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: 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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Q & A with Dr. Z: Radiofrequency Ablation Sacral Ala & Lateral Branches

Q & A with Dr. Z: Radiofrequency Ablation Sacral Ala & Lateral Branches

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC For the following dictation, what can be coded? “Procedure: Fluoroscopy guided radiofrequency ablation at right sacral ala and lateral branches at S1, S2, and S3 (12 sites). Detail: Following informed consent, and with the patient under general anesthesia, she was prepped and draped in usual […]

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Q & A with Dr. Z: Coding for 93623

Q & A with Dr. Z: Coding for 93623

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Coding for 93623 Is the documentation below sufficient to code 93623? Would you please explain why or why not? “Bi-directional block was demonstrated in and out of all 4 pulmonary veins post ablation. Adenosine was administered in 9 mg boluses to check for dormant […]

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Q & A with Dr. Z: 61624 – CNS Embolization Right Internal Carotid Artery

Q & A with Dr. Z: 61624 – CNS Embolization Right Internal Carotid Artery

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: 61624 – CNS Embolization Right Internal Carotid Artery I’m looking for clarification on the catheter placement for the above procedure. I understand a true diagnostic angio is separately billable, but somewhere along the line, I thought that when there is no diagnostic angio that […]

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Q & A with Dr. Z: Spinraza Injection

Q & A with Dr. Z: Spinraza Injection

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: SPINRAZA INJECTION I am seeing two opinions on how to bill this. The first way is to bill with CPT code 62323 [Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, […]

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Q & A with Dr. Z: Heart Cath with IMA Coil Embolization

Q & A with Dr. Z: Heart Cath with IMA Coil Embolization

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Heart Cath with IMA Coil Embolization Please see following medical record: Right and left congenital heart catheterization; angiography of the SVC; imaging of the left PA, RIMA and LIMA; followed by coil embolization of both the RIMA and the LIMA. Can we report 37242 […]

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Q & A with Dr. Z – Lumbar Artery Arteriography

Q & A with Dr. Z – Lumbar Artery Arteriography

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Lumbar Artery Arteriography Is arteriography for the lumbar arteries subjective to the reason for the exam? We sometimes see the doctors select L1-L4 and branches off the lumbar arteries to look for bleeds. If the dx is Flank hematoma from a fall and they […]

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Q & A with Dr. Z – Percutaneous Aspiration Ovarian Cyst

Q & A with Dr. Z – Percutaneous Aspiration Ovarian Cyst

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Percutaneous Aspiration Ovarian Cyst Is CPT code 58805 or 10160 most appropriate for the following? TECHNIQUE: Percutaneous ultrasound-guided aspiration through 5 French Yueh catheter. Sterile; 1% lidocaine for local anesthesia. Location: Left lower abdominal quadrant and right lower abdominal quadrant. Needle size: 5 French […]

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Q & A with Dr. Z – Lower Extremity AV Fistula Peripheral Segments

Q & A with Dr. Z – Lower Extremity AV Fistula Peripheral Segments

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Lower Extremity AV Fistula Peripheral Segments For lower extremity AV fistula peripheral segments – what is the adjacent segment of native artery, peri-anastomotic region/arterial anastomosis? Does this mean only the common femoral artery or also the iliac arteries? Please clarify. Answer: The iliac veins […]

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Q & A with Dr. Z – Embolization 37244 vs 37242

Q & A with Dr. Z – Embolization 37244 vs 37242

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries […]

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Q & A with Dr. Z – Nephrostomy Tract Dilation with NU Cath Placement Earlier Same Day

Q & A with Dr. Z – Nephrostomy Tract Dilation with NU Cath Placement Earlier Same Day

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries. […]

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Q&A with Dr. Z – Sclerotherapy

Q&A with Dr. Z – Sclerotherapy

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries. […]

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His Bundle Lead Upgrade

His Bundle Lead Upgrade

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries. […]

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CMS has Revised NCD 20.4 – Guidance for Implementation Period

CMS has Revised NCD 20.4 – Guidance for Implementation Period

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries. […]

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CMS Has Revised NCD 20.4 – Implantable Cardiac Defibrillators (ICDs)

CMS Has Revised NCD 20.4 – Implantable Cardiac Defibrillators (ICDs)

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries. […]

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HCPCS 2019: C9754 & C9755

HCPCS 2019: C9754 & C9755

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries. […]

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MUE Updates

MUE Updates

Libman Education is proud to offer ZHealth Publishing’s broad range of coding products to assist both the novice and the seasoned coder to become experts at coding and charging for complex procedures in Interventional Radiology, Interventional Cardiology, Vascular/Endovascular Surgery, and Diagnostic Radiology. Periodically, ZHealth Publishing experts offer general recommendations in response to specific customer inquiries. […]

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