurrent, severe approximately 75% stenosis of the right brachiocephalic vein. Given the excellent palpable thrill of the fistula, assessment of the arterial anastomosis was deferred. Subsequently, the stenosis was angioplastied to 16 mm using a 16 mm x 4 cm Atlas Gold angioplasty balloon. Repeat fistulogram was performed. This demonstrated improvement in the brachiocephalic vein stenosis but with persistent moderate stenosis remaining. The stenosis was again angioplastied to 16 mm using the Atlas Gold balloon with prolonged angioplasty balloon inflation time utilized. Repeat fistulogram was performed, demonstrating mild less than 30% residual narrowing of the brachiocephalic vein."

In a patient with pancreatic cancer, a Renovo balloon occlusion catheter is placed in the SMA, and gemcitabine is infused. Does this qualify as a chemoembolization? I do not see documentation of any typical embolic agents.

Persistant atrial flutter Is this coded 93656 or 93653?

"Procedures performed: 

Confirmed Durable Pulmonary vein isolation from prior ablation

Lateral mitral isthmus line, anterior to LAA

Posterior scar and inferior posterior wall ablation

Posterior septal scar ablation

Atrial pacing was performed to reinduce atrial flutter. Initial pacing from the distal CS down to 240ms induced atrial fibrillation. Reentry formation in AF were seen along the posterior septum. AF terminated spontaneously. REpeat pacing (atrial double extra stimuli from the lateral LA appendage successfully reinduced the clinical flutter. Activation mapping confirmed a left atrial flutter circuit around the LAA, through the scar at the anterior base of the LAA and through the coumadin ridge. RF ablation lesions were performed at this site, with a line created from superior-anterior base of LAA, adjacent to the LSPV to the lateral wall scar with termination of the flutter. Pacing from HRA identified persistent conduction and further ablation lesions were applied until pacing identified bidirectional conduction block across the anterior."

"Wide area circumferential ablation around right and left pulmonary veins was performed. Right carinal line was added. Septal complex fractionated atrial electrograms were targeted for ablation. Left atrial roof line was created next to address multiple complex rhythm dated atrial electrograms in the left atrial removed. Left atrial posterior wall isolation was performed next to address multiple complex fractionated atrial electrograms on the left atrial posterior wall.. Adequate isolation of the left atrial posterior wall was demonstrated with exit block during pacing from ablation catheter at multiple locations on the left atrial posterior wall. No additional arrhythmias /target for ablation were identified with program stimulation and adenosine administration."

I have coded 93656, 93657 x 2, and 93623. Is the left interatrial septum considered a separate ablation area from the left atrial roof and wall? Do you agree with these codes?

Would it be appropriate to order CT of heart (75573) and have two reads? One read is from the cardiologist billing as 75573, and the other read is done by a radiologist and billed as 71260. Currently the facility is billing 71260.

In your Diagnostic Radiology Coding Reference the chest imaging bundles into the heart imaging, and I want to make sure that the cardiologist can bill the 75573 and the radiologist bill 71260-59. Should the facility be billing 75573 instead of the 71260?

We are having issues with pre-authorizing the physician with 75573, particularly when the facility pre-authorizes 71260.

During a TCAR procedure (37215) they are also placing a retrograde innominate stent (percutaneous from right arm access). Can this be coded separately? Looks like that code is 37217, and it hits an NCCI edit.

Our provider did 1. Neurolysis of left brachial plexus for decompression of thoracic outlet 2. Left first rib resection for neurogenic TOS. Provider wants to bill both 64713 and 21615. There is NCCI edit between both codes but can be overridden with a modifier. Could you please clarify whether we need to bill both the services with a modifier or only the 64713 is billable? We billed only for 64713 but provider disagrees stating both should be billed. As per an article from society of vascular surgery from 2009 they recommend to bill for both the services. But NCCI edit for these codes were placed only after April 2020. Please clarify.

Our office is still having a coding discrepancy with dual vs. multi-chamber device exchanges, lead removals, and device checks.

CPT clearly states that a single lead is one chamber, dual lead involves two chambers, and multiple involves three chambers of the heart.

