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

What code would you bill for revision of Barostim generator pocket with subpectoral placement? Patient has lost weight, and the generator has become more prominent. 

If the physician treats a proximal CFA bypass anastomosis with atherectomy 90-99% and also documents atherectomy treatment in the native CFA of 60-65%, can we report codes 37271 and 37272 for the native CFA?

Have the rules around coding CNS procedures, specifically 61624, changed for 2026? Or should we still code both procedures when done in separate hemispheres?

When is endarterectomy separately reportable in the setting of an artery repair (direct and/or EVAR)? Are there any guidelines/resources I can provide to my provider regarding this? 

With the middle meningeal artery on opposite sides of the head, are these two separate surgical areas? Are codes 61624 and 61624-59 appropriate? We recently had the same procedure done bilateral for acute subarachnoid bleed.

Regarding the facility coding, would we submit the comprehensive CPT code, 55882?

What are the correct CPT codes for this situation?

Would you report both codes 78195 and 78803 or just the 78195?

How would you code for a bilateral shoulder arthrogram if the needle placement is done under CT guidance, then taken to MRI for imaging?

My provider has asked if there are specialized CPT codes specific to the techniques called dynamic myelogram or digital subtraction myelogram? If not, can we use modifier -22 because these are more complex? My understanding is there is not but billed the same as routine.

Is this 2 units for 93657 and 2 units of 93655? Or is this just 93656?

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?