by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: If more than one abscess drain is placed within a large, loculated abscess, can you code 49406 and 49406-XS or can you just code for one abscess drainage? Answer: We would recommend one. Loculations can be broken up with catheters or wires. Large abscesses […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: The patient was placed on the CT scanner in the supine position. Initial CT images of the upper abdomen were obtained. Automated exposure control was utilized. The skin overlying the liver was prepped and draped in the standard sterile fashion. Under CT guidance 3 […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Which CPT code would best describe a VSD closure that is not for a congenital VSD, but post MI? Answer: We recommend reporting unlisted code 93799 for ventricular septal defect (VSD) closure of a NON-congenital (post-infarct) VSD.   November 30-December 4: ZHealth IR/CV Medical […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Report: Vessel catheterized: Segment 2 hepatic artery Gives rise to a subsegmental vessel that is the minor supply to large tumor spanning segments 2 and 3. Vessel catheterized: Subsegmental branch of the segment 2 hepatic artery would the codes be 36247 and 36248? Answer: […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Angiogram (DSA) of the entire left lower extremity and iliac arteries using a 4-French x 45 cm long Rim catheter advanced from the right common femoral artery up and over and down into the left SFA. Selective angiogram of the left Posterior Tibialis, peroneal, […]

National Government Services (NGS), the Medicare Administrative Contractor for Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin, just posted guidelines for billing for the intrathecal injection of Spinraza. NGS requires CPT code 96450 for the injection procedure and HCPCS code J2326 for the nusinersen. HCPCS code J2326 is reported […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Can you please let me know if I coded this correctly? The doctor says I should be able to code the cath placement into the collateral vein and the venogram. I thought it was included in the fistulogram and embolization. US guided access into […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Does the 2020 code 64451 (nerves innervating the sacroiliac joint) replace the 27096 when the injection states “into the SI joint,” or is the code used in place of billing the S1, S2, S3 as peripheral (64450)? Answer: No, it does not replace CPT […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: How would you code the following ablation procedure? 1. Pulmonary vein antral ablation was performed to isolate PV antral regions with bilateral PV isolation (PVI) confirmed on HDX mapping electrogram. 2. Additional linear ablation was performed at the left atrial (LA) roof to achieve […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Patient is status post pipeline embolization. Patient clinically, CTA (CT Angiography) and TCD’s (Transcranial Doppler) are consistent with vasospasm. Right vertebral angiogram showed vasospasm. Vasospasm was treated with 10mg of intra-arterial verapamil over a 10 minute infusion. Left internal carotid angiogram showed vasospasm and […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC Question: Can we use CPT code 49185 if imaging guidance wasn’t performed and contrast wasn’t administered? Can we also use CPT code 49185 when sclerosants aren’t used? Per documentation, provider Injected 30 mL of desