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1 venous stent for 2 veins

My provider is documenting that he placed a stent in common iliac vein, and placed a stent in external iliac vein. however he is only using 1 stent. Would this fall into "a single therapy"? Do I only bill 37238 since he used 1 stent? Or do I bill 37238,37239 since 2 different vessels were treated? 

messenteric artery duplex scan

If a renal duplex scan is done plus the mesenteric artery, do I bill code 93976 only, or do I also add 93976?

Open Carotid approach for TAVR

Cardiac Surgery came in and opened the right carotid artery. Cardiologist then performed the Aortic Valve Replacement using the Carotid Artery for Delivery of the Valve. Is this still an unlisted procedure code 33999?

Profunda Reimplantation During CFA Aneurysm Repair

Would the profunda reimplantation to the graft be part of establishing inflow/outflow in code 35141 or would this be separately billable with a 22 mod or unlisted 37799?

"Patient has right CFA aneurysm with complete occlusion of right SFA and profunda femoris. We dissected the CFA proximal to the aneurysmal area. The vessel was encircled with a vessel loop and controlled. We repeated the same process for the SFA and profunda. The aneurysm was then entered anterior arteriotomy with a 11 blade. The arteriotomy was extended proximal and distal with scissors. We completely transected the proximal and distal ends of the affected artery in order to proceed with reconstruction. An 8 mm Dacron graft was sewn to the CFA in an end to end fashion. The same process was repeated for the distal anastomosis to the SFA. Next, the profunda was transected and ligated. The distal portion was mobilized in order to anastomose to the Dacron graft. End to side anastomosis with 5-0 Prolene was performed. All the arteries were flushed prior to completing the anastomosis."

TIPS - 37182 and ICE

Just confirming -

If TIPS procedure is performed, and ICE (Intra-Cardiac Echo) is used - does it fall under the "all associated imaging guidance" or can Intra cardiac echo be charge separately with 93662?

36819 vs 36832

Patient has pre-existing brachiocephalic av fistula which now has aneurysms. Physician resects the cephalic vein from where it was anastomosed to the brachial artery. A subcutaneous tunnel was then made distal to the antecubital fossa

with the distal cephalic vein brought in juxtaposition to the previous brachial artery anastomosis. The anastomotic segment was cleared to allow for end-to-side anastomosis to be completed from the brachial artery to the cephalic vein. This was then completed.

due to lack of significant palpable thrill, in order to better provide outflow from this retrograde system, incision was made overlying the basilic vein in the forearm. Subcutaneous tunnel was made and the distended basilic vein was passed through. Distal basilic vein was transposed and juxtaposed to the cephalic vein. A venotomy was made within the cephalic vein and the basilic vein spatulated to accommodate an end-to-side anastomosis.

Since original anastomotic site used, is this revision (36832) or new creation (36819)?

G0260 and fluoroscopy and CT

Since code 27096 now includes fluoro, does G0260 follow the same rules and include Fluoro? Because in the lay description it says The physician injects the sacroiliac joint for the purpose of arthrography, which is taking radiographic pictures of the joint internally to visualize the cartilage and ligaments. The contrast material, or gas, is drawn into a syringe and the target structure is localized. Through a posterior approach, the needle is inserted and advanced into the sacroiliac joint, the articulation between the sacrum and ilium in the pelvis, and the contrast injection is visualized under the aid of separately reportable computerized tomography (CT) or fluoroscopic guidance.

In facility do we report G0260 and 77002?

Please advise thank you

Can 64905 be used for TMR combined with Nerve Ped8ical Transfers?

I have a vascular surgeon who wants to bill CPT 64905 for the TMR a newer technique that he states is allowed with Nerve Pedicle Transfers. He did a below knee amputation. After that the op note reads:

"The Tibial Nerve was identified and isolated. The Soleus muscle was meticulously dissected until the motor nerve plexus was identified. A coaptation was created between the nerve and the motor nerve plexus using 6-0 prolene, and the vascularized muscle was closed around the nerve."

We have exhausted our appeals and are unsure if this is going to work or if a Unlisted code should be used?

dual chamber pacemaker

Does this support a dual chamber insertion?

"Using fluoroscopic guidance a lead was inserted into the area of the left bundle via guide sheath. Pacing and sensing parameters were appropriate with LV activation time of 71 ms. The guide was slit. The lead was anchored in position using sutures around the anchoring sleeve. Next, another sheath was used to place an atrial lead in the area of the right atrial appendage. The lead was anchored in position using sutures around the anchoring sleeve. The leads were then connected to generator and the pocket was irrigated with saline.

The device and leads were placed in the pocket and the pocket was closed with a combination of subcutaneous absorbable sutures and Steristrips. Pacing and sensing parameters were checked through the device and were appropriate, there was no phrenic stimulation with high outpatient pacing from both atrial and ventricular leads."

White matter small vessel ischemic disease ICD-10-CM

What code should be used for white smatter small vessel ischemic changes? Some coders use R90.82; some use I67.82. Is there a definitive code that should be used?

LIMITED US WHEN NOT ENOUGH FLUID

In the cases where US is done prior to thoracentesis if not enough fluid, we report the limited chest US only. However, if US is done on both RT and LT side but only LT side has enough fluid and thoracentesis is done, are we still able to report the limited US done for the RT with not enough fluid?

36832 vs 37607

Is this considered a revision or a ligation of the AV fistula?

"Intraoperative ultrasound was used to visualize the arterial anastomosis. An oblique incision was made with a scalpel, and the incision was deepened with electrocautery and metzenbaum scissors until the brachial artery and fistula were both identified. The artery and fistula were both confirmed to be as such with Doppler. A 6 mm Dacron tube graft was brought onto the field, opened with metzenbaum scissors so that it was formed into a patch instead of a tube, and wrapped around the proximal fistula for sizing. This was then sutured into place sizing the fistula to the graft with interrupted 5-0 prolene suture. A palpable thrill was still noted over the fistula. Hemostasis was obtained with electrocautery. The wound was closed with 3-0 vicryl, 4-0 monocryl, and skin glue. A radial pulse was palpable on completion."

Iliac Artery Dissection Caused by Other Intervention Stent Repair

For iliac artery stent procedures, we understand the coding is first based on pathology and then based on the type of endograft used to treat the pathology. For an iliac artery dissection (not stated for occlusive disease), should we use code 37236 or 34707 when a Cook Zilver 8 mm x 60 mm stent is used? Would this type of stent qualify for the ilio-iliac tube endograft code 34707, or would this be considered a “regular" stent code 37236? If the dissection was caused during a lower extremity revascularization procedure, is the iliac artery dissection stenting still codeable?

3 Phase Bone Scan w SPECT CT - 78315 & 78832?

Based on the following, would CPTs 78315 and 78832 both be reported?

Order- NM Bone Scan 3 phase w/SPECT CT

Tech Info- Pt injected w/ 24mCi. Blood flow imaging of pelvis performed. Blood pool imaging of pelvis and knees (4images) performed. Whole body anterior & posterior & 10 spot views of skeleton obtained 2hrs later. Subsequently, 2 SPECT-CT acquisitions, one of the pelvis and another of the knees.

Findings- Blood flow of pelvis shows subtle hyperemia regional to R hip prosthesis. Blood pool imaging shows periprostatic uptake outlining the entirety of the prosthetic, though the greatest laterally at the hip and lateral R knee. Delayed images of pelvis, there is increased tracer uptake R acetabulum... at the level of the knee there is tracer accumulation w/i the patella. SPECT-CT of the pelvis shows increased uptake R greater trochanter & L femoral head. SPECT-CT of knees shows increased tracer uptake R patella. Remaining whole body images show flare metaphysis at the L knee, compatible w/ marrow expansion in setting of SCD & splenic autoinfarction.

CPT for Abdominal Fat Pad Biopsy

At our hospital facility we do a number of abdominal wall fat pad biopsies for amyloidosis. Are there any updates for what CPT code should be used for these? I've read unlisted code 17999, Unlisted procedure, skin, mucous membrane and subcutaneous tissue, from a 2019 Dr. Z. response. 

Pulmonary Pressures

Patient had PA, PWCP, AO, and LV pressures. I think 93458 for the LV and AO pressures and then one of these add-on codes for the pulmonary piece: 93568, 93569, 93573, or 93574? Thoughts?

"Coronary angiography was performed. We then did the right heart catheterization and performed cardiac output in triplicate by thermodilution method. We then also did left ventricular end-diastolic pressure along with pulmonary capillary wedge pressure to calculate the mitral valve area and a 6-French Angio-Seal was deployed at the right femoral artery and D-stat pad was used to do the closure in the femoral vein. The right coronary artery shortly after its origin has diffuse disease to the mid-vessel stenosis maximum of about 40% proximal, and about 20% mid. The ascending root is mildly dilated, aortic valve area 1.1cm2 capillary wedge pressure was approximately 18 to 20 mmHg, pulmonary artery pressure 48/26. Initial left ventricular pressure 183/21 mmHg. Left ventricular end-diastolic pressure 26. 40 mm, peak to peak gradient across the aortic valve max gradient 50 mmHg."

What codes are supported for billing the Endovascular procedure & Why?

What codes are supported for billing the endovascular procedure and why?

"Ultrasound-guided cannulation right common femoral artery- Selective left leg angiogram- Left anterior tibial lithotripsy with 3 mm x 40 mm Shockwave lithotripsy balloon- Angioplasty distal left anterior tibial artery with 2 mm x 100 mm ultra verse balloon-

Operative findings:

#1. The left posterior tibial artery still patent with minor areas of disease proximally and distally. The posterior tibial goes into the foot but does not appear to supply much of any blood flow to the digits on the left foot.

#2. The anterior tibial was able to cannulated with 0.018 wire and 0.014 wire. The wires could not be advanced all the way into the foot. After treatment of the anterior tibial with 3 x 40 mm lithotripsy shockwave balloon, it was quite obvious that the lithotripsy balloon could not be advanced all the way into the foot. This was replaced with 2 mm x 100 mm balloon which once again could not be advanced across the heavily calcified and diseased distal anterior tibial artery into dorsalis pedis. The procedure was then terminated."

Thyroid bed (soft tissue lesion) percutaneous biopsy

Would you code this as 20206/76942 or go with unlisted 20999?

Pre-procedure diagnosis: Right thyroid bed vs. paratracheal nodule

Post-procedure diagnosis: Same

Device: Temno Evolution

Size: 18 Gauge

Passes: 5

Specimen: Surgical pathology

Successful US-guided right thyroid bed / paratracheal nodule biopsy.

gastroduodenostomy

What is the correct CPT coding for the initial insertion of a gastrostomy tube (Moss) with extension into the proximal duodenum? This was performed percutaneously and under fluoroscopic guidance.

Left Heart Catheterization 93454 - 93458

I could use your expertise. A left heart cardiac cath was performed. The procedure report goes into detail about entering all major arteries and branches but does not describe how the catheter entered the left ventricular. There are, however, pressures recorded for the left ventricular reading. Are we to code from these pressure readings assuming the left ventricular was done?

Open Impella Removal w/Embolectomy or Endarterectomy

The 2023 CPT book now directs us to bill the repair code when an Impella device is removed from an open exposure. If an embolectomy or endarterectomy is also required, would that still be considered a repair or would you bill those procedure codes instead? Is the repair code appropriate for open exposure and closure with just suture for the removal?

Initial vertebroplasty and Initial Kyphoplasty

We have a debate amongst our team as to if you can charge an initial vertebroplasty and initial kyphoplasty in the same operative session. The patient had a T5 and T7 kyphoplasty and T12 and L1 vertebroplasty. Can we charge 22511 and 22512 for the vertebroplasty and 22513 and 22515 for the kyphoplasty?

CT Guided Localization of Foreign Body with Tatoo Ink

Patient placed in a supine position. Skin left lateral abdominal wall cleaned and draped in usual sterile fashion. 1% lidocaine used as a local anesthesia. Patient monitored by radiology nurse using automated blood pressure cuff, EKG, and pulse oximetry. No sedation related complications.

Using CT for guidance. the tip of a 20-gauge Quincke spinal needle was placed immediately adjacent to the foreign body in the left side of the peritoneal cavity. Next, a mixture of 2 cc of endoscopic tatoo ink and a half a cc of Ominipaque 240 was injected through the needle. Patient tolerated the procedure well with no immediate complications. Patient was sent to recovery in stable condition. Radiologist performed this procedure.

How would this be coded? Would it be coded as 49411 or 10035?

Post Operative TEE

The patient undergoes a procedure, can be various types of procedures for different reasons. The cardiologist performs a TEE pre, and post operative on the same day. Are both of these TEE procedures billable on the same day? Are they billable if they perform them on different days? They are performing these as a post operative check for the procedure. We are struggling with the medical necessity rationale other than a routine post operative check.

EIA to CFA Endarterectomy with CIA Stent

If the provider performs an endarterectomy of the external iliac artery to common femoral artery and places a stent in the common iliac artery, can we bill both codes 35355 and 37221? If so, does the documentation need to support two separate lesions to bill both, or can it be a contiguous lesion?

Patient Drain Sclerotherapy

We have a patient who is returning multiple times for sclerotherapy of a lymphocele. However, after a few visits they are now sending the patient home with instructions as to wait 1 hour and then drain the doxycycline. "...The catheter was reconnected to a closed suction drainage bag. A sterile dressing was applied. The patient was instructed to reopen the stopcock after allowing the doxycycline to dwell for at least one hour. The patient was discharged."

There are mixed reviews as if it would it be appropriate to bill this out as 49185 or 49185-52 with the reduced services modifier for these cases. Can you please advise?

Findings but no documentation of catheterization?

Report only has documentation for catheterization of the left internal carotid artery, but the findings section has imaging results for both the left and right internal carotid arteries. Can I code this as 36224-50?

Left Bundle Branch Pacing Lead Insert

How does Profee code for a left bundle branch pacing lead insertion? Please see example below. Patient had a dual pacemaker insertion (atrial and ventricular leads in addition to an LBB pacing lead. "LB pacing lead guiding catheter and .035 wire advanced, 3830 lead advanced and positioned in left bundle branch area. LB pacing lead position stable and lead sutured in place." Is this included in the insertion pacemaker/ICD codes? I'm not sure 33224/33225 would be correct in this situation either. Please advise.

Super saturated oxygen therapy using Zoll Therox System

We have a patient that received a DES for an acute MI originating in the LAD. In the cath report after IVUS and stenting they state "Following this super saturated oxygen therapy was started with ZOll system for 1 hour. Following this the system was disconnected, sheath was removed and Angio-Seal closure device used." I cannot find any guidance about a CPT for this type of procedure. Is this oxygen therapy included in the MI stenting procedure or should I look at an unlisted code?

Abbreviated MRI breast

May i ask you if we can still bill 77046-77048 if our radiology tech perform an abbreviated MRI with the following sequences :• · Sequences (all axial, no sagittal sequences)

o o Ax T2 FS

o o Ax FS Multiphase

 § 1 Pre contrast

 § 2 post contrast. Standard 10 mL gadavist 20 sec delay

o o MIP early phase

Thank you very much.

Bradycardia with second degree heart block

When a patient is having a pacemaker implanted and has second degree heart block causing symptomatic bradycardia, would both diagnoses be coded? I'm trying to determine if the bradycardia would be considered a sign or symptom and not coded, or if it can be added since it may or may not be present with a heart block and further explains the patient's condition?

MULTI-FOCAL VENOUS MALFORMATION

Please help. We have a patient w/a multi-focal venous malformation. Physician did sclerotherapies at the shoulder, upper arm, and forearm. Separate draping was required for each one. These malformations are not at all connected. Can we bill for three units of 37241 for three separate Op sites?

3D Transthoracic Echo

Can 76376/76377 be reported on the same day as 93306, 93307, or 93308 when 3D imaging is used? Or are 76376/76377 only reportable when the 3D rendering occurs on a different day from the base procedure?

VATS resection of right 4th rib

Would the below VATS procedure be coded as 32662 or unlisted?

"The 3rd and 4th inner intercostal muscles were widely dissected off of the posterior 4th rib to make room for division. Arm #2 was removed and a Stryker Pi drive drill with a long shaft was placed allowing precise division of the posterior 4th rib. Division of the posterior 4th rib allowed the rib to be retracted inward like a trap-door, which facilitated division of the surrounding muscles from the outer surface of the 4th rib. As the tumor was approached, a rim of external intercostal muscle and likely serratus anterior were taken with the specimen. Dissection continued anterior to the prior costal cartilage division, at which the remaining muscular connections were divided, completing the 4th rib resection."

Ascending aortogram with diagnostic card cath

During diagnostic cardiac cauterization, aortogram was performed to locate origin of the circumflex. Would the ascending aortogram be coded in this case?

Per cath report "Anomalous origin of the left circumflex. Prior CT chest from 5 years ago reviewed during the case. Circumflex does not originate from the aorta, it may originate from a branch of the pulmonary artery, although difficult to visualize origin. Non-aorta take-off was confirmed with aortogram."

Bilateral renal artery stent placement - 37236, 37237 or 37236-50?

