Ask Dr. Z

"Physician replaced the aortic valve with an Epic Supra tissue prosthesis size 23, He also enlarged the aortic root using Manougian technique. This is the Dr. verbiage for the root enlargement " Resection of the valve was carried out. Calcium deposits were removed with routine loose debris care. The aortic root was measured and was not suitable to admit a size 19 prosthesis. Manougian reconstruction was accomplished by extending the incision into the commissure between the noncoronary and left coronary cusp into the dome of the left atrium across the anulus of the aortic valve. Hemashield Finesse graft patch was utilized to enlarge the root by creating a teardrop fashion patch that was sutured to the sub annular surface of the aortic valve using running suture technique of 5-0 Prolene." 

33405 with 33999?

The CPT codebook does not specify a code for SFA to ATA artery bypass with PTFE. Therefore, would I use unlisted code 37799 comparable to 35666? Coding for bypass would the SFA and profunda be the same as common femoral? I have also looked at comparable to 35671. Any extra guidance be appreciated.

I have read many of your questions regarding deep vein arterialization for limb salvage. I understand currently we use unlisted code 37799. However, in this particular case the doctor not only PTA vein to artery, the doctor placed a stent from the peroneal artery into the right peroneal vein and also from the right peroneal artery to the common plantar vein. This was also salvaging the limb. How would I bill those stents, as there is no stenosis given?

Is there a separate code for the MitraClip removal done prior to TMVR, or would this warrant modifier -22 being appended to 0483T?

1. Successful removal of a MitraClip using electrosurgery and retrieval with an OnO basket

2. Successful transcatheter mitral valve replacement (TMVR) with Edwards 29 mm M3/ENCIRCLE Docking system

-Residual PVL s/p closure with 14 mm AVP 2

3. Normal LA pressure and LVEDP

4. Successful closure of iatrogenic ASD with a 30 mm Gore cardio form device

Provider performed the following procedures:

• Shockwave IVL; left common femoral and external iliac artery
• Ranger drug-coated balloon angioplasty of left CFA and external iliac artery
• Stent of left external iliac artery

On the facility side, should we only submit one unit of C9765 since two IVLs were performed in the same "above the knee" territory even though one artery (CFA) was not stented? As for the angioplasties, my understanding is this is included as part of C9765.

On the professional side, would it be 37221, 37224, & 37799 x 2 (for IVLs)?

"History: Left Lower extremity, foot, gangrene. Status post LLE bypass and anterior compartment fasciotomy. Procedure: Exploration, washout, and closure of LLE anterior compartment fasciotomy. Description: The anterior compartment fasciotomy incision was entered, and the muscle was found to be pink, reactive, and viable. We irrigated with Irrisept. The skin was then closed using sutures, leaving fascia open. A Pevena skin VAC was applied."

Everybody has a different idea of how to code this, from VAC application only, to coding for layered repair code for closure of fasciotomy. Please give us your thoughts.

What is the documentation requirement for a Swan-Ganz insertion?

This patient had IR percutaneous cholecystoduodenostomy lumen apposing metal stent placement. The procedure involved placing an NG tube to the duodenum, obtaining direct access into the gallbladder and then using those two sites to create a direct access between the gallbladder and the duodenum, and then passing a flanged metal stent between the gallbladder and the duodenum for bile drainage due to bile duct obstructions. The bile ducts were not accessed. This does not seem to fit the descriptions of percutaneous biliary stent procedures and was not performed using endoscopy. How should this be coded?

Can you please clarify if this procedure would be reported with code 33016 or 33017 for facility? Patient had a pigtail sutured in place, but the description of code 33017 states "indwelling catheter", so I am not sure if this procedure can be coded as 33017.

"Procedure: Using micropuncture needle we accessed the pericardial space. Using echo, we confirmed position in the pericardial space with agitated saline. We exchanged micro wire for J wire and dilated track with 6 French dilator then 8 French dilator. We then placed 8.3 French pigtail and aspirated 350 cc bloody fluid. Post ECHO showed resolution of pericardial effusion. Pigtail was sutured in place."

I have a few providers who perform coronary angiographies 93454 for pre TAVR purposes with a dx of I35.0. I35.0 is not a payable dx. Should these be billed with the Q1 modifier and Z00.6 since they are related to the TAVR? I know the LCD states that a dx of R93.1 can be used for billing 93454 in patients undergoing a non-coronary surgical procedure, however, the providers only document aortic stenosis I35.0.