We have noticed that Dr. Z states that the AMA has clearly stated that a BV device with an RV and LV lead is considered a multi-lead system. (Example ID: 14385 dated 9/11/20... Dual vs. Multiple Lead Replacement.) CPT would consider this a dual chamber device, right? Why would 33264 be the correct code when only two chambers are being paced? Could you send us the AMA clarification that you referenced?

Authorized user for Y90 performs mapping angiogram and injects Tc-99m MAA for simulation. Patient is sent to Nuc Med. What is required to be documented in the IR report to bill for 77290? Can we bill for the simulation 77290 and the nuclear medicine study, typically 78803 or 78831 on the same day?

The radiologist first performed an ultrasound-guided thyroid cyst aspiration, and then administered sodium tetradecyl into the cyst for ablation. Would this be reported with codes 60300 and 76942 for the cyst aspiration? Also, would code 49185 be appropriate to report for the chemical ablation, or would this be reported with unlisted code 60699?

Can an iliac branch device be billed in conjunction with a FEVAR? Since 34717 is an add-on code that can only be used with specific CPT codes, I am wondering if it is correct to use 34718 with 34848 in this situation. Any advice would be appreciated.

Our IR doctor wants to bill codes 38790 and 75805-26 for a percutaneous transhepatic lymphangiogram. Would you agree? And would I still report code 38790 as well? 

"Using ultrasound and fluoroscopic guidance, a 22 gauge needle was inserted into the periportal segment of the right lobe of the liver under realtime ultrasound guidance from intercostal transhepatic approach. A diagnostic transhepatic intrahepatic lymphangiogram was obtained with iodine-based contrast after a few attempts with a 22 gauge needle. Following the diagnostic study using iodine-based contrast, lipiodol was injected into the relatively peripheral aspect of the intrahepatic lymphatic ducts. With unstable needle position as well as noticeable refluxed of the lipiodol into the hepatic vein, the initial injection of the lipiodol was stopped at 0.2 to 0.3 cc of lipiodol. No cyanoacrylate glue was used. Findings: Technically successful percutaneous transhepatic intrahepatic lymphangiogram demonstrated small chylous leak at the gallbladder fossa level with three separate lymphatic channels visualized as inflows."

Which is correct 34201 vs. 37184 and 37211?

"Using a glide catheter and Glide Advantage wire, we advanced the Glide Advantage wire to the level of the proximal to mid superficial femoral artery. This was followed by placement of a 45 cm, 6-French sheath from the left common femoral artery access. Heparin 4000 units were given intravenously. Serial ACTs were performed and additional heparin given to maintain an ACT of greater than 250. At this point, we used a Glidewire and a Rubicon catheter to traverse through the occluded SFA stent. We were able to navigate the Rubicon catheter to the popliteal artery contrast injection, revealed a patent TP trunk artery, anterior tibial artery, posterior tibial artery as well as peroneal artery. The peroneal artery, however, is diseased. TPA 4 mg was given through the sheath intra-arterially. We then used an AngioJet device and sprayed tPA solution in the entirety of the popliteal artery and the stented SFA. After 15 minutes had elapsed, mechanical thrombolysis was performed in two passes."

Order by referring physician .yelogram of cervical with CT to follow:

"A lumbar puncture was performed. Myelographic contrast material was injected under fluoroscopic guidance. Spot films were obtained. The patient was then sent to CT for post-myelographic CT images which will be reported separately.

LEVEL INJECTED: L5-S1.

FINDINGS: Myelographic contrast is noted in the subarachnoid space. There are no obvious abnormalities. CT myelography is more sensitive and see that report for additional findings.

OTHER: Request for both lumbar and cervical myelogram. Patient was placed into a headdown position on the gurney prior to CT scan for cervical myelogram as well

IMPRESSION: Intrathecal injection of myelographic contrast for subsequent CT myelography."

CT 72126 and 72132 were done with findings described by a different radiologist.

There is a different coding for physician and hospitals? The codes in this account are 62305, 72126, and 72132.

