CONTACT
STUDENT LOGIN

dzielske

Home/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.
7 09, 2022

Q & A with Dr. Z: Coronary IVL – 0715T

By |2022-09-07T14:06:18-04:00September 7th, 2022|Coders' Corner|0 Comments

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Can code 0715T for coronary IVL (Shockwave) be reported with C9600-C9608 for coronary interventions performed with the use of drug-eluting stents? Or is its use limited to 92920, 92924, 92928, 92933, 92937, 92941, 92943, and 92975? Answer: For now, we are reporting with non-DES and DES. Due to one set of codes being from the CPT Codebook and the other set being HCPCS II, there certainly may be add-on code edits that kick out 0715T with DES (until that is addressed by CMS and AMA). Complete Interventional Radiology

15 08, 2022

Q & A with Dr. Z: Iliac Artery Aneurysm

By |2022-08-15T19:57:24-04:00August 15th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: Iliac Artery Aneurysm

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: If an aorto-bi-iliac graft is used for an iliac artery aneurysm only, would you report code 34707 or 34705? Answer: Initially code to the pathology (aneurysm), then to the device (ABI endograft). Codes 34705 and 34707 are used to report endovascular endografts for treatment of aneurysm, pseudoaneurysm, traumatic disruption, etc. (not stenosis). We would report 34705 here. If an ABI endograft was placed for stenosis, code to the stenosis first (37236, 37237), not the device.   Complete Interventional Radiology and Cardiovascular Coding Detailed information on a broad range

13 07, 2022

Q & A with Dr. Z: Correct Coding of Complex Atrial Fibrillation Ablation

By |2022-07-13T16:53:53-04:00July 13th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: Correct Coding of Complex Atrial Fibrillation Ablation

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Radiofrequency ablation for atrial fibrillation (pulmonary vein isolation), additional radiofrequency ablation for atrial fibrillation (roof line), additional radiofrequency ablation for atrial fibrillation (posterior line with isolation of posterior wall), additional radiofrequency ablation for supraventricular tachycardia (mitral annular line), additional radiofrequency ablation for supraventricular tachycardia (cavotricuspid isthmus line), additional radiofrequency ablation for atrial fibrillation (CFAE lesions along coronary sinus). Would the correct coding of this procedure be 93656, 93657 x 2 (box-roof line and posterior wall then CAFE lesion) and 93655 x 2 (mitral annular line and cavotricuspid)? Does it

8 06, 2022

Q & A with Dr. Z: Collateral Angiography

By |2022-06-08T22:40:07-04:00June 8th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: Collateral Angiography

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Will you please advise on coding for the following case: No heart cath done, only angiography. Angiography: Descending aorta: pigtail catheter placed in the proximal DAO shows the aorta to the level of the transverse arch and both the left and aberrant right subclavians are visualized. This shows the level of the two anterior DAO collaterals for selective angiography. There is a suggestion of additional subclavian or IMA collaterals, but this is not well seen. Collateral #1: No injection only findings documented Collateral #2: Selective injection with findings Collateral

11 05, 2022

Q & A with Dr. Z: Embolization of Access Site

By |2022-05-11T20:05:36-04:00May 11th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: Embolization of Access Site

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: "After cardiac ablation procedure had been completed, attention was then turned access closure. Given large size of the transhepatic sheath required for ablation, with direct communication with the systemic vasculature, access site embolization was necessary to prevent hemorrhage on sheath withdrawal. Then after diagnostic venogram of the right hepatic vein performed. Venogram demonstrates brisk central outflow from the right hepatic vein to the IVC, with the site of venous access identified as mild luminal irregularity at the sheath tip encountered on slow sheath withdrawal. Embolization of the venous access

11 04, 2022

Q & A with Dr. Z: CT Cystography

By |2022-04-11T21:00:07-04:00April 11th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: CT Cystography

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: What would be the appropriate CPT codes for CT cystography performed for bladder evaluation? The codes I came up with are 51600 and 74430. Answer: If the contrast was administered intravascularly, this would meet the criteria of a with-contrast exam, and possible codes would be 72193 or 72194. If the contrast was administered via a catheter placed into the bladder, this would be defined by codes 51600 and 72192. Remember, when a code description contains the verbiage "with contrast", contrast material must be administered: intravascularly (situated in, occurring in,

4 03, 2022

Q & A with Dr. Z: Billing for ERCP Imaging in OR

By |2022-03-04T23:24:39-05:00March 4th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: Billing for ERCP Imaging in OR

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Our techs in Radiology take C-arm fluoro imaging in operating room to assist surgeon, then the radiologist dictates findings. Can Radiology charge one of these codes for the ERCP images (74330, 74328, 74329)? Also along those lines, could we charge for cholangiogram, uretherogram, etc. for images taken in the operating room then dictated by radiologist? Answer: From a facility (i.e., hospital) billing perspective, as an institution, the facility may code/bill for services rendered. Billing of OR services can be tricky, as there are other surgical procedures (and CPT codes)

4 02, 2022

Q & A with Dr. Z: Aborted Upgrade of Dual PPM to Bi-V ICD

By |2022-02-07T11:19:37-05:00February 4th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: Aborted Upgrade of Dual PPM to Bi-V ICD

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: "Patient brought to ASC cath lab, prepped, draped and local anesthesia was administered. The left axillary vein was cannulated using fluoroscopic landmarks. 2 guidewires were inserted through the needle to establish IV access. A micropuncture needle was used & the micro sheath was advanced into the vessel and used for electrode placement. The left infraclavicular pocket was opened with an incision over the previous one. The pocket appeared normal. Patient developed progressive SOB after being placed on the table for the procedure with 02 saturation dropping to low 90's

13 01, 2022

Q & A with Dr. Z: Arch, Upper Extremity, or AVF?

By |2022-02-03T17:51:02-05:00January 13th, 2022|Coders' Corner|Comments Off on Q & A with Dr. Z: Arch, Upper Extremity, or AVF?

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: How would you code this case? 36221, 36902, 0237T? Pre/post op diagnosis: left AV fistula inflow stenosis. Description: The right common femoral artery was accessed using a micropuncture needle. This was exchanged for 5 French sheath using Seldinger technique. A pigtail catheter was advanced into the ascending aorta and arch angiogram was performed. Please see above findings for details. Next the left subclavian artery was selectively catheterized and a left upper extremity angiogram and left upper extremity fistulogram was performed. 5 French short sheath was exchanged for 5 French

7 12, 2021

Q & A with Dr. Z: TEE with Color Flow

By |2021-12-09T20:52:09-05:00December 7th, 2021|Coders' Corner|Comments Off on Q & A with Dr. Z: TEE with Color Flow

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: The cardiologist performed a TEE, and his documentation states that he performed color flow, but there's no mention of spectral Doppler. Would you bill 93312-26 and 93325-26, or would you include 93321-26 for the documentation of the regurgitation and wall motion? Study details state: "A complete echo was performed using complete 2D and color flow Doppler. During the study the esophageal view was captured. The probe was inserted by the cardiologist. There was no probe insertion difficulty. Anesthesia performed sedation. Irregularly irregular rhythm was present during the study. The

25 11, 2021

CODING UPDATE from ZHealth: Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination Removed

By |2021-11-26T18:38:57-05:00November 25th, 2021|Coders' Corner|Comments Off on CODING UPDATE from ZHealth: Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination Removed

The following decision was released by CMS effective October 28, 2021. The main focus of this document and decision was that there will no longer be a National Coverage Determination (NCD) for this procedure and instead, coverage or non-coverage will be made at the local level by the Medicare Administrative Contractor (MAC). Additionally, based on this change, when reporting code 37184 for pulmonary thrombectomy, modifier GZ will no longer be needed. The document in its entirety can be found at: NCA - Transvenous (Catheter) Pulmonary Embolectomy (CAG-00457R) - Decision Memo (cms.gov) As this NCD is effective October 28, 2021, ZHealth

16 11, 2021

Q & A with Dr. Z: Incision and Debridement of the Infected Port Pocket

By |2021-11-16T22:52:20-05:00November 16th, 2021|Coders' Corner|Comments Off on Q & A with Dr. Z: Incision and Debridement of the Infected Port Pocket

