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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 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, as there are no coronary artery grafts. Instead, report an extremity angiography when looking for AP collaterals off the subclavian arteries. Do not report additional selective imaging (75774) for imaging of the collaterals at the time of embolization, as the determination to embolize is based on the bilateral extremity angiography – 75716 (usually). Do report catheter placements into the AP collaterals based on their locations. Report embolization codes once per surgical site. So, if the RIMA and LIMA collaterals are supplying the right and left lung respectively, report 37242 twice. The mediastinum and one lung are considered one site, and this includes both arterial and venous embolization of that site, if done.

 

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About the Author

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.

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