I need some guidance for this case. Background, the patient does not have a previous endograft in place they are presenting with blue toe syndrome and aortoiliac disease with tissue loss but findings show an embolized aortoiliac with focal dissection associated with a plaque/thrombosis. Kissing aortoiliac stents were placed... I'm going back and forth over using 37221-50 vs using 34707-50. Am I on the right track? Which of these would you use, or do you have another suggestion. Unfortunately, the doctor does not describe a stenosis with measured percentages which is another frustrating layer which has me leaning more towards 34707-50.

"The patient came in with history of PE and bilateral lower extremity DVT and presents with IVC filter removal and venoplasty and reconstruction of the IVC and bilateral iliac veins. The physician removed the filter from the right internal jugular and left femoral access. Under US guidance he then accessed the right femoral vein, placed the catheter in the IVC, and placed a stent in the IVC and kissing stents in the bilateral iliac veins."

Would you be able to report code 36010 for the separate right fem access? If so, I don't know which X modifier would fit, or would it be just use a -59? Or would I just code the stents plus IVC filter removal?

The bilateral groins were prepped and draped in normal sterile fashion. Under ultrasound guidance a micropuncture kit was used to advance a 5 French sheath into the right common femoral artery Mickelson catheter was introduced over a Glidewire. Diagnostic spinal angiography was then undertaken of the left T6, bilateral T7, bilateral T8, bilateral T9, bilateral T10, bilateral T11, bilateral T12, bilateral L1, bilateral L2, bilateral L3, bilateral L4, bilateral iliac and median sacral arteries.

Do I code for additional 36245 for the contralateral catheterization of the LT iliac since the initial access was in the RT common femoral artery? I don't see medical necessity and looks like done for comparison only.

What do I code when the only procedure performed was left atrial 3D mapping? The only documentation I have is, "We went transseptal with the Baylis sheath and needle into the left atrium add we exchanged over stiff pigtail for the Agilis sheath through the Agilis sheath we used the HD grid 3D anatomic mapping catheter and mapped out the entirety of the left atrium left atrial mapping demonstrated continued isolation of pulmonary veins and posterior wall and the lateral mitral isthmus we found significant fractionation along the anterior roof and the anterior septum and the floor we loaded the patient with IV amiodarone we are able to cardiovert him to sinus rhythm we removed the catheters back to the right atrium no pericardial effusion we removed catheters."

The EP lab wants to charge 93613, but I cannot find a primary CPT code to use. 

Atrial pacing lead extracted and not replaced during biventricular ICD generator change. RV ICD lead and LV lead remain.

Would the atrial pacing lead extraction be coded as 33235 or 33244?

Our thoracic surgeon billed code 33213 for generator insertion. In the same setting our EP physician did testing and programming in the operating room. Can the EP physician report code 93280 for his services?

Our physician documented: "Using a Seldinger technique and peel-away sheaths, the defibrillator lead was placed under fluoroscopic guidance. Once testing showed adequate and stable function, the ICD lead was secured using the suture sleeve. The pocket was liberally irrigated with antibiotic solution. First the ICD lead was connected to the ICD generator, then the existing RA and RV (LBB) lead were separated from the permanent pacemaker generator and secured/connected to the ICD generator. The permanent pacemaker generator was removed. The ICD generator and leads were then placed within the pocket. Fluoroscopy confirmed stable lead position" Since there is no LV lead I was coded 33233 and 33249, the hospital was added 33225. Can you please help with this scenario? Thank you

REMOVED/EXPLANTED: PM GENERATOR

IMPLANTS:

ICD GENERATOR

RV

RETAINED:

RA

Left Bundle

Has there been any updated guidance in regard to coding angiograms for Angio-seal placement? The most recent article I could find was from 2013. (Question ID: 4836 from April 30.2013)

Our vascular surgeons express that angiograms are a medical necessity for proper placement of Angio-seals in order to ensure proper function of the device.

Would it be appropriate to code the angiogram and Angio-seal together and if so what type of documentation would be required to support coding the angiogram? We normally see a brief statement like 'View of the left groin revealed that Angio-Seal could be utilized.' Would this be adequate?

