Ask Dr. Z

My physician successfully placed an Ellipsys vascular access system. One month later the patient returned for a diagnostic duplex scan of the fistula (93990). The clinical indication was soft thrill, but the study was normal. What is the ICD-10-CM code for soft thrill?

"Patient with a complicated type B aortic dissection. TEVAR Cook main body graft was advanced in its 20 French sheath, landing site covering the left subclavian. The covered stent was deployed and accurately landed. The first distal bare metal TEVAR was advanced and deployed to just above the celiac artery. The final distal bare metal TEVAR piece was advanced and deployed from above the celiac to just below the IMA."

Is this final bare metal extension of the TEVAR included in code 33880 even though it is deployed below the celiac?

U/S GUIDED VASCULAR ACCESS OF R FEMORAL VEIN. FLUROSCOPYICALLY GUIDED ENDOMYOCARDIAL BX - 2 PASSESS W/ 5 SAMPLES OBTAINED. RHC WITH THERMODILUTION AND FICK CARDIAC OUTPT.

Question: should we keep RHC and apply modifier -59 due to NCCI edit?

We had a planned Melody valve case where the patient's anatomy was not quite suitable for valve placement. A stent was placed across the valve, and the patient will be brought back once the stent endothelialization has occurred for valve placement. Would you code the stent across the valve with 33745, or continue to use an unlisted code?

Are codes 33880, 37236-XU, and 37217 correct for the following, or are stents bundled in 33880?

"ON back table primary thoracic endovascular aortic device was deployed 2 fenestrations were placed according to preop plan for lt common carotid/subclavian artery,fenestrations reinforced, device reconstrained within inner sleeve and resheathed within original device.Next arteriotomy was serially dilated and primary fenestrated thoracic endovascular device, Terumo aortic relay Pro 34/30 X 209mm device advanced under fluoroscopic guidance into arotic arch where it was deployed under fluoroscopic and 3D fusion guidance. Next from the lt femoral access a 7 FR Oscor twist conformable sheath was advanced into the thoracic aortic device multiple attempts were made to select Lt carotid fenestration. Due to double curve of type III aortic arch this was unsuccessful. Attention was turned to performing retrograde cannulation/stenting of lt carotid/subclavian fenestrations. From retrograde 7 FR sheath LT common carotid/subclavian primarily stented in retrograde fashion."

New HCPCS code 0715T goes into effect on 07/01/2022, but it does not appear on the MUE table. Would you advise to assign the code once for each major coronary artery treated with IVL?

Patient present for cardioversion due to persistent atypical A-Flutter-

As patient was being sedated attempts to pace terminate his atrial flutter were attempted to his pacemaker. Through the noninvasive programmed stimulation capabilities of his pacemaker was able to pace patient into atrial fibrillation which then spontaneously converted to sinus rhythm. DC shock was not required. Patient was able to take and maintain sinus rhythm. Patient tolerated the procedure well and there were no apparent complications. Patient was monitored for approximately 30 minutes after the procedure.

Successful pace termination of Atypical A-Flutter to sinus rhythm using the noninvasive programmed stimulation capabilities of his pacemaker- Defibrillation shock not required.

This similar question was answered by you and you stated to bill 93724 for a pacemaker and 93799 if done with a defibrillator- however, this was answered -Question ID 8709- I am unable to find any other guidance.

Our providers will generally document that the vessel is patent when documenting for code 76937. But sometimes, the vessel is not "patent"; the vessel may have thrombus, be tortuous, have calcification or any number of conditions. Would this qualify as documenting the state of patency for the coding of 76937?

Do we need to bill arterial repair with saphenous vein patch separately after excision of AV fistula (infected graft-35903)? I have seen some Q&A where you recommend to code repair separately, but per NCCI edit blood vessel repair is bundled with 35903. Could you please clarify at what scenarios do we need to bill repair code separately with 35903?

When a coder uses an unlisted code, are the coders qualified to also provide the relatively closest comparable CPT codes to the physician or billing office?

Do codes 78306 and 78803 apply here?

MC NM BONE SCAN WHOLE BODY WITH SPECT WHEN NECESSARY 

HISTORY: This is a x8 year old x with prostate cancer undergoing staging.

 COMPARISON: CT chest abdomen and pelvis 5/19/20 

PROCEDURE: Approximately 2 hours following injection of 26.9 mCi Tc99m MDP anterior and posterior whole body images were obtained with lateral views of the skull. 