Should bilateral renal artery stent placement be reported as 37236, 37237, or 37236-50? We understand that past guidance (such as from question IDs 5462 and 8218) states to use 37236, 37237 in this given scenario. The rationale given in Question ID 8218 was that modifier -50 “applies to lower extremity revascularizations, but not to renal, visceral, [or] upper extremities”. However, code 37236 is a "conditional bilateral" code as per CMS, meaning that modifier -50 is applicable to it. Is this to say that modifier -50 is only applicable to code 37236 when lower extremity revascularization of non-occlusive disease is performed? Or, should it apply to any applicable anatomy that has bilaterality, such as the renal arteries?

Perfusion bypass catheter with ECMO

As we begin to see patients on ECMO longer and longer, surgeons are adding another catheter to support continued perfusion to the extremities. Would this be considered included in the ECMO, or could another CPT code be applied? I found that code 36620 might be a good representation code for this work. What are your thoughts?

"The 5 French catheter in the Right SFA was serially dilated to accept a 6 French distal perfusion catheter and flushed with hep saline. Contrast was administered through distal perfusion catheter with confirmation of flow down the SFA. The SFA cannula connected to the side port of the arterial cannula. ECMO flow initiated with good color change."

Pocket Revision for erosion prevention

Physician performed a pocket revision for device erosion prevention and placed an Aigis antibiotic pouch. For this, would 33222/33223 be applicable depending on the device used?

cpt 93306,96374, and Q9957

Provider billed 93306, 96347 and q9957 and claim was partially paid. Payer denied 96374 as inclusive it this correct and/or can we add modifier 59

Biventricular ICD pocket infection with extraction

Incision extended to pre-existing pocket. Device was freed from the pocket. There is pus coming from the pocket which was irrigated & culture sent. Leads disconnected from old generator. All 3 leads were able to be easily removed with placement of stylette and retraction of the screws with gentle traction. The upper pocket incision was then. Access obtained to left IJ under ultrasound guidance with placement of guidewire. A 6 French peel-away sheath was then advanced over which a Boston Scientific pacing lead was advanced to the right ventricular apex and secured with active fixation. The explanted generator was then cleaned and attached to the lead and the atrial port. The RV and LV port were then plugged with pin plugs. Externalized device and lead used to continue backup pacing for a few days.

I am new to EP I currently have 33244, 33241. Would I also add 33234 since there were 3 leads removed, or since there was a new lead attached for the external device leave the 33234 off of the claim?

Bilateral Iliac Vein IVUS

How would you code the following? Surgeon accesses right IJV, advances the sheath and performs a bilateral LE venogram. After diagnostic venogram, they proceed with intervention. Catheter is placed in IVC, then in RT CIV, LT CIV, RT EIV, LT EIV, RT common femoral vein and LT CFV; all with IVUS performed in each vessel. Compression is found in each vessel and measurements are documented. Surgeon decides to place stent in RT CIV, RT EIV and RT CFV. I am coming up with 37238-RT, 36012-RT, 37252, 37253x5, 75822-59.

AVF Angioplasty Medical Necessity

An AVF angioplasty and embolization was performed and provider queried because stenosis percentage was missing for intervention. The provider responded that the stenosis was greater than 50% but angioplasty was performed for low flow volume due to failure of maturation and treated with assisted maturation (angioplasty) to increase the diameter of the AV fistula to allow for access in dialysis and adequate flow volumes to achieve dialysis. The patient also underwent coil embolization to redirect outflow of the fistula at the same time to increase flow volumes in the distribution of access in the cephalic vein. When angioplasty is performed for this reason, is stenosis percentage still required in the documentation?

2ND TIME! Epicardial Hybrid Thoracoscopic Sinus Node Modification for IST

Facility charges only. Performed by CT Surgeon and Cardio Interventionalist in EP Lab. Pericardium retracted, exposed right atrium SVC and IVC. Exposed the pulmonary veins and posterior SVC. SA node mapped by CIV in baseline and on isoproterenol. Area marked and SVC RF ablation line with 2 burns above SA node, series of burns along the crista terminalis of RA. 3 burns places across the IVC RA junction. Elevated heart rate on isoproterenol so further mapping and RF ablation- 34 burns on CTI. 2 more burns at SVC RA junction. Further mapping by CIV as well as endocardial ablation via femoral access with RF ablation catheter. Due to cross-clamping of the patient's pacemaker leads during the SVC lesions, we performed testing both before and after the case. All lead parameters including impedance, threshold and sensing we restable both before and after. The patient's device was programmed to DDDR, 60-125 beats per minute at the end of the case. I am thinking 33265, 93631, 93286, 93623 for the facility charges. Please help!! Thank you in advance, you're the best!