The report documents a nerve block of the posterior coccyx nerve fibers. Then, with a new and different needle, a coccyx steroid injection at the coccyx joint and posterior distal coccyx inferiorly.

Coding Clinic for HCPCS (Third Quarter 2019) says to report CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch, for the coccygeal nerve block. So according to Coding Clinic, the appropriate codes for this case would be 64450, 20605, and 77002.

The problem I have with this advice is that 64450 is for peripheral nerve or branch, so it requires a laterality modifier. Since the coccyx has no laterality, I’m not sure what to do. Do I skip the edit, use the unlisted code (64999), or should it be something else entirely?

"ICE catheter was placed for continuous pacing and recording from the left atrium. Cardioversion was performed using 200 J His AFib organized into flutter and that was ablated. AFib ablation was then done via pulmonary vein isolation. Following this adenosine 18 mg was administered x 2, which resulted in paroxysmal AV block to confirm isolation of the left pulmonary veins and the right pulmonary veins.

The catheter was withdrawn from the left atrium at that time. Reassessment of the cavotricuspid isthmus found the line of ablation had reconnected. Additional ablation was delivered near the annular aspect of the line, which resulted in bidirectional block. The patient was monitored for 15 minutes without evidence of apparent reconnection. Final ICE images showed no evidence of pericardial effusion. Protamine was administered to reverse the effects of heparin. Lidocaine was administered to both groins, and the sheaths were removed."

Can 92960-XU be coded with the 93655, 93656, 93312, 93320, and 93325?

Would an echo performed after VSD/ASD/PDA corrected with patches/devices with no residual shunt be coded as a non-congenital echo (93306) since the congenital issue has been corrected with no residual findings?

How would you code coronary dissection? Catheter-induced spiral dissection of the mid RCA treated with drug-eluting stent with excellent angiographic results.

DX:  left ICA terminus aneurysm

Final Coil Mass and Removal of Comaneci Device - Series 27-29

A stable coil mass is seen within the aneurysm. Shown here is removal of the Comaneci device without any evidence of coil loop protrusion or coil mass position change.

Post Coiling Angiograms

Post Coiling Superselective Angiogram (Coil #1), Left Internal Carotid Artery, cranial biplane projection (Magnified Water's AP, Lateral, Ipsilateral Oblique) - Series 15

The framing coil is seen occupying volume within aneurysm without any evidence of coil loop protrusion into the parent artery.

Post Coil Embolization Superselective Angiogram, Left Internal Carotid Artery, cranial biplane projection (Magnified Water's AP, Lateral, Ipsilateral Oblique) - Series 30

Coil mass present in the aneurysm with progressive occlusion. Minimal residual filling. Normal parent vessel appearance. Excellent antegrade flow in the left ICA and branches.

Impression: Successful Comaneci-assisted coil embolization of the left internal carotid artery terminus aneurysm as described above.

Would codes 62290 and 72295 be correct for this procedure?

"74-year-old woman with suspected vertebral genetic pain. Prominent discogenic endplate marrow edema changes (Modic type I) at L3-L4 on the right (4-9 and 5-9). Patient now presents for image-guided diagnostic anesthetic disc injection. Following written informed consent, the patient was placed prone in RAO position on the biplane angiography table. Following sterile prep and drape of the left flank, and after local anesthesia with 1% lidocaine, a 25 gauge 3 1/2 inch spinal needle was advanced into the central aspect of the L3-L4 disc space, approaching from the left. Following confirmation of needle tip position within the central aspect of the L3-4 disc space, negative aspiration for blood or fluid, possibly 1.2 cc of 0.5% bupivacaine were slowly injected and the needle withdrawn. The skin was cleansed and a bandage applied at the puncture site. Total fluoroscopy time equals 2.6 minutes."

When transcatheter mitral valve-in-ring replacement via transseptal approach is performed with Lampoon bisection of AML, is it appropriate to report code 33999 for the Lampoon procedure?

In order to bill codes 37211 and 37212, what specific documentation is required? Does the physician have to state he/she (physician) initiated the thrombolytic agent? Is the name of the agent and the amount required?

