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

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 the catheter placement is separately billable - 32617 for the artery being embolized, so in this case 61624, 36217, 75894, 75898. Is that correct or is the catheter placement inclusive? Answer: You are correct. Catheter placements (36217, 36218) are separately reportable with a CNS embolization

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, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)]. The second way is to bill with CPT code 96450 [Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture]. I understand 96450 includes the lumbar puncture (LP), but

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 and 37242-59 or only report 37242 once? We report 93564 for angiography for IMAs, is that correct? Also, should we report the catheter replacements for embolization codes 37242 and 37242-59 (36216 and 36217)? Answer: When performing a congenital heart catheterization, do not report graft angiography,

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 don't mention spinal process in the findings, would this be coded 75705 or 75726? (There is evidence of active extravasation from a lateral branch off the right L3/L4 lumbar artery-dx right flank hematoma). Answer: Yes. If the arteriography is to look at spinal cord, CPT

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 Yueh. Fluid amount/Color: 1.4 L total fluid; 300 mL yellow fluid from the right lower abdominal quadrant and 1.1 L yellow fluid from the left lower abdominal quadrant. Complications: None. Laboratory: None. Successful ultrasound guided percutaneous therapeutic aspiration of recurrent symptomatic ovarian cyst. Answer: Code

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: WavelinQ System We have implanted a WavelinQ device but are not sure how to code this procedure. There is a supply C-code available, but we don’t know which CPT code to use. Answer: The WavelinQ is fairly new technology for creating an AV dialysis fistula. It requires separate percutaneous venous and arterial access and uses two catheters with a built in magnet to position the catheters. RF energy is then used to create the fistula. The C-code you refer to as a supply code is probably the procedure code.

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 by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Embolization 37244 vs 37242How should the following be coded, since there is no active bleeding seen on the current angiogram? Technically successful selective superior mesenteric, celiac and superselective GDA angiography with demonstration of hyperemic flow

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. by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Acute MI I’m coding for hospital cath lab services. We had a patient transferred to us on 7/5 with elevated troponin and had initial chest pain at outlying hospital, chest pain had subsided, but 2

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. by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question:  Provider performed laser atherectomy of the subclavian artery. CPT code 35475, which would describe this procedure, has been deleted. The claim has been denied and we’re trying to appeal with a comparable code for the