Interventional Radiology Coding . One of our interventional cardiologists scrubbed in and performed multiple venoplasties on the very tight CS lesion. The LV lead was reinserted and advanced, but still could not pass the stenosis. The attempt was aborted. My thought is to bill code 3. I normally would not bill for the venoplasty, as it would be included in the lead placement, but since the lead attempt was aborted, would it be appropriate to bill it in this case? LUE arteriogram performed, and then angioplasty of the brachial artery and mechanical thrombolysis of the brachial, ulnar, and interosseous arteries.

Infusion catheter placed in the ulnar artery for overnight thrombolysis. Is it appropriate to bill 3. We believe the correct codes for the procedure are 3. Please confirm. Then, the arterial plug was removed using again the Fogarty catheter. Graftotomy repaired with interrupted sutures. Upon restoration of the flow, patient had pulsatile flow within the graft. Graft was cannulated through separate skin incision using entry needle.

It was upsized to 7- French sheath and a fistulogram was performed, which revealed patent graft. There was high- grade stenosis in the venous anastomosis.

Subclavian, axillary vein, brachiocephalic vein was widely patent all the way to the right atrium. Glidewire was introduced, parked in the right atrium and high- grade stenosis within in- stent was angioplastied using 8 x 2. During inflation of balloon, contrast was refluxed in the arterial system, which revealed absence of any hemodynamically significant stenosis of arterial anastomosis. Balloon was deflated and another fistulogram was performed, which revealed excellent flow through the angioplastied area. Cultures were taken and irrigation of the thoracic cavity performed. Three chest tubes left in pleural space, one posterior apical tube into the abscess cavity.?

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It seems to me the VAD would be for ports that are placed in a pocket, and the tunneled line would be coded the same as the non- tunneled line. It says the revised codes will become effective October of this year. Will you send out updates to membership holders? Patient is evaluated by the physician and sent for ultrasound imaging. After scanning the patient's fistula, the physician reads the ultrasound and determines that the patient will require an intervention. Can we still bill code 9.

If so, what diagnosis code should we use with the 9. We have not been billing them due to denials. Intervention on the ramus intermedius was performed as detailed above with no balloon angioplasty or stent placement.?

Or can we only report code 2. Here is what the physician documented: .

We then prepared another scepter 4 mm x 1. Superselective angiogram was then performed.

Breast biopsies are being performed at the “new” facility. We are having trouble getting reimbursed for the surgical codes of the breast biopsy. The remit states: “Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.” From what I have read, only the physician performing the biopsy can bill for the surgical codes for a breast biopsy. This is split billing of course, not global.

Can you please give information and guidance on this situation? The left pectoral region was prepped and draped in the standard fashion. The skin and periclavicular region were anesthetized with 1% lidocaine. An infraclavicular incision was made and carried down to the prepectoral fascia using electrocautery.

Using blunt dissection and electrocautery, the generator pocket was created and hemostasis assured. Micropuncture needle was used for axillary vein access x 1. A 7 French safe sheath was placed. Free Online Dating Las Cruces Nm. Via this sheath, a His bundle introducer sheath was placed in the right atrium. Using the His bundle lead, the His bundle was mapped. The lead was secured to the His bundle tissue, and pacing characteristics were reevaluated. Under fluoroscopic guidance, the guiding sheath and safe sheath were removed.?

Access organ: soft tissue. Additional access organ information: mid- line mesenteric mass. Access side: right and left. Since this was a minimally invasive procedure and bypass was performed (the femoral vein was repaired due to the cannulation of the vein for bypass), I wanted clarification whether the femoral vein repair could be reported. When imaging is performed via pre- existing shunt access, only report code 3.

FLUOROSCOPY TIME: 0. FINDINGS: No contrast was able to be instilled via the NG tube. Visualization of the upper portion of the tube reveals there was a kink in the oral pharynx. This was removed under direct fluoroscopic visualization. The tube was resecured with tape. Instillation of contrast revealed filling of the stomach. IMPRESSION: Initially malpositioned NG tube with kink.

This was repositioned. Functioning NG tube.

After this, I proceeded to the right side where I reopened the previous incision going through the same scar. The device was delivered out of the pocket. The pulse generator was disconnected and washed with antibiotics. The old lead was freed of any of the stitches around it, and, under fluoroscopic guidance, I unscrewed it and then pulled the lead out. It came out in its entirety. The lead was visually intact.