When a midline catheter insertion is done with ultrasound guidance at bedside by the Vascular Access team, what would be the appropriate code to bill: 36410 vs. 76937 vs. 36573? 

Patient had repeated VT shocks and had an upgrade to his device along with azygous vein coil insertion. Are there any updates on how to code this?

Pulmonary artery banding performed for Hybrid Stage 1 with RHC and pulmonary angiography. Should we code the diagnostic RHC, pulmonary angiography, and selective catheter placement into the PDA with PA banding code 33620? Or does the PA banding code encompass it all?

"Patient came in, and vascular surgeon performed open thrombectomy of fem-pop above the knee PTFE bypass graft, and then angioplasty was performed in the native popliteal artery. They closed the graftotomy and performed angiogram, which showed there was still thrombus. They re-opened the graftotomy and further dissected the CFA, profunda, and SFA as well as the bypass graft and opened the anterior portion of the hood of the graft and found there was some dissection flap. Femoral endarterectomy was performed, a portion of the hood was excised, and pericardial patch was used to patch the graft. Angiogram showed flow through the graft to the posterior tibial artery on final angiography."

Would this be reported with codes 35376 (graft thrombectomy with revision of graft hood) and 37224 (native popliteal angioplasty)? And since the endarterectomy was performed in the area of the hood of the graft, endarterectomy (35371) that was performed to clear dissection flap can't be coded; is that correct?

What CPT code would we use for the following scenario?

"After informed consent was obtained from the patient, a formal timeout was performed. An appropriate site in the ventral upper right thorax was prepped with ChloraPrep antiseptic and allowed to dry. Using 1% local lidocaine anesthesia, sterile technique, and intermittent CT guidance, a 22 gauge needle was advanced into the 1.8 cm hypermetabolic right apical pulmonary nodule. As the 22 gauge needle was removed, approximately 0.1-0.2 cc of methylene blue was injected to mark the visceral pleura prior to VATS procedure. The patient tolerated the procedure well with no immediate complications or complaints."

I am not sure how to code this case and would appreciate your assistance. It is done for gastric varices. Right common femoral vein accessed and selected IVC, left renal vein selected and then to the gastrorenal shunt. Venogram performed and Amplatzer plug deployed. Attempts made to advance into fundal varices were unsuccessful but did get slightly more superior and another venogram done. This demonstrated nonvisualization of fundal varix and showed filling of cardiophrenic vein. No sclerotherapy was performed due to possible injuring cardiophrenic vessels. The Amplatzer plug was recaptured due to concern for increase pressure. A left renal venogram was performed and no thrombus seen." I am thinking of coding 75831, 36012, and 75810, but I did not feel 37241 is appropriate due to plug removed.

"After cardiac ablation procedure had been completed, attention was then turned access closure. Given large size of the transhepatic sheath required for ablation, with direct communication with the systemic vasculature, access site embolization was necessary to prevent hemorrhage on sheath withdrawal. Then after diagnostic venogram of the right hepatic vein performed. Venogram demonstrates brisk central outflow from the right hepatic vein to the IVC, with the site of venous access identified as mild luminal irregularity at the sheath tip encountered on slow sheath withdrawal. Embolization of the venous access site was then performed through the microcatheter with a 6 mm x 20 cm Ruby Soft detachable microcoil, with tight coil packing extending into the hepatic tract, confirmed with ultrasound."

I'm not sure what to code for embolization here. Please advise. 

Will you please advise on coding for the following case: No heart cath done, only angiography.

Angiography: Descending aorta: pigtail catheter placed in the proximal DAO shows the aorta to the level of the transverse arch and both the left and aberrant right subclavians are visualized. This shows the level of the two anterior DAO collaterals for selective angiography. There is a suggestion of additional subclavian or IMA collaterals, but this is not well seen.

Collater #1: No injection only findings documented

Collateral #2: Selective injection with findings

Collateral #3: Selective injection with findings

Collateral #4: RIMA selective injection with findings

Collateral #5: Selective injection with findings

Collateral #6: LIMA selective injection with findings

Rt and Lt Subclavian angiograms

Will you please advise on ICD 10 PCS codes for this case as well?

