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    Vent anterolateral wall aneurysm plication

    I need some help coding this part of the procedure! During the same encounter as a CABG... "At this time, the anterolateral wall was examined. It was noted to have a very significant weakness and thinned out wall, therefore plication was done with 2-0 prolene with pledgeted sutures. A base...
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    Saphenous Vein for CABG

    Thanks for confirming! Diane
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    Saphenous Vein for CABG

    Hi, I see a note in CPT before the 33510-516 and 33517-530 codes that the procurement of the saphenous vein graft is included. I also see CPT 33508 for endoscopic harvest of the saphenous vein for CABG. Can anyone explain what the note is referring to? Is open harvest included in CABG but...
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    Foley Cath in Cardiovascular Procedures

    Chapter 1 of the cci policies states that insertion of urinary catheters is included in a large number of procedures. Can anyone tell me if the foley cath insertion (when performed by the physician) is included in cardiovascular procedures, or is it separately billable with a 59 modifier...
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    35400 Primary Codes

    Hi, Can anyone tell me what the related or qualifying codes would be for cpt 35400? Thanks, Diane Huston, CPC
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    Vein to vein anastomosis in CABG

    Thanks Julie. I'm not in the office so maybe I don't have the wording right. One more question...if they have to join two pieces of the vein to make one bypass graft, is there anything to code for the extra work of joining those two pieces? Thanks for your help, Diane
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    Vein to vein anastomosis in CABG

    I'm new to this specialty and I'm trying to understand what's going on when the report says the aorta was punched and there was an end to end anastomosis of the vein. This is before they use the vein on the arteries being bypassed. Is there a code for this? Thanks for your help! Diane...
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    Superbill - Does anyone have a good Cardiovascular

    I'm new to this specialty and could really use a copy of your superbill also. Could you send one to medcoder@cox.net? Thanks so much! Diane Huston, CPC
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    Doppler Doucmentation

    I don't see a question/answer for May 5th and I don't think there's any set wording that you have to have for dopplers. You can't just say "flow" but the documentation should say something that indicates the spectral waveform analysis was done. Since the CPT description includes "arterial...
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    Circc - Do I need ICD9 Vol 1-3

    Do I need ICD9 Vol 1-3 for the test or just Vol 1-2? I do hospital based physician coding. Thanks, Diane Huston, CPC,RCC
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    Shunt Series Vs Shuntogram Coding

    Assuming that there is NO nuclear medicine injected for this, you should code the regular skull, chest, and abdomen x-ray codes. Diane Huston, CPC,RCC
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    Thrombolysis

    I think you can code both 37187 for the mechanical thrombectomy and 37201 for the infusion that was left overnight. Diane Huston, CPC,RCC
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    DX's for PICC for Total Parenteral Nutrition

    V58.81 Diane Huston, CPC,RCC
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    Consistent or Compatible with

    Apparently the Coding Clinic (or whatever the AMA's ICD9 publication is called) put out an article that said consistent with is not codeable. I think compatible with was always uncertain. But I find it interesting that the AMA didn't update the official diagnosis guidelines with the term...
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    Hepatic Artery Chemo-Embolization

    No, 37204 is the right code for this. It covers embolization by any method. Diane Huston, CPC,RCC
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    CCI Edits

    Who do you get Encoder Pro Expert from? Diane
  17. D

    Case

    What about the nephroureteral stent part of the case? How would you code that? Diane Huston, CPC,RCC
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    DEXA Scan - Screening or Diagnostic

    A screening is a screening is a screening. So I agree with you that if it's ordered as a screening then it's a screening with the findings coded 2nd. Same for mammograms. Diane Huston, CPC,RCC
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    Removal of PICC with Port

    Sorry, it's the Society of Interventional Radiology. They have an excellent Interventional Coding User's Guide. Diane
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    Removal of PICC with Port

    SIR advises to use 36590 for this. Diane Huston, CPC,RCC
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    CCI Edits

    Can anyone recommend a good vendor for checking CCI edits? I'm looking for something that I can enter certain codes into and get the edits just pertaining to those codes. Thanks, Diane Huston, CPC,RCC
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    Accepted verbage for post processing

    I've been told that MIPs and curved reformations can be 3D but it's best to check with your doctors to make sure that they mean 3D if they use those terms. Diane Huston, CPC,RCC
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    Internal Iliac Sclerotherapy

    What, if anything, would you code for the sotradecol injection and what code would you use for an internal iliac venogram? Thanks, Diane Pelvic congestion syndrome, persistent unimproved pelvic pain despite bilateral gonadal vein embolizations Moderate sedation was employed using Versed and...
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    Abscess Drainage and Catheter Placement

    49061 (retroperitoneal drainage) includes the placement of the catheter. I assume you mean the catheter was placed in the same session. Diane Huston, CPC,RCC
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    atherectomy/angioplasty same vessel

    I believe that CMS has rescinded their previous instruction to only code the successful procedure and you can bill all the procedures if they were all provided to treat the condition. Diane Huston, CPC,RCC
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    New or Established?

    I appreciate all the responses. Just to add a little more confusion...it's been suggested to me that perhaps the specialty in my case would be Interventional Radiologist vs. Diagnostic Radiologist rather than cancer-treating doctor vs. neuro-treating doctor since both are Interventional...
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    IR modifiers

    Modifiers vary depending on the payor. They also vary between CMS's MACs. Diane Huston, CPC,RCC
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    Nephrostomy-Pls clarify the codes

    I was told at an RBMA coding seminar that a nephroureteral to ureteral stent exchange would be 50387. In order to bill for 50394/74425 a true nephrostogram must have been done. Often times contrast is injected just for roadmapping. If you don't have an interp, a nephrostogram wasn't done...
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    New or Established?