FINDINGS: Whole body images demonstrate normal distribution of activity throughout the axial and appendicular skeleton with nearly diffuse increased activity involving the spine, sternum, clavicles, ribs, pelvis, proximal femurs, and shoulder regions. Lower extremities suboptimally evaluated due to motion artifact. There is reduced soft tissue, renal, and urinary bladder uptake. 

IMPRESSION: Extensive osseous metastatic disease, approaching "SuperScan".

Would both codes 78306 and 78803 be applied with this imaging?

"MC NM BONE SCAN WHOLE BODY WITH SPECT WHEN NECESSARY.

HISTORY: history of rectal adenocarcinoma with metastatic disease undergoing evaluation for osseous lesions. 

COMPARISON: Concurrent CT chest and abdomen, PET/CT 7/21/xxx 

PROCEDURE: Approximately two hours following injection of 24 mCi Tc99m MDP anterior and posterior whole body images were obtained with lateral views of the skull. 

FINDINGS: There is increased activity of the bilateral shoulders and knees which are likely related to degenerative changes. Otherwise, whole body images demonstrate normal distribution of activity throughout the axial and appendicular skeleton. 

IMPRESSION: No evidence of osteoblastic metastatic disease."

Are you able to bill code 76937 with codes 37243 and 36247? Dictation supports the code 76937.

A scenario was raised in which they started off using moderate sedation and then they needed to call in the anesthesia team. Let's say they used moderate sedation for 30 minutes with the IR doctor, but then needed to switched to anesthesia for the rest of the case, say another 45 minutes. Can you code for the moderate sedation and then also for the anesthesia time completed?

Another situation: Moderate sedation for an IR procedure 30 minutes. Physician leaves room for 30 minutes for an emergency in room next door and then he returns to complete IR procedure another 15 minutes. How would you code this?

WE DID-LEFT HEART CATH,DFR ,IVUS, PCI WITH DES OF LAD. We are not getting paid for the DFR,IVUS.For left heart cath,coronary angiography &left ventriculogram and to visualize lt and right coronary system. The left main was engaged with an EBU 3.5 guide.Heparin was used for anticoagulation,after confirmation of a therapeutic ACT, the LAD was wired with a comet wire and DFR measurements with pullback were obtained. The proximal to mid LAD lesion was predilated NC emerge 2.5x15mm &3.0x15 mm at18 ATM. The lesion was stented with DES. Then IVUS was performed & the stent was post dilated with NC euphora 4.0x15 mm at 22ATM. Right radial access to preform procedure. Medicare states that claim /service lacks information or has submission /billing errors. I HAVE TRIED MODIFIER XU ON DFR &IVUS STILL NOT PAID. The DFR & IVUS OF LAD.

"Patient with hypoplastic left heart syndrome (mitral/aortic atresia). Patient underwent stage I palliation with Norwood, Sano conduit, PDA ligation and atrial septectomy as a neonate. He then underwent Sano takedown, creation of a right cavopulmonary anastomosis (bidirectional Glenn shunt) and intraoperative direct aortic balloon angioplasty. A 4 French was placed in the right femoral artery. Complete right heart and left heart catheterization via abnormal native connections was performed with oximetry, hemodynamics, and angiography in multiple planes." Would these cases be coded to 93597?

Would it be correct to use 38900 when the method of sentinel node identification during surgery is gamma probe, or is an injection required intraoperatively when using 38900? Op note states, "We then opened the clavipectoral fascia and used the gamma counter to identify a total of four lymph nodes with counts of 88, 129, 256, and 401 per second ex vivo. They were submitted as right axillary sentinel lymph nodes #1-4."

Coding PCI cases in hospital when IVL used... do you recommend using add-on code 0715T with the C1761? According to current info per CMS it appears only for physician billing. Can you please recommend best practice when coding in hospital?

Patient had diagnostic and intervention. Almost a month later, she was brought back for intervention of LAD and iFR. Based on iFR decision was made not to do intervention.

Past guidance: If here for staged intervention and imaging indicates not necessary, charge a diagnostic. Does the same hold true in this situation - charge diagnostic and IFR?

