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

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 The drain was manipulated and slightly withdrawn from the spinal canal.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.

For the above tests, the supervising provider listed in the report is the PA. The interpretation is done by the physician. The codes billed are 78452 MC, 26 and 93018. If the physician is only billing for the interpretation of the stress test, do we add ...

Real-time visualization of the common femoral artery and vein were identified as the artery was accessed. At this time the Neurosurgery team expose the T10 screw and transected the upper segment of the rod and prepared the screw for removal.

We are coding for a professional client and came across a CTA report that clearly states the 3D reconstruction was NOT supervised by the radiologist. Can you please clarify whether supervision of the 3D reconstruction is a required element of CPT 71275? Sample section of the report below. Thank you so much!

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Patient sent to our facility for pelvis and transvaginal ultrasound. Our standard protocol is to do the ultrasound with color Doppler and obtain spectral waveform ovarian arterial and venous flow. Is 93976 appropriate in addition to the ultrasounds? We did not have a provider order but it is our standard. Indication menorrhagia Technique Routine pelvic ultrasound protocol. Transabdominal evaluation of general pelvic anatomy and uterine size. Transvaginal evaluation of the endometrium, myometrial detail and evalulation of ovaries and adnexa with doppler FINDINGS: bladder is not adequately

POST CORRECTED 6/23/2023 by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: When using the code C7516 with a Coronary Angiogram and Intravascular Ultrasound (IVUS) of say the left anterior descending artery, if you also did an IVUS of the Circumflex at the same time of the procedure, would you use 93454, C7516LD, 92979LC? Answer: No, I would use C7516 and 92979 in the Ambulatory Surgery Center (ASC) setting. You may find that the additional IVUS is not paid, however the entire case will be paid higher than 93454, 92978 and 92979 in the ASC

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Patient had emergency bypass due to multiple dog bite wounds. Two bypass procedures were required, radial-radial & ulnar-ulnar. Would we code 35523 X’s 2 or 37799 & compare to 35525? Cut down onto the radial artery. Radial artery was dissected free from structures proximally. There was obvious injury to the radial artery. Complete disruption was a through and through puncture injury on the radial artery at the antecubital fossa. No brachial artery at the antecubital fossa. Total bypass length 4 and half centimeters onto. It was a functional

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: A provider performed angioplasty of the tibioperoneal trunk. Pre-treatment stenosis was 100%, post-treatment stenosis is documented as 50%, and it is documented as follows in the report: "We balloon dilated the right tibioperoneal trunk to 6 Atm for 2 min with a 2.5 mm by 100 mm Coyote balloon from Boston Scientific. Pre-treatment stenosis was 100%. Post-treatment stenosis was 50%. The distal most peroneal artery could not be traversed but there appeared to be improvement of flow into collaterals." The payer is denying payment with these remarks: "Per

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: This pertains to the new pulmonary artery angiogram 93569 and 93573 codes during congenital cardiac catherization. If the main pulmonary artery is selected with bilateral pulmonary angiograms, is this a "selected" 93573 or does the selection need to be of the left and right pulmonary arteries? Answer: The selection has to be in both the right and left pulmonary arteries to report CPT 93573. If done non-selectively from the IVC/SVC, RA, RV or main PA, report 93568. Updated for 2023! IR/CV Courses and Webinars From ZHealth Publishing, the

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: How should the Alterra prestent with transcatheter pulmonary valve replacement/implant be coded? Would CPT code 33477 be all inclusive, or should this be reported with two different CPT codes? Answer: The Alterra acts as a stent and anchoring site for the deployment of the Sapien valve. Any valvuloplasty, angioplasty, or stent placement in the valve deployment zone is bundled with 33477. Do not report any additional CPT code for the pre-deployment of this stent in the PA valve deployment zone. Updated for 2023! Complete Interventional Radiology and Cardiovascular