    I checked and Dr. A's subspeciality is cancer treatments. Drs B and C are neuroradiologists. Dr. A would never perform a neuro surgery and Drs. B and C would never perform the RF ablations or chemotherapy on cancer patients. Based on this then, it would appear to be a new patient? Diane...
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    New or Established?

    A patient was sent to our out patient IR clinic by his oncologist to be seen by Dr. A for RF ablation of liver cancer on 5/19/09. Prior to this, Dr B inserted a tunneled catheter in the hospital on 3/6/09 and Dr C did a port check in the hospital. No E&M services were provided in the hospital...
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    Consultations - new to IR coding

    We're often asked to consult and we have an out patient clinic where we do non emergent consults as well as patient visits. But you have to have a request for a consult. If a test is already scheduled, it doesn't sound like a consult is needed. This may be just someone taking history and...
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    Documentation Required for 99232?

    Ahhhh, now I understand. Thanks!!!
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    Documentation Required for 99232?

    Thanks for answering. I think it's the history that has me confused. If there was only 1 HPI and 1 ROS wouldn't that be the lower level problem focused 99231? Or is problem focused just 1 of either? Thanks. Diane
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    Documentation Required for 99232?

    Since we're a radiology group our hospital follow ups to the IR procedures are normally 99231. But now the group wants to do a new procedure which (per Society of Interventional Radiology) would fall under a hospital follow up code. I'm wondering what would be required to bill a 99232 for...
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    Coding for Interventional Neuro Radiology

    The SIR Coding Users Guide at www.sirweb.org , The Interventional Radiology Coder at www.medlearn.com , Dr. Z's Interventional Radiology Coding Reference at www.zhealthpublishing.com . Diane Huston, CPC,RCC
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    Mri of right sternoclavicular joint

    Could go either way, depends on the reason for the exam. Diane Huston, CPC,RCC
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    73110---# views

    The description says minimum of 3 views which means 3 or more views = 1 code (unless bilateral or done in different sessions like you said). Diane Huston, CPC,RCC
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    Which date of service?

    The rules say bill the service on the date it was performed, in your case both on the same day. But I don't think anyone actually does that, at least not in radiology. We always bill the pro-fee date to match the technical portion. Diane Huston, CPC,RCC
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    DX codes for 37205/36010/37250

    I think 459.2 compression/stricture of vein is covered by Medicare. Diane Huston, CPC,RCC
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    balloon angioplasty uretero-enteric anastomosis.

    SIR states that ureteral balloon dilatation can be coded as 50553 or 53899 based on your practice's understanding of the change in the CPT introductory language that took place in 2002 and the CPT and CMS instruction to use the most closely descriptive endoscopic codes. Diane Huston, CPC,RCC
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    Radiology - profee billing for multiple studies

    You can bill for each and use the 76/77 modifiers. There's no limit on the number per day that can be billed but some insurances have their own policies on how many they're going to pay for per day. Diane Huston, CPC,RCC
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    Infusion for thrombolysis-How to code

    I just received an answer directly from SIR today on a similar question. My question was about injection of tpa into an existing pleural catheter but I believe their answer would apply to this also. They said it would be an E&M code. This didn't make my docs happy since there's a lot more...
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    75774? ?(CPT Assistant)?

    I don't know of any place you'll find in writing that you can use it for venography but multiple very reputable people have said they would use it for multiple vessels in the same venous family. They've also said they expect to have to appeal it by saying the description says angiography which...
  44. D

    fistula 20501 76080

    You'd need to see that the doctor injected and studied a sinus tract (an open cavity) or a fistula (an abnormal connection of two areas that don't normally have a connection). This is for a study of the sinus tract or fistula, not to study a tube that may have been placed there. Diane Huston...
  45. D

    percutaneous vertebroplasty

    72291/92 aren't assigned just as S&I codes. Either code is valid for either thoracic or lumbar. It's based on whether fluoro or CT guidance was documented. Diane Huston, CPC,RCC
  46. D

    Nephrostomy removal without a stent

    Personally and without any additional knowledge of your doctors, I would code this based on this documentation as an E&M code. I say this because: 1) I don't know that the fluoro was used for the purpose of removing the nephrostomy. My docs use also use fluoro to inject the tube and I tell...
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    Nephrostomy removal without a stent

    I don't believe that 50389 requires that there be a stent present. But it does require that the nephrostomy be removed under fluoro guidance. And since I don't know the reason for the removal, I should probably also say that I wouldn't code the removal if it was for the purpose of placing a...
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    Nuclear Medicine Studies

    I bill for the professional component only and I don't code for injections. The answer could be different for out patient centers. Diane Huston, CPC,RCC
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    Cerebral Carotids verus Cervical Carotids

    If I'm coding cerebral angiograms, generally speaking I'd like to see mention of some cerebral arteries. But maybe the internal carotid is obstructed before it gets to cerebral arteries so they can't be seen. I think the answer could vary depending on the situation. Diane Huston, CPC,RCC
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    Av fistulogram -Ultrasound examination of the arteriovenous anastomosis

    Shirley...I tried to respond to your message with the link but I'm not sure it went thru. Sorry if this is a duplicate.... Hi Shirley, Thanks for the article. I see where they're talking about the 75710. I'm still not sure I would code it in this case because the brachial artery is the inflow...
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