"History: 58-year-old female with recent inferior STEMI s/p PCI to 99% OM2 lesion. She was also found to have moderate LAD and RCA disease and was brought back for PCI of LAD and iFR. She remains symptom-free and compliant with DAPT. Findings: Right radial artery access. Right dominant circulation. LM minimal luminal irregularities. OM stent patent with TIMI-3 flow. mLAD 60% stenosis and iFR of 0.93. pRCA 60% stenosis with iFR of 0.97. No intervention performed today. LVEDP normal."

Can a diagnostic and IFR be charged in this situation?

I am not sure how to code this. I'm hoping you can help explain what they are doing here and what codes are best. 

"Patient had CABG and on ECMO days ago now in shock and going back to operating room. Esmarch dressing removed . The mediastinum was evacuated of clot. Rt pleural space was opened and fluid evacuated here was small in amount. The patient then underwent a ramp study, epinephrine increased. Ejection fraction was 55%. We weaned to 3/4, intermittently clamping the LV vent for a limited time because patient was not heparinized. At the end of the 5 minute period of clamping, Lactate was stable. EJ fraction was unchanged. The balloon was paused with good pulsatility, but not ready for weaning. Quikclot and Esmarch dressing replaced."

What is the code for the RAMP study? I assume it has to do with the ECMO? I think the mediastinal washout is 35820?

What would be the correct CPT code(s) for a CT-guided cryoablation of bilateral medial branch nerves at L2-L3? Is this covered by 64635 and 64636? It is unclear if only RFA is covered by 64635 and 64636. Or do these codes also cover cryoablation? Would cryoablation have to be unlisted 64999?

Radiofrequency ablation for atrial fibrillation (pulmonary vein isolation), additional radiofrequency ablation for atrial fibrillation (roof line), Additional radiofrequency ablation for atrial fibrillation (posterior line with isolation of posterior wall), additional radiofrequency ablation for supraventricular tachycardia (mitral annular line), additional radiofrequency ablation for supraventricular tachycardia (cavotricuspid isthmus line), additional radiofrequency ablation for atrial fibrillation (CFAE lesions along coronary sinus).

Would the correct coding of this procedure be 93656, 93657 x 2( box-roof line and posterior wall then CAFE lesion) and 93655 x 2 (mitral annular line and cavotricuspid). Does it matter that the mitral annular line was done prior to completion of the pulmonary vein isolation?

Has there been any update for 2022 on how to properly code an IFR? We have been using 93571 with -52/-74 modifier, but some staff are pushing back stating to use unlisted code 93799. We are unsure what is correct.

Leadless pacemaker was placed in right atrium and right ventricle. Would this be reported with codes 33274 and 33999? Or only 33999?

"The introducer was advanced through the long sheath into the right ventricle where it was positioned at the apical septum. Contrast was used to confirm location and proximity to the myocardium. Once appropriate position and contact was noted, the leadless pacemaker was exposed and screwed into the walls. Next the atrial lead was pursued. The introducer was advanced through the long sheath into the right ventricle where it was positioned initially at the base of RAA but didn't have good numbers and eventually positioned at lateral RA wall. Contrast was used to confirm location and proximity to the RA wall. Once appropriate position and contact was noted, the leadless pacemaker was exposed and screwed into the walls."

Can you code both an IVUS and an OCT in the same coronary artery? If not, what can you can code for two different procedures in the same coronary artery?

"Procedures: 1) Redo right femoral to anterior tibial artery bypass with 6 mm PTFE. 2) Cephalic vein patch angioplasty of anterior tibial artery. 3) Ligation left SFA. 4) Left common femoral artery thrombectomy/endarterectomy. 5) Left arm cephalic vein harvest.

Due to concerns about the thrombus in the SFA potentially washing out into the bypass or into the profundofemoral artery the SFA was then divided off of the common femoral artery at the level of the femoral bifurcation and ligated with a 3-0 Prolene suture. The arteriotomy on the common femoral artery was then debrided and shaped so that the bypass could lay very nicely with the heel of the graft just at the start of the profundofemoral artery coming off the femoral bifurcation."

I understand that the ligation is typically included in the bypass procedure. Would the ligation be billable in this instance?