I irrigated it also and cleaned it completely with antibiotic solution. The same lead was now already introduced through the introducer sheath that is in the left subclavian vein.

I navigated that lead under fluoroscopic guidance into the apex of the right ventricle cavity. I actively fixated it. Pacing and sensing functions were assessed and were adequate.

I thus fixed that lead to the fascia of the first and second ribs with multiple stitches of 2- 0 silk.? Fistulogram was performed, which showed a patent fistula of the cephalic arch where there were two tandem stenoses. The one at the very top of the cephalic vein was nearly occlusive.

There was a second approximately 8. The micropuncture was exchanged for a 7 French sheath. A 0. 0. 35 guidewire was advanced easily through both stenoses and into the central veins. Adorado balloon was then across more central of the two stenoses and inflated. The balloon fully inflated at 1. The second stenosis was then addressed and the balloon fully inflated.

Fistulogram showed no residual stenosis. Partial central venogram was performed through the innominate level, which showed no stenosis. Fistula was clamped and was entered through third incision right between venous and arterial cannulation site. Kelly clamp was used to milk out thrombosis. The fistulotomy was closed and flow restored. Cannulation site was closed.? If not, what codes are appropriate?

I noticed that you answered a similar question in March, but I was wondering where you got your information so I can provide that information to my provider. She was taken to the OR for excision.

A duplex Doppler was used to measure the brachial artery flow and to check the outflow vein to decide on the area of disconnection and division. Images were retained. The fistula was excised by disconnecting it from the brachial artery, followed by anastomosis and repair of the brachial artery.

The aneurysm, chronic thrombus, and overlying skin were excised in the needle access segment of the fistula. The cut end of the outflow vein was repaired at the level of the shoulder. The 6 x 4 cm skin defect was closed with flaps.? How do we code for the excision of the fistula? Do I need a modifier for the use of existing pocket?

The port was removed in its entirety. The pocket was flushed thoroughly. No drainage was noted from the pocket. Under ultrasound guidance, access into the left internal jugular vein was obtained using a 5 French micropuncture system. A permanent sonographic image of the vein was obtained to document patency. An Amplatz wire was then advanced into the inferior vena cava under fluoroscopic guidance with the utilization of a Kumpe catheter. A tunneling device was utilized to bring the catheter from the port site utilizing existing pocket to the jugular vein.

CONCLUSION: Successful placement of left internal jugular Bard single lumen Power. Port catheter and removal of left subclavian Infuse- a- Port. However, the report states the wire was advanced from radial, after left and right femoral would not allow wire to cross, and into the aorta. Abdominal aorta performed, showing severe occlusion with no collateral flow on long leg runoff bilaterally.

Would it be more appropriate to report codes 3. I see 9. 29. 28, but not C9. C9. 60. 0. In this case, would we treat it like the FFR is performed alone and charge the unlisted as well as C9. These lines are placed in the internal jugular vein as described here: .

The 5 French microcatheter was left in the right IJV. It was capped and covered with a tegaderm. From other questions listed, we should be adding modifier - 5. Another suggestion is to use code 3. What is/are the correct CPT(s) for this exam? An aortorenal angiogram was obtained, showing patency of the renal arteries and infrarental aorta with excellent flow through the iliacs on either side.?

Here is my current scenario. Abdominal aortogram and bilateral lower extremity study from one cath position; findings are of infrarenal AA, BCIA, BEIA, and BCFA. Then the physician moves the cath to the left popliteal artery and completes the left leg run- off with further detailed imaging down to the foot. Should I report code 7. Or codes 7. 56. 25 and 7. LT? Or codes 7. 56. Can we bill for code 9.

PVI? The physician's documentation is as follows: . The QRS width was measured at 9. QT interval was measured at 3. The HV interval was measured at 5. The attrial flutter showed concentric left atrial activation and counterclockwise rotation of the right atrium, negative sawtooth waves in leads II and III, and a VF and positive in lead V1. Utilizing Carto 3- dimensional mapping as a guide, energy was then targeted in a linear fashion from the tricuspid, mid isthmus to the inferior vena cava. This resulted in termination of the tachycardia.