At the start of a transvenous extraction of a dual chamber pacer system, including leads, with the insertion of a leadless pacemaker. Under ultrasound guidance and using micro puncture technique, 4 femoral venous access (12 French, 9 French, 9 French, 5French) and 1 femoral arterial access (4 French) were inserted. The super stiff wire was inserted under fluoroscopy guidance to left brachiocephalic vein. Bridge balloon was prepped and inserted into the level of SVC/RA junction. Balloon was inflated and the location of the balloon was marked on the Super Stiff wire. The volume of contrast injected was marked on the syringe. The balloon was then deflated and pulled back into the IVC. The balloon was inflated for medical necessity as there was concern for high risk of SVC tear given the lead location and dwelling time. The provider wants to bill 37244-52, as instructed in a 2018 document from Phillips Corp. We aren't familiar with this procedure and want to use 33999 (unlisted code) for 33370 (Embolic protection). Who is correct?

Would you code 37618 with 20103?

"The patient then underwent general anesthesia with endotracheal intubation. The patient was then repositioned in supine position with all pressure points padded in the standard fashion.

The patient was then prepped and draped in the standard fashion. Final time out was performed prior to incision. Patient's wound was irrigated and diffuse oozing from the base of the hematoma cavity. Significant hemostasis was achieved using electrocautery. Additional hemostasis was achieved with figure-of-8 stitches using 3-0 Vicryl. The wound was irrigated and found to be hemostatic. The wound cavity was fulgurated, and packed with Surgicell and Gelfoam. A Kerlix roll was then packed into the wound, and the wound was dressed with 4x4 gauze and silk tape. Patient tolerated the procedure well, with no immediate complications. She was extubated and taken to PACU in stable condition."

When would you anticipate using 76018 in addition to device peri-procedural code 93286 or 93287?

Patient comes in for an ERCP. The IR physicians are doing the S&I for the ERCP. They are assessing this patient's stricture at the anastomosis. The other providers may balloon the anastomosis and replace the stent or remove the stent if no longer needed.

• If they need to replace the stent, would the stricture at the anastomosis be considered a transplant complication - T86.49?
• If the stricture has resolved and they remove the stent, would this be Z48.23, Aftercare following liver transplant?
• If the transplant was within the global period and they insert or replace the stent, would we use K91.89, Other postprocedural complications and disorders of digestive system, or do we still use T86.49 or Z48.23?

I recently started at a new facility and came across this documentation for moderate conscious sedation: "Under my direct supervision, intravenous moderate sedation was administered during this procedure with continuous monitoring of hemodynamic parameters by trained nursing staff. Sedation time commenced at 1259 and terminated at 1317. Moderate sedation was achieved with Versed and fentanyl, and dosages were recorded in the patient's medical record." This seems close to meeting the requirement for an independent observer, but I’m unsure if it’s sufficient. Perhaps I’m being too black-and-white in my interpretation. Would you consider this enough to support coding 99152?

Per provider report- Esophageal varices arising from the portal vein/splenic vein were selected more centrally, and further coil embolization was performed with detachable coils. The more dominant esophageal varix contributing branch arose from the main portal vein, around the level of the portal end of the stent and required access with a reverse curve Contra catheter. Further access with 2.4 French microcatheter was obtained, followed by coil embolization with detachable coils. The splenic vein was again selected with a marking pigtail catheter, and splenic venogram was performed demonstrating satisfactory embolization of varices and preserved brisk flow through the patent TIPS stent to the right atrium. In this case patient has existing TIPS- is this TIPS revision? Patient also had a gastric varix from the splenic vein, so 37241 would be coded for this regardless. My documentation frequently states the varix arises from the portal vein- if placing TIPS or doing a revision in this case, would 37241/37244 in addition to 37182/37183, be coded?

"Right common femoral access was obtained using micropuncture system and sheath. Angiographic images were performed, and there was noted to be diffuse ulnar artery calcification with two areas of stenosis distal to the fistula. The fistula anastomosis looked patent and without disease. Catheter was used to advance past the area of stenosis. Distally POA was performed with balloon extending into the ulnar artery to the proximal metacarpal joint. More proximally, a 2.5 x 100 mm was used to perform POA. Completion angiogram showed adequate results. The radial artery was evaluated, and our decision was not to perform POA, as there was no significant disease, and contrast washout now preferentially occurred in the ulnar artery prior to the radial making us feel satisfied with our results. Subsequently, a perclose device was used for closure of the arteriotomy."

Do I report code 36902-LT or 37246-LT for the POA of the ulnar artery? The diagnostic angiogram is 75710-LT.

I have an external iliac artery to distal anterior tibial bypass with cryopreserved vein. I'm not finding a CPT code for this combo. How should I code?

Which embolization CPT code do you report for pre-operative embolization prior to Whipple procedure?

What codes are supported for this coiling of the left circumflex to coronary sinus fistula? RFA was accessed. A fine cross microcatheter was then advanced to the previously placed plug and a whisper wire was used to access one of the micro channels into the upper third of the AVP2. Once the microcatheter was advanced past the disc we deployed a 3 mm x 8 cm Azur CX 18 detachable coil. Repeat angiography showed significant flow through the area and we felt there were multiple micro channels contributing. We then placed a second 3 mm x 4 cm Azur CX 18 detachable coil with significant flow. A third 3 mm x 8 cm Azur CX 18 detachable coil was then deployed prolapsing into a very small obtuse marginal branch. After 3 coronary deployments there was still significant flow therefore a fourth 6 mm x 20 cm Azur CX 18 detachable coil was packed tightly into the mid left circumflex avoiding the major obtuse marginal branch. The guide cath was exchanged for a pigtail catheter which was used to perform left ventricular manometry. Thank you!

Are there any guidelines for picking which level is primary when the physician performs kyphoplasty in the thoracic region and the lumbar region? I have seen documentation that states the first performed is the initial and the other the additional code, but I am not sure if that is current advice, and there was not a reference to where this information was found.

Dearest Dr. Z and Team,

The patient was positioned supine on the procedural table. The patient's left leg was then prepped and draped in normal sterile fashion. A timeout was performed to ensure proper patient, procedure and site.

Contrast was injected through the indwelling catheter of the left lower leg lesion. Contrast was seen pooling in an irregular fashion. Ultrasound evaluation showed significant septations throughout the lesion. The catheter was then cut and a wire was advanced through the catheter. The catheter was removed over wire and a new 10.2-French by 45 cm biliary catheter was advanced over the wire and into the lesion. Approximately 50 cc of fluid was aspirated from the lesion and sent to the lab for analysis. Following this 6 mg of alteplase was mixed into 50 cc of saline and instilled into the lesion through the biliary catheter. This was left to dwell for approximately 1 hour and was aspirated at the bedside. Approximately 100 cc was aspirated at that time.

Appreciate your expertise/advice.

Kind regards,

Vj

Would you use code 47536 (replacement) or 47535 (conversion) for the following?

"A gentle hand injection of contrast via the indwelling cholecystostomy tube demonstrates the existing tube is in good position. The indwelling tube was removed over a Bentson wire and exchanged for a 7 French sheath. A safety 0.018 wire was placed into the gallbladder. Using an angled catheter and Glidewire, the cystic duct, common bile duct, and small bowel were catheterized. Cholangiogram revealed a patent cystic duct, common bile duct, with antegrade flow of contrast into the small bowel. A 12.2 French extra side hole biliary drainage catheter was placed. IMPRESSION: 1) Cholecystogram reveals a patent but narrowed cystic duct and common bile duct (no CBD stones). 2) Successful conversion of the 12 French gallbladder drainage catheter for a 10 French internal external biliary drainage catheter with extra side holes terminating in the duodenum - transcholecystic drain."

Can you please clarify if this ICA stent would be charged as 37215 vs. 61635?

"There is high grade stenosis measuring up to 95% at the origin of the left ICA. Distal protection device was advanced in the distal ICA. The balloon catheter was deployed. The Viatrac 4X20 advanced and positioned across the lesion and inflated. Over the wire Xact 8/6 X 30 stent advanced across the lesion and deployed. The stent is completely deployed in the internal carotid to common carotid artery with complete apposition against the wall. Status post angioplasty, followed by stent using distal protection device. There is significant increase in the flow noted in the internal and middle cerebral artery post procedure."

The code descriptions for 36561 and 36566 seem self explanatory. Why is the 36561 MUE= 2, if 36566 is to be coded for the placement of 2 separate cvc with subcutaneous port with separate access sites? 36566 requires a laterality modifier. Does 36566-50 mean a left and right cvc with subcu port was placed or that 2 left side and 2 right side were placed? Are 77001 and 76937 correctly coded to match the number of separate access cvc? I appreciate any incite or other suggested referances.

Our Cardio-Thoracic surgeons use Pulsavac often on surgical wounds that are not healing properly. They also usually place a wound vac. My question is for CPT 97597 since it falls under active wound care management- is it true that this CPT generally describes debridement that is limited to the surface and does not go below skin level. However, CPT 97597 (and 97598) describes debridement with high pressure waterjet.