"Retrograde coronary sinus venogram. Vascular US guide access to right femoral vein. Using direct US guide access obtained to right femoral in two separate locations. The long steerable sheath advances in the right atrium. A decapolar electrophysiology catheter advanced to the right atrium. Guided by fluoroscopy and intracardiac electrograms, the coronary sinus engaged successfully and the steerable sheath advanced over the decapolar EP catheter to the coronary sinus. IV contrast injected in the steerable sheath and coronary sinus venogram showed normal to large size coronary sinus two marginal branches of small to medium size. RAO to LAO images stored. Total contrast 30 cc."

Please advise on CPT codes to bill. 

For 2022 hospital billing, is there any additional guidance on territories for IVL above the knee? Are the iliac arteries and femoral arteries considered one territory or two? If IVL on left common iliac artery and IVL on left superficial femoral artery, would C9764 x 2 be correct?

If the radiologist accesses the right common carotid, right internal carotid, and right distal M2/proximal M3 and performs thrombectomy, then retracts the catheter and manipulates through the A-comm into the left ACA and performs thrombectomy, would that still be considered two vascular families even though he did not retract into the arch and go through the left common carotid to left internal carotid to the left ACA? Can we report codes 61645, 61645-59?

Our physician brought a patient in for atrial tachycardias and paroxysmal atrial fibrillation. He starts out with Afib ablation (93656), then states, "Following a period of observation, all pulmonary veins were remapped and were persistently electrically isolated." The patient was then given adenosine with no evidence of acute reconnection. The physician chose to look for SVT. Isuprel was given. The patient developed an artial tachycardia, which quickly transitioned to atrial fibrillation. Isuprel was stopped. Cardioversion was unsuccessful. A series of ablation were performed around the SVC. I chose 93657, but my co-worker is saying it would be 93655 because the rhythm started as SVT. What are your thoughts?

I’m not really sure how to code this. Would this still code to 37197 even though a cutdown was performed?

"Angio demonstrates a RFB extending from distal ext iliac into thrombosed pseudoaneurysm. 6 French sheath advanced over g-wire to left external iliac proximal to the RFB. Multiple attempts to snare the FB was unsuccessful as FB incorporated the vessel wall of the external iliac. Elected to remove via cutdown. Under u/s guidance RFB extended into the thrombosed left groin  pseudoaneurysm closest. Stab incision made using 11 blade. Grasped the foreign body and carefully remove it while applying pressure over the arteriotomy site. A flow-limiting dissection in the distal left external iliac at point of proximal attachment of the foreign body. There was little distal  flow to the dissection. 4 French catheter was advanced over g-wire, contrast confirm position of cath. G-wire was readvanced. Attempt to treat dissection with prolonged inflation and 8 mm balloon. Some improvement post prolonged inflation, but dissection flap persisted and hemodynamically compromising. Repair with 10 x 30 Protege stent."

Does the provider need to specify "angioplasty of the stent due to re-coarctation" to code 33897 for angioplasty of a previously placed coarctation stent? Would angioplasty of coarctation stent due to a patient growth or small stent size fall under coding as 33987?

Are codes 47382 and 47540 appropriate for the following? 

"Contrast was injected to fill the right-sided biliary system. Under fluoroscopic guidance, a 21 gauge needle was advanced in a peripheral right-sided biliary duct. A vascular sheath was then placed. Angled catheter and Glidewire were used to pass the stricture and gain access into the duodenum. Stiff wires were then placed. Endo biliary RFA was then performed from both the right and the left sides. A 7 x 80 and a 9 x 80 LifeStar uncovered stent were then deployed from the right and left sides. Post stent placement cholangiogram was performed. Two 10 French long biliary drains were then placed. The drains were secured in place. The patient tolerated the procedure well with no complications. FINDINGS: Cholangiogram from the left-sided access demonstrates severe stricturing at the biliary hilum consistent with the patient's history. Impression: Endo biliary radiofrequency ablation with bilateral biliary stents and bilateral biliary drain placement."

"Patient with a biventricular ICD has generator changed to a dual chamber ICD. New subcutaneous lead was tunneled, inserted, and connected with a Y connector to the RV socket. LV lead was capped." Would codes 33270 and 33241 be correct to report? Codes 33271 and 33263 cannot be reported for this because 33263 edits outs.

In 2021, code 33508 falls under NCCI Edit 1 and can be billed with modifier -59. We still get denials that it is an integral component of the procedure and therefore procurement of saphenous vein should not be reported separately with the venous graft codes. Is it appropriate to bill this and how do we fight it in an appeal? Any suggestions? We now have the same issue with the new code 33509.

