placement of infusion wire

superorozco

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Hi everyone,
I need some help on choosing the correct codes for the below. I have some of the codes, but not sure of the placement part of the infusion wire. Thank you for your time. Here is what i think: 93530.26, 93542,93556.26.59, and 37201,75894.26.



PROCEDURE:
1. Left heart retrograde catheterization.
2. Selective subclavian artery angiography times 3.
3. Selective shunt angiogram times 3.
4. Placement of chronic indwelling 0.035-inch infusion wire into left
pulmonary artery through the clotted left Blalock-Taussig shunt.

DESCRIPTION OF INTERVENTIONAL PROCEDURE: Placement of chronic indwelling infusion wire through the left modified Blalock-Taussig shunt: A 4-French MPA catheter was placed in the proximal stump of the left shunt. First a 0.025 inches Terumo Glidewire with angle tip was advanced and torqued carefully into the shunt and found its way partway through the shunt and then ultimately into the left pulmonary artery. We then used an angiogram to confirm a tiny lumen. Then we used a 0.035 inches angle tip Terumo Glidewire also out into the left pulmonary artery. Angiogram again confirmed flow into the left pulmonary artery. Then, finally were able to place a 0.035 inch Boston Scientific Katzen infusion wire with a 9 cm distal infusion wire at the end of the 180 cm catheter. We were able to slightly angle the tip of the wire so that we were able to manipulate out into the distal left lower pulmonary artery and the
proximal infusion marker was in the subclavian artery right near the entrance of the shunt. There were no complications with placement of this. No evidence for blood in the costophrenic angle. No evidence for extravasation of contrast in the injections in the left subclavian artery or proximal shunt.

Thank you!!!
 

deeva456

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Hello,

I was looking at your question and researched the codes you were asking about. I am not familiar with the infusion wire placement, however your codes appear to be correct except for one. Per CPT, when billing 37201 the correct radiological code to use is 75896-26. You may want to recheck this.

If in doubt, since Boston Scientific manufactures the wire, you may want to call a rep and ask if they have any information about coding this procedure.

Good luck!

Dee, CPC,CCC
 

superorozco

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Thank you Dee!
Now, do you know if I can bill it again (37201) 4 days later and the following day angiography to evaluate the status of pulmonary artery. I am really confused with this one!
 

deeva456

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I would first check to see what the global period is on 37201. If there is a zero day global period then you should be able to bill this procedure 4 days later. Heart cath codes have a 1 day global period so you can bill for another angio days following the first procedure. Make sure medical necessity is documented in the reports as the payer may deny the charges for frequency.

good luck,

Dee
 

superorozco

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I would first check to see what the global period is on 37201. If there is a zero day global period then you should be able to bill this procedure 4 days later. Heart cath codes have a 1 day global period so you can bill for another angio days following the first procedure. Make sure medical necessity is documented in the reports as the payer may deny the charges for frequency.

good luck,

Dee
Thank you! I called Boston and didn't get an answer yet. However, i was doing some more research, what do you think of code 36593 since the procedure was done for shunt that became occluded. (or what do you think of 37184)?

Thanks for your help!
 

deeva456

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Hi again,

I was researching the descripitions of these codes and, I dont know if 37184 is the correct code to use. The full description of this code also includes distal and proximal balloon inflation on either side of the treatment zone or occlusion. 36593 appears to be used on catheters placed for withdrawing fluid, long term parenteral feeding or the administration of fluids or medications. What is the dx or reason for placing the infusion wire or shunt in the pulmonary artery?

Dee, CPC, CCC
 

deeva456

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Hi again,

I was researching the descripitions of these codes and, I dont know if 37184 is the correct code to use. The full description of this code also includes distal and proximal balloon inflation on either side of the treatment zone or occlusion. 36593 appears to be used on catheters placed for withdrawing fluid, long term parenteral feeding or the administration of fluids or medications. What is the dx or reason for placing the infusion wire or shunt in the pulmonary artery? Like I said I am not familiar with this procedure but am always willing to learn more.

Thanks,

Dee, CPC, CCC
 
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