Please advise how you think the following scenario could be coded : PROCEDURES:

1. Right neck exploration, drainage of the abscess, which was sent for

cultures.

2. Durable wound VAC placement.

3. Pulsavac with 3 liters of antibiotic irrigation total surface area 28 cm2. Local antibiotic

irrigation with Irrisept, chlorhexidine and Betadine.

4. Antibiotic bead placement for long-term antibiotic coverage in the wound.

Thank you so much.

I received the below HCPCS codes to review for possible CDM builds for the facility. I am not having much success with finding information. I did find a file on Ohio.gov that leads me to think these are only for ASC usage, not the hospital facility.

C7562- R&L HRT ANGIO W/FFR & 3D MAP

C7563- TRLUML BALLO ANGIOP ALL ART

C7564- VEIN MECH THROM W/INTRVAS US

Could you provide any information on these 3 new HCPCS codes, please?

Question about answer to question 18309 The answer was 36510. This CPT code has the word newborn in the description. The scenario didn't give an age of patient. I s there a CPT code that would cover adult. Can you recommend a CPT code for access to umbilical vein.

"The patient was placed in supine position on the angiography table and the abdomen was prepped and draped in sterile fashion.  The skin and subcutaneous tissue overlying the umbilical vein were infiltrated with 2% lidocaine for local anesthetic. Ultrasound of the abdomen was performed demonstrating patency of the umbilical vein.  Under ultrasound guidance, the umbilical vein was accessed with a micropuncture needle. Needle entering the vessel was documented and sent to PACS.  A 0.018" wire was advanced through the needle into the vein. The needle was exchanged for a 4 French transitional catheter. The inner dilator and the 0.018 wire were removed and a 0.035 Amplatz wire were advanced into the vein."

For the 3D that is performed as part of a MRCP, the definition of concurrent supervision is the physician must actively participate and monitor the reconstruction process. The physicians have created protocols for these exams that outline the design, tissue types, and achieved images. The quality of the outcome is monitored when they are reviewing the images. Does this meet the definition of concurrent supervision since the elements are outlined in a protocol?

Ordered as bilateral US breast complete. What would proper code assignment be?

"Complete real-time ultrasonography of the left breast was then performed. Dense tissue is seen throughout. There is a 4 mm simple cyst at 12:00 2 cm from the nipple. No concerning solid mass is seen in the left breast. There is a prominent left axillary lymph node measuring 9 mm in short axis. Ultrasonography of the right chest wall and axilla was performed. No concerning lesion is identified."

We have a provider wanting to submit code 92973 for mechanical thrombectomy of the distal RCA using the Penumbra Indigo engine canister and Penumbra Indigo Catheter Rx. I have read in previous responses that thrombectomy with the Penumbra device is considered aspiration thrombectomy and should not be billed separately. But, that there could be a chance this might change. Is this still considered aspiration vs mechanical? Would it make a difference if a different catheter was used (i.e. Lightning Flash)?

Angioplasty of the SFA is done to treat stenosis (37224). Follow-up imaging demonstrates acute arterial extravasation of the SFA (MD documents this as a complication-intra-procedural rupture of SFA). Next, deployment of a Viabahn stent is successful at treating the arterial extravasation. Would the stent be coded with 37236 with the angioplasty 37224? Or should this be 37226 (for the angioplasty & stent in the SFA)? Or no code at all for the stent?

Can the femoral stent placement be billed in addition to TAVR for failed Perclose to control bleeding?

"A J-wire was then advanced across the arteriotomy in the left femoral and eight 8.0 mm x 40 mm Mustang balloon was used to perform tamponade. We then reattempted Perclose of the left femoral artery which was unsuccessful. At this point we transition to covered stent placement. The right femoral artery was reaccessed using direct ultrasound guidance. A 45 cm Pinnacle destination sheath was placed into the left iliac. A crossover and glide advantage wire were used to advance past the arteriotomy. We then performed stenting using a 9.0 mm x 50 mm Viabahn covered stent. There was still leak near the bifurcation therefore we performed prolonged balloon inflations using the 8.0 mm Mustang balloon at high pressure. At the conclusion of the procedure there was no active extravasation by angiography."

We have a patient who was scheduled for an Afib ablation. She was placed under anesthesia for 40 minutes. We had an equipment failure, and no part of the procedure was done. For the hospital part, can we just bill for anesthesia, or would the planned procedure with a -74 modifier be billed?