How should complete non-invasive Doppler be coded with three or more levels studied for both upper and lower extremities during the same encounter? From what I've read it would be 92923 and 92923-59, but we've received a denial from Medicare, so I wanted to double check.

The procedure is a CABG x3 (33533; 33518), PV isolation with RF clamp ablation (33257), and LAA ligation.

The patient is a 74-year-old female who presents with atrial fibrillation and severe CAD on angio.

"PROCEDURE: Patient was systemically heparinized. Right and left pulmonary vein isolation was performed with atrcure system clamp ablation. Pt had bradycardia to 50 and conversion to NSR during right side PV isolation. LIMA was carefully anastomosed to the proximal LAD with 7-0 prolene. De-airing was performed. Sidebiting clamp was placed on the proximal ascending aorta and the proximal SVG was carefully anastomosed to the ascending aorta us 6-0 prolene in standard running technique. Ascending aorta and SVG were carefully de-aired and the sidebiting clamp was released. Heart was then lifted and the SVG was carefully anastomosed side-to-side to the D1, followed by end to side to the D2 using 7-0 prolene sutures. Careful deairing was performed and SPY angio imaging was used to visualize all grafts. Hemostasis was confirmed."

This question is for Pro Fee. Since LAA closure with a percutaneous approach (33340) is reported for patients with atrial fib, does the new add-on code LAA closure with an open approach at the time of other sternotomy (33268) follow the same medical necessity guidelines? My provider performed an ascending aorta graft, with cardiopulmonary bypass (33858) with an open LAA for diagnoses of aortic dissection and IVC thrombus. Can 33268 and 33858 be reported together?

How would you code the following?

"3 cm left chest incision was made and two LV epicardial pacemaker leads were placed. GBM 511 served as the primary new epicardial lead and GBM 5112 was placed as a back up. Both leads had excellent pacing and sensing thresholds. The left pacemaker incision was reopened and the DDD pacer was explanted. The two epicardial leads were tunneled into the pacer pocket and all leads were connected to a new St Jude Allure RF biventricular pacemaker model # PM..."

It's been quite some time since I've coded pacemakers, so I am unsure of the appropriate codes here. I was thinking 33202 for the epicardial lead placement via thoracotomy and 33228 for the removal and replacement of the pacemaker pulse generator. Am I close on this?

Would it be appropriate to report code 93287 with 93642?

Does the CPT coding of cardioneural ablation differ from the usual types of cardiac ablation? A patient presented with SVT and syncope. She underwent cardioneural ablation of vagal ganglionated plexi in both left and right atria. Would this procedure still be coded with 93653? If not, what should we report for this?

For biopsy of a lymph node in the axillary tail of the breast, should this be coded as a lymph node biopsy (38505) or a breast biopsy (19083, for example)?

"Fractional flow reserve (FFR) of the entire LAD artery lesion was performed. A 6F EBU3.5 LAUNCHER guiding catheter was used to engage the vessel. Once ACT came therapeutic, a Volcano Verrata 014x185cm wire was used and equalized at the guide catheter tip. Guide was engaged and Adenosine was given, the guide was disengaged  with measurements obtained. The iFR of the lesion was measured as 0.83. Baseline Pd/Pa was 0.85. Following administration of 100 mcg of intracoronary adenosine, the FFR was 0.62. Apical LAD wire position. Measurements recorded before nitroglycerin administered. Multiple pressure wire artifacts observed FFR: 0.62. The iFR of the lesion was measured as 0.88. Baseline Pd/Pa was 0.86. Following administration of 100 mcg of intracoronary adenosine, the FFR was 0.82. Apical LAD wire position. Measurement recorded after nitroglycerin 100 mcg IC bolus administered. Multiple pressure wire artifacts observed. FFR: 0.82."

Is this enough to support 93463, or only 93571 will be reported?

A patient was transferred from a smaller facility for STEMI. MD documented that the patient was delayed in our ER due to another case being performed in the cath lab and no other team available and that the patient was brought to the cath lab as soon as they were able. A LHC and angiography was performed and drug-eluting stent placed in the LCX (culprit lesion). Can we still code C9606 for the AMI intervention?

How would you code a RHC and LHC with only graft selections? The physician did not select the coronary arteries at all, only the grafts. Would you code 93461-74 or unlisted where selection of coronary arteries are part of the 93461 code?