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Which code would you use for incision and debridement of the infected port pocket? "The port pocket incision and neck dermatotomy site were reopened. Using manual pressure, purulent contents were expressed from the incisions. The pocket was copiously irrigated and anterior antegrade and retrograde fashion using normal saline. The port pocket was debrided. The incisions were packed and were then left open and packed with iodoform gauze." If unlisted, which unlisted code would you suggest and what will be the comparable code for it? Answer: Report the appropriate debridement

1 10, 2021

Q & A with Dr. Z: Arch Study (36221) Medical Necessity

By |2021-10-01T20:54:00-04:00October 1st, 2021|Coders' Corner|Comments Off on Q & A with Dr. Z: Arch Study (36221) Medical Necessity

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Hoping you can help us resolve a dispute over medical necessity for use of arch study code 36221. Because the code describes diagnostic imaging, I assume that we need documentation of indications and findings to use it. Without an indication, I assume it is just a guiding shot to find the orifice of the subclavian or innominate for angiography of the arm. Cath lab staff wants to apply this code without indications (i.e., trauma to the arm only). Is a history of PVD enough? What if there is no

13 09, 2021

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

By |2021-09-13T20:08:43-04:00September 13th, 2021|Coders' Corner|Comments Off on 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 day the patient is taken to IVU and has a left renal angiogram, segmental left renal angiogram and embolization. The doctor notes in his dictation the left renal hemorrhage noted on CT angiogram. In this case I don't believe the angiogram done by IVU would

17 08, 2021

Q & A with Dr. Z: Atrial Flut­ter

By |2021-08-17T15:13:16-04:00August 17th, 2021|Coders' Corner|Comments Off on 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, re­sulting in gradual slowing of the atrial flutter with eventual termi­nation. The ablation catheter was then placed in the lower lateral right atrial wall, and pacing was performed from the coronary si­nus catheter from coronary sinus. Conduction times across the ca­val tricuspid isthmus were noted

8 07, 2021

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

By |2021-08-14T22:33:06-04:00July 8th, 2021|Coders' Corner|Comments Off on 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 you be able to bill for the additional studies (e.g. 93930/93931)? I know code 93930 is a column 2 code for 93985, but you may use a CCI-associated modifier to override the edit under appropriate circumstances, so just wanted to check whether the use of

4 06, 2021

Q & A with Dr. Z: Stab Phlebectomy Abdomen

By |2021-06-04T13:37:26-04:00June 4th, 2021|Coders' Corner|Comments Off on 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 report unlisted code 37799 for this treatment.   Complete IR and Cardiovascular Coding Detailed information on a broad range of IR and Cardiovascular procedures and the guidelines for proper coding. Includes 25 individual self-study medical coding elearning modules. Each module is CIRCC certified! Learn more

3 05, 2021

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

By |2021-05-03T23:39:30-04:00May 3rd, 2021|Coders' Corner|Comments Off on 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 the bilateral common carotid arteries (intracranial), bilateral ECAs and bilateral MMAs, along with the embolization. I am coding 36222-50, 36227-50, 75894, and 75898, just unsure whether to assign the 61626 or the 61624. Our coder says it should be 61624 but the provider thinks it

30 03, 2021

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

By |2021-03-30T17:35:09-04:00March 30th, 2021|Coders' Corner|Comments Off on 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 thought this modifier was for professional use only. Answer: There is no code for IVL in the coronary arteries at this time. The procedure was just FDA approved and, hopefully, they are working on new codes for us. We are not recommending any change in

4 03, 2021

Q & A with Dr. Z: Vascular Access ICD-10

By |2021-03-04T17:24:28-05:00March 4th, 2021|Coders' Corner|Comments Off on Q & A with Dr. Z: Vascular Access ICD-10

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Would Z45.2 - Encounter for adjustment and management of vascular access device be an appropriate ICD-10 code for the placement of central line - 36556 or arterial line - 36620? One source says that these are appropriate while another one does not define this diagnosis as including placement. Answer: Note code Z45.2 Encounter for adjustment and management of vascular access device is an after care code. Based on the Official Guidelines for Coding and Reporting, Section I.C.21.c.7, report the acute condition requiring the initiation of a vascular access, rather

Go to Top