Provider is submitting 35102 and 37617. I have recommended they do not bill for the ligation, as this would seem inherent to the bypass graft creation. Provider is insistent that the ligation be billed for. There are no NCCI edits showing these two codes cannot be billed together. My employer and I are having a difficult time showing the provider any evidence that this cannot be billed aside from NCCI manual chapter ! statement and also trying to convey the rationale the 35102 descriptor specifically states involvement of the iliac vessels and thus the ligation cannot be billed. I think the physician's rationale is that they normally dont have to ligate but because they felt it was necessary in order to prevent any progression of the already present occlusive and aneurysmal disease in the iliacs that this circumstance warrants the separate billing for 37617. Please advise.

If the provider is performing a PCI CTO in the PDA, then inserts a drug-eluting stent in D2 and ballon angioplasty in OM1, are we required to use the add-on codes for the drug-eluting stent and angioplasty even though they are in a separate major artery?

How is the following reported?

"Patient was brought to the OR and was properly positioned in the supine position. A time out was performed. Patient was placed under general anesthesia and an ET tube was placed. She was prepped and draped in the usual sterile fashion.

An elliptical incision was made over the exposed fistula and stent. After dissecting off the fistula from the surrounding tissue, proximal and distal control of fistula with exposed stent was obtained with vascular clamps. The exposed stent was sharply cut and removed. Both ends of the fistula was over sewn with 3-0 prolene in running fashion. The wound bed was hemostatic, and the wound was irrigated with normal saline. The wound was closed in layers with 3-0 vicryl and staples. Sterile dressing was applied.

The patient was redraped for dialysis catheter placement. The right internal jugular vein was accessed under ultrasound guidance. The temporary dialysis catheter was placed using standard Seldinger technique. All ports flushed easily with saline flushes. Sterile dressing was applied."

While our physicians are performing the 3D postprocessing as seen on saved images, the documentation does not always state, “maximum intensity projection (MIP)", "curved planar reconstruction", "complex image reconstruction post-processing", "3D postprocessing", or other similar terms. Would the below technique be adequate documentation for capturing the elements required for code 70498 including post processing, or is additional documentation needed?

"CTA CAROTID. TECHNIQUE: Multiple axial images were obtained through the neck utilizing a CT angiography protocol. Coronal, sagittal and bilateral sagittal oblique reformatted images were also generated and reviewed.

FINDINGS: Beam-hardening artifact in the right subclavian vein, SVC and adjacent veins limits evaluation of the right lower neck. There is a left-sided three-vessel aortic arch. . . .

IMPRESSION: 1. Likely calcific and non-calcific atherosclerotic disease at the left carotid bulb with 0% stenosis by NASCET criteria."

Does code 37215 (TCAR) still require an NCT number?

There is a debate on when a transseptal puncture can be added with an ablation (not including 93656). Should a provider mention that a LHC was done with the puncture?

In a previous answered question, you stated -Normally they do record pressures everywhere they go; however, I would still report code 93462 when the MD performs a transseptal access for LA or LV ablation procedures. His proof that he did the access into the LA is shown when he ablates in the LA, and he did state he did this approach with ICE guidance.

Here is an example of the documentation-

"Using an intracardiac echo catheter (ICE) guidance and fluoroscopy, a transseptal puncture was made with SL1 sheath and Bayless needle brought down to the interatrial septum from the SVC. Left atrial placement was confirmed by ICE and fluoroscopy."

An Ask Dr. Z. response from 2019 (question ID: 12723) stated, "Per the AMA and ACC, CTA of the coronaries is not equivalent to catheter-based angiography. A diagnostic catheter-based angiography should be performed to confirm a lesion on CTA." Is this still true, and if so, are you able to tell us exactly where the AMA and ACC have made these statements? We were recently told by an auditor that a coronary CTA is a diagnostic exam that for coding purposes should be regarded the same as any other CTA (e.g., lower extremity). The auditor cited the NCCI manual on this matter. We see very many cases for which a patient has had a prior abnormal coronary CTA and undergoes a complete catheter-based angiogram in the Cath Lab right before an intervention is performed. We are trying to understand the current coding guidelines for these scenarios so that we can code accurately and consistently. We are having trouble finding literature on this issue.

I listened to the free webinar and asked a question, but it did not get answered. The new T-code 0913T (DEB with angioplasty) is now going to be charged for coronary arteries. Can it be used along with DES charge in the same vessel where there are two different lesions? Also, can you use this charge peripherally? We have some interventionalists using drug-eluting balloons in the iliacs.