TIPS with Coronary variceal shunt embolization

1. Successful creation of a TIPS from (likely) the middle hepatic vein a branch of the left portal vein with placement of a 10 mm x 9 cm Viatorr stent graft, extended cranially with a Viabahn VBX 10 mm x 37 mm stent graft. The portosystemic gradient

decreased from 12 mmHg to 10 mmHg following placement of the TIPS.

2. Embolization of a large coronary variceal shunt leading to esophageal varices.

37182,37241,36012?

93656 verses 93653

93656 vs. 93653. To save space, I am only including the actual ablation portion of the report. 

"Pt presented for atrial fib ablation. A complete 3D electroanatomic map of the left atrium, pulmonary veins, and region by the left atrial appendage was drawn with an Octaray mapping catheter. All four pulmonary veins were still electrically isolated from prior ablation. There was a fragmented signal anterior to the right-sided PVs and one lesion was placed here on the septal side. Some scarring was noted along the roof and inferior posterior wall of the LA, with a few areas of other scattered scarring. Next, using a thermocool Smart Touch ST SF DF ablation catheter , the roof line connecting the left and right superior PVs was reenforced. A floor line was created conecting the left and right inferior PVs. A "+" was created in the PW creating four quadrants, and fractionated signals were ablated within each quadrant. Entrance and exit block were demonstrated. A repeat map of the LA confirmed posterior wall isolation. All lines were then removed, and protamine was given."

"Recent" CTA

From your seminars I've attended in the past, there is always a slide regarding physician documentation best practices. Regarding peripheral studies, one of the bullet points is to state reason for repeat diagnostic study such as: change in clinical status since prior study, prior study doesn't include the area of current interest, prior study was inadequate for visualization of area of concern, emergent transfer and images not available. Is there guidance on what time frame is considered a recent CTA/MRA/Angiogram? Within that certain time frame the physician would need justification for repeat diagnostic at time of intervention. There is a discussion amongst our team as to whether recent means within the past 1,3 or 6 months. As always, our team greatly appreciates your guidance.

Trans-Apical Access for TEVAR

What is the CPT code for transapical access for TEVAR with coverage of the left subclavian artery: 33880, unlisted, or something else?

Percutaneous ethanol ablation of the bilateral pudendal nerves

PROCEDURE SUMMARY:

- Target organ: pudendal nerves

- Image-guided chemical ablation

Chemical ablation

Under CT guidance, the ablation needle was advanced and positioned within the target(s). For each target lesion, the needle was placed and repositioned as necessary to achieve the desired ablation zone. Contrast injection through needle: Performed, confirming extravascular position.

Ablation needles: 21 gauge Chiba

Target #1

Ablation position 1

- Volume of chemical (mL): 5

Ablation position 2

- Volume of chemical (mL): 5

Intraprocedural imaging findings: appropriately positioned needles in the pudendal canal.

Needle removal :The ablation needle was removed and a sterile bandage was applied.

Imaging following ablation

Post-ablation imaging: noncontrast CT

Post-ablation imaging findings: post ablation changes without complication.

Contrast

Contrast agent: Omnipaque 180

Contrast volume (mL): 8

Radiation Dose

CT dose length product (mGy-cm): 2208

Will this be coded as 64999? What is an equlivent procedure for billing purpose?

Tomosynthesis core needle biopsies

I know there's official guidance that states if both stereotactic AND tomo are used to only report 19081, and if it's just tomo to report 19499. What code would you consider for this excerpt below? I'm getting confused when a report states, "Mammo guided WITH tomo."

"TECHNIQUES: Patient was placed sitting upright and erect.  FINDINGS: Mammographically guided with tomosynthesis core needle biopsies of calcifications in the upper-outer quadrant of the anterior left breast. This was done with aseptic technique and local anesthesia, 1 percent lidocaine with bicarbonate. The breast was compressed in the CC projection and biopsy was from the superior aspect of the breast. A small dermatotomy incision was made. Twelve biopsies were done with the vacuum assisted 9 gauge Eviva needle. A top hat marker was placed at the site."

93598 with 93505

Can we report thermodilution code 93598 with 93594 and 93505 for a congenital heart biopsy case? I know we cannot report it with non-congenital heart codes 93451-93460; however, nowhere in the CPT Codebook says that it cannot be reported with 93505. Moreover, the CPT Codebook says to use 93598 in conjunction with 93593-93597. Now my question is, can it be reported separately with 93505 in congenital cases? Is thermodilution still considered part of 93505? I'm not talking about Fick cardiac output method.

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