Author Archives: David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

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

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.
Q & A with Dr. Z: Catheter-Based Angiogram After a Prior Catheter-Based Angiogram, CTA or MRA

Q & A with Dr. Z: Catheter-Based Angiogram After a Prior Catheter-Based Angiogram, CTA or MRA

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: I read where even though no catheter used CT and MR angiograms are considered catheter based. If a patient has a CT angiogram at 800 and it shows Active contrast extravasation in the pyelocalyceal system in the midpole of the LEFT kidney. Later that […]

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Q & A with Dr. Z: Atrial Flut­ter

Q & A with Dr. Z: Atrial Flut­ter

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Patient has AF and atrial flut­ter. After completion of success­ful PVI, the physician performs a typical atrial flutter ablation. Three-dimensional mapping and conventional catheter mapping were performed using this abla­tion catheter and the left atrial coronary sinus decapolar cath­eter. Multiple radiofrequency lesions were administered, […]

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Q & A with Dr. Z: Vein Mapping with Additional Duplex Scan

Q & A with Dr. Z: Vein Mapping with Additional Duplex Scan

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: When performing a duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access (93985/93986), if you were to perform a duplex scan on the entire radial and ulnar artery as well as the palmar arch, would […]

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Q & A with Dr. Z: Stab Phlebectomy Abdomen

Q & A with Dr. Z: Stab Phlebectomy Abdomen

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: “11 Stab phlebectomies were performed over varicose veins of her abdomen,” Since 37765-37766 are for extremities, would this be unlisted? 37799? Answer: There is no code for treatment of varicose veins by stab phlebectomy anywhere but the lower extremities. We agree with recommendation to […]

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Q & A with Dr. Z: Embolization of Middle Meningeal Artery

Q & A with Dr. Z: Embolization of Middle Meningeal Artery

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: What is the correct code to bill for the embolization of middle meningeal artery (MMA)? Is it CPT code 61624 or 61626 since the MMA is part of the external carotid artery (ECA)? For this procedure, selective catheter placements and angiograms were done on […]

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Q & A with Dr. Z: Facility Coding for Coronary IVL (Shockwave)

Q & A with Dr. Z: Facility Coding for Coronary IVL (Shockwave)

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: How would you recommend the facility coding for coronary intravascular lithotripsy (Shockwave) with a drug-eluting stent? We would bill C9600 for the stent, but how can we capture the intravascular lithotripsy (IL)? We are being told to add modifier 22 to C9600, but I […]

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Q & A with Dr. Z: Subclavian Artery Angiogram/Intervention

Q & A with Dr. Z: Subclavian Artery Angiogram/Intervention

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Access site left CFA. Catheter was advanced over the wire to the ostium of the left subclavian, selective angiogram was performed. This demonstrated a subtotally occluded left subclavian artery. Using digital subtraction angiography, the distal vessel did fill suggesting some hibernating arterial supply for […]

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Q & A with Dr. Z: 47383 VS 0600T CT Guided Percutaneous Liver Ablation

Q & A with Dr. Z: 47383 VS 0600T CT Guided Percutaneous Liver Ablation

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: The patient was placed on the CT scanner in the supine position. Initial CT images of the upper abdomen were obtained. Automated exposure control was utilized. The skin overlying the liver was prepped and draped in the standard sterile fashion. Under CT guidance 3 […]

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Q & A with Dr. Z: VSD Closure

Q & A with Dr. Z: VSD Closure

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Which CPT code would best describe a VSD closure that is not for a congenital VSD, but post MI? Answer: We recommend reporting unlisted code 93799 for ventricular septal defect (VSD) closure of a NON-congenital (post-infarct) VSD.   November 30-December 4: ZHealth IR/CV Medical […]

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Q & A with Dr. Z: Liver Segment and Subsegmental Coding

Q & A with Dr. Z: Liver Segment and Subsegmental Coding

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Report: Vessel catheterized: Segment 2 hepatic artery Gives rise to a subsegmental vessel that is the minor supply to large tumor spanning segments 2 and 3. Vessel catheterized: Subsegmental branch of the segment 2 hepatic artery would the codes be 36247 and 36248? Answer: […]

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Q & A with Dr. Z: Lower Extremity Angiogram Codes

Q & A with Dr. Z: Lower Extremity Angiogram Codes

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Angiogram (DSA) of the entire left lower extremity and iliac arteries using a 4-French x 45 cm long Rim catheter advanced from the right common femoral artery up and over and down into the left SFA. Selective angiogram of the left Posterior Tibialis, peroneal, […]

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Medicare Administrative Contractor Posts Guideline on Billing for Intrathecal Injection of Spinraza

National Government Services (NGS), the Medicare Administrative Contractor for Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin, just posted guidelines for billing for the intrathecal injection of Spinraza. NGS requires CPT code 96450 for the injection procedure and HCPCS code J2326 for the nusinersen. HCPCS code J2326 is reported […]

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Q & A with Dr. Z: 93656 Ablation Procedure

Q & A with Dr. Z: 93656 Ablation Procedure

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: How would you code the following ablation procedure? 1. Pulmonary vein antral ablation was performed to isolate PV antral regions with bilateral PV isolation (PVI) confirmed on HDX mapping electrogram. 2. Additional linear ablation was performed at the left atrial (LA) roof to achieve […]

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Q & A with Dr. Z: Cerebral Aneurysm Embolization with Vasospasm

Q & A with Dr. Z: Cerebral Aneurysm Embolization with Vasospasm

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Patient is status post pipeline embolization. Patient clinically, CTA (CT Angiography) and TCD’s (Transcranial Doppler) are consistent with vasospasm. Right vertebral angiogram showed vasospasm. Vasospasm was treated with 10mg of intra-arterial verapamil over a 10 minute infusion. Left internal carotid angiogram showed vasospasm and […]

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Q & A with Dr. Z: Sclerotherapy without Imaging Guidance, Diagnostic Study, Contrast

Q & A with Dr. Z: Sclerotherapy without Imaging Guidance, Diagnostic Study, Contrast

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Can we use CPT code 49185 if imaging guidance wasn’t performed and contrast wasn’t administered? Can we also use CPT code 49185 when sclerosants aren’t used? Per documentation, provider Injected 30 mL of desiccated ethanol into the abdominal wall seroma via previously placed drain. […]

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Q & A with Dr. Z: Clarification of Lower Extremity Angiogram followed by Intervention

Q & A with Dr. Z: Clarification of Lower Extremity Angiogram followed by Intervention

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC If a diagnostic abdominal angiogram and bilateral runoff is performed (2 cath positions) (36200, 75716) and then the physician decides to do an intervention in the contralateral leg, do we need to drop CPT code 36200 (catheter placement for the diagnostic exam) or do we […]

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