We have a placement of AFX bifurcated aortic endograft device, and our patient is here for aortoiliac disease. We are having a discussion coding this because they are not getting the endograft done for aneurysm, pseudoaneurysm, dissection, penetrating ulcer. What code should we use for this?

"Case background: Right CFA accessed angio performed due to tortuosity hanged from short to long sheath during exchange pt became agitated and vascular access was compromised. Hematoma formation noted manual compression applied. Switch to LT CFA ,LT heart cath was done, afterwhich noticed pt became more hypotensive and actively bleeding fr RT CFA,distal aortogram w/bilateral runoff was done w/h showed active bleeding at the level of distal CFA and above SFA and profunda.Omni flush cath selec angio was done and confirmed the bleed , omni flush exchanged with 7x80mm armada balloon inflated nominal pressure fro approx 5 mins. Subsequent angio still showed active bleeding.Balloon re-inflated for prolonged time and vascular team were page. Subsequent balloon was removed; pt is having rapid expanding hematoma + hemorrhagic shock. Pt directly taken to OR for open repair of her RT CFA."

We got 37246 for the angioplasty fro the hematoma. MD thinks it should be 37224. Any suggestion?

"Pelvic and left lower extremity angiography demonstrating a flow-limiting dissection extending from the distal aorta into the left common iliac artery. A VBX covered stent was deployed in the left common iliac artery." The code description for 34707 includes treatment of dissection. The narrative instructions for code 37221 state "for occlusive disease". Would this VBX covered stent for treatment of flow-limiting dissection be considered ‘occlusive’ directing towards 37221 or instead reflect iliac endograft 34707?

Based on the CPT description, code 93657 is used for an additional ablation of the left or right atrium for treatment of Afib remaining after completion of pulmonary vein isolation. Clarification is needed if continued Afib must be documented after the PVI is complete to code 93657. Can the following documentation of the roof line and floor line ablation performed resulting in posterior wall isolation be coded as 93657 in addition to 93656?

"Wide antral circumferential ablation was performed around the LSPV and LIPV, resulting in electrical isolation. Wide antral circumferential ablation was performed around the RSPV and RIPV, resulting in electrical isolation. Roof line and floor line ablations were performed, resulting in posterior wall isolation. The patient remained in Afib after ablation, so DCCV with 360J was performed, resulting in conversion to sinus rhythm."

We are looking for the best codes for a limited MRI. These would be done to look for syrinxes and would likely only include sagittal T2 images of the C, T, and L spine. Would you recommend each spine level with a -52 modifier?

What CPT code would you use if a limited ultrasound was done, and they they did an US-guided nephrostomy tube removal? Code 50389 is for fluoro, so I'm not sure if that code can be used when US guidance is used.

If catheter is placed in the posterior tibial artery with an intranidal ethanol injection to treat an a hindfoot arteriovenous malformation (37242) AND a direct transvenous ethanol embolization of the nidus (37241), would this just be 37242 because he is treating the same hindfoot arteriovenous malformation? Or would it be two surgical sites since there were two separate accesses and treatments?

Can the BASILICA procedure be billed separately from TAVR? Last guidance given by Dr. Dunn was unlisted 33999 in 2020.

Under what circumstances would it be appropriate to append modifier -59 to 64483 when performed with 64636? Is it only appropriate when 64483 is performed on the contralateral side?

Our physicians are now performing pulmonary embolectomies via Flowtriever device. When (if ever) would it be appropriate to also bill a right heart catheterization? The doctors are asking, and I am not sure about billing both. Can you offer any direction, and what would be necessary for documentation?

Can you review and advise how to potentially code the following note? Patient was evaluated for possible erosion due to odd appearance after ICD implantation done at outside facility.

