David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

For an embolization, if the indication is for gastrointestinal hemorrhage, and when performing the arteriogram, no active extravasation is found but an embolization is still performed, would this be coded as 37244 or 37242?

Would the statement "recurrence of conduction from prior ablation" documented after PVI was completed be considered Afib after PVI (93657)? What would recurrence of conduction mean?

Patient came for follow-up after a right upper extremity arteriovenous graft placement. She has developed steal syndrome, recommended to proceed with banding of the graft in order to alleviate the steal syndrome. Should we report code 37607 or 36832 for reducing the size of graft and banding of graft?

Which procedure is primary when both PVC ablation and PVI isolation are performed at the same session? 93654 and 93655 OR 93656 and 93655?

For the following, would it be appropriate to report code 93641 (DFT), or would there need to be additional documentation?

How would I code for the removal of a Substernal (extravascular, or "EV") ICD with insertion of a biventricular ICD at the same operative session?

I have read a few responses from prior Dr. Z questions regarding what documentation is needed to support IVUS CPT 97928. I'm having a little trouble deciphering if this documentation supports that CPT code.

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?

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?

Can you advise as to what the correct CPT charging would be for 4D CT angiography?

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

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?

What if the marker is placed in the lumpectomy cavity, not in a different location on the same breast? Would it still be appropriate to code both procedures? There is a CCI edit and modifier is allowed, but I am thinking that that is if the lumpectomy and marker placement was done in different locations on the same breast.

"We are trying to figure out what code we would use for repositioning of lumbar drain with fluoroscopic guidance. The drain was manipulated and slightly withdrawn from the spinal canal. Location confirmed by fluoroscopy. What would you recommend coding?"

Is catheter placement reported with shockwave lithotripsy in the lower extremities? For example, would 36247 be reported with C9674?

Can we code 36247 with 78202 and 78830 without 75726? Or should this be 75726, 36247, 78830, and 78202?

Please review our coding. A group of us have put our heads together and after research we came up with code 33863 for the following op note:

In the update released this December (2023), which provides guidance on what may or may not be done in 2024, the following instruction was released pertaining to CPT code 76937. This information is verbatim from the CCI Manual. This is found in Chapter 9 and is part of the section labeled “General Policy Statements”:

Would I use CPT 42400, 76942, and 10160? Ultrasound of the left parotid region was performed. The cyst was identified and multiple images were stored. The skin was prepped using ...

Can you please advise if the portion that our cardiologist performs would be considered complex? I know that we cannot bill for the stent, and I am not sure we can bill with the -22 modifier.