What do you code if physician selectively engaged in right and left common carotids and said this: "The right common carotid artery injection demonstrates normal antegrade flow into the external and internal carotid arteries with normal filling of the external carotid artery branches. Course and caliber of the cervical portion of the right internal carotid artery is unremarkable." Then he also says he engaged in right and left internals, right and left subclavians, and right and left vertebrals. He engaged in all these selectively.

If a child has a cardiac congenital defect such as TOF repaired, should the follow up imaging be ordered/coded as non-congenital? Our practice routinely performs CT Heart post surgical repair that comes over ordered as 75573 (congenital) but our coders feel this should be 75574 (non-congenital).

"EXAMINATION: CT HRT W/3D IMAGE CONGEN.

CLINICAL HISTORY: 17-year-old with repaired Tetralogy of Fallot presents for evaluation of pulmonary arteries.

Technique: CT angiogram (CTA) of the heart with prospective gating and volumetric (wide axial) technique on a Canon AquilionOne CT scanner. Test bolus technique was used with 18 mL Optiray 320 intravenous contrast. 105 mL was used for the CTA. The total amount of Optiray 320 is 125 mL. Before contrast injection, the heart rate was 56 bpm. Heart rate during the study was 49 bpm regular. CTDI used during the CTA portion was 6.9 mGy. Total DLP 110.9 mGy-cm."

Is unlisted code 37799 the appropriate code to use? If not, what would you use for this procedure? "DIAGNOSIS: Superficial left knee AVM. PROCEDURE: Ultrasound was used to localize the left medial suprapatellar arteriovenous malformation. I placed two 17 gauge cryoprobes in parallel through the long axis of the malformation which measures approximately 3 x 3 x 1.5 cm and is adjacent to the vastus medialis muscle. The probes were placed approximately 15 mm apart. Following probe placement, a 5 French centesis catheter was placed between the skin and the malformation, and hydro-dissection was performed with warm saline to displace the lesion away from the skin. Cryoablation protocol was as follows: 100% power x10 minutes, passive thaw, and 100% power x5 minutes. At all times, a sterile glove filled with warm saline was applied to the skin at the ablation site. Ultrasound monitoring was performed on the cryoablation to observe the ice ball. At the end of the ablation, the probes were removed and sterile dressing was applied. IMPRESSION: Technically successful ultrasound-guided cryoablation of superficial medial left knee arteriovenous malformation."

Should this be reported with 50431 x 2?

"TECHNIQUE: The 2 left nephrostomy tubes and surrounding skin were prepped and draped. Scout imaging was obtained. The more superior left nephrostomy tube was injected with dilute contrast and fluoroscopic images were obtained. The contrast was then aspirated out. The more inferior left nephrostomy tube was then injected with dilute contrast and fluoroscopic images were obtained. The contrast was then aspirated out. Both tubes were then reconnected to gravity drainage.

FINDINGS: The 2 existing left nephrostomy tubes appeared patent and in good position and so no intervention was performed on them. The patient is due for routine exchange of all 3 nephrostomy tubes on 07/19/2022. It should be noted that, in the past, one of the left nephrostomy tubes was felt to be a perinephric drain, but on further evaluation of prior imaging and the patient's medical record, it appears both left-sided tubes are nephrostomy tubes.

Impression: SUCCESSFUL LEFT NEPHROSTOMY TUBE EVALUATION X2 DEMONSTRATING THE TUBES TO BE PATENT AND IN GOOD POSITION."

I'm a charge analyst at a hospital. Our radiologists are using endoscopes occasionally with percutaneous procedures. We had a patient with a cholecystostomy tube where the radiologist used an endoscope with an attempt to cross the cystic duct.

"The Spyglass endoscope was introduced through an 11 French sheath. Visualization of the gallbladder demonstrates small gallstones. The origin of the cystic duct was visualized. The scope was advanced to the cystic duct. Multiple attempts were made to advance a wire through the cystic duct without success due to extreme tortuosity of the cystic duct. Given the difficulty decision was made to abandon attempts at internalizing the cholecystostomy tube. The endoscope was removed. A wire was advanced through the 11 French sheath. The sheath was removed over a wire. A new 12 French cholecystostomy tube was placed." 

Is it appropriate to report 47552 and 47536? I'm questioning 47552 since the code description states "diagnostic".