"As we opened the incision, we noted that there was presence of suture that appeared to be a V-Loc. There were multiple pieces of this. Despite the implant having been at least 3 months ago, the suture material was quite intact in pieces about a centimeter 2long. We did remove the device and carefully explored the pocket. It seemed as if this area of prominence was gone after we removed the suture material. The pocket was copiously irrigated with antibiotic solution and hemostasis was assured. The device was placed back in its pocket using a TYRX antimicrobial pouch. The pocket was closed with 2 layers of running Vicryl suture and overlying Histoacryl glue. This appears to be a case of very superficial V-Loc suture that has not been absorbed and with the appearance of concern for erosion. Fortunately, this was not related to lead."

A patient presents for diagnostic coronary angiography. Per the procedure report: "There was 100% occlusion in the proximal to mid left main coronary artery due to leaflet from a pre-existing surgical bioprosthetic valve after valve-in-valve TAVR with complete effacement of the sinuses by the transcatheter heart valve with no visible antegrade filling of the left main during this or by prior angiograms performed after TAVR. This lesion meets the definition of a chronic total occlusion, greater than three months old." A CTO device was used to facilitate crossing the chronic total occlusion prior to intervention, and balloon angioplasty was performed. Since the left main's occlusion was not caused by atherosclerosis, intimal hyperplasia, thrombus, inflammation, etc., but rather by an aortic valve leaflet, does revascularization code 92943 still apply? If not, what CPT code should be reported and why?

Can 93623 be billed? How many units of 93657 can we bill? Physician always bills more than the MUE of (2). 

"Patient was prepped and draped in usual manner. Bilateral femoral veins were entered. Double transseptal puncture was performed. Under ICE and 3D mapping of LA, low voltage fractionated electrograms were seen on the posterior septum and anteriorly near the mitral valve. Posterior wall appeared healthy. RF therapy was delivered to achieve wide antral isolation of left veins and right veins sequentially. Once isolated both left and right demonstrated isolated firing. Isoproterenol was infused at 12 mcg/min. PACs were seen from posterior septum and anterior wall near mitral valve. Runs of A-tach were seen from inferior coumadin ridge. All three of these locations demonstrated evidence of supporting AF triggers. RF was delivered at these three additional locations. Lesions at posterior septum and inferior coumadin ridge were connected with RF to adjacent isolated pulmonary vein. Anterior region was connected to RF mitral valve. Catheters were removed."

Can add-on code 76937 can be reported with 93505 when the provider is using ultrasound for vascular access while the biopsy is being done via TTE (76932) or fluoro (included) guidance? In the NCCI Manual, Chapter 11, says CPT code 76937 shouldn't be reported with cardiac catheterization, percutaneous coronary artery interventional procedures, and internal cardioversion. Code 93505 technically falls in the cardiac catheterization section within the CPT Codebook. There is not a procedure-to-procedure edit, but there are many directives in the NCCI Manual that do not have PTP edits, so we wanted an expert opinion. Please advise.

What CPT code would we use for the stent for securing the lead? Is this billable? We are billing the 33225. Is modifier -22 applicable?

"Using an over-the-wire technique, a left ventricular coronary sinus lead was advanced into this branch and carefully wedged in place. The absence of diaphragmatic stimulation at high output was confirmed. The CS lead was further stabilized with 2.5 x 8 mm drug-eluting stent dilated to 12 ATM over the wire to stent the lead in place."

We need some help clarifying proper coding when a fenestration is embolized. Had a unibody with bilateral renal stent and SMA stent placement.

The fourth fenestration, the celiac was chronically occluded and was embolized. Does this make this a 3 vessel?

If it does, would it matter why a fenestration was occluded? There has been another case but not with celiac occlusion. Seems like they would just order a three vessel if the intention was to occlude the vessel.

We have been performing and reporting the following CPT codes:

• Myocardial imaging, PET scans: 78492, 93015, J2785, and A9555 and
• Myocardial imaging, PET scan with concurrent CT scan: 78431, 93015, J2785, and A9555

NGS Medicare is beginning to deny the A9555, Rubidium Rb-82, diagnostic, per study dose, up to 60 mCi. NGS states that there is a second PET scan code that we are failing to report in order to receive reimbursement for the Rubidium Rb-82. I am hoping that you can direct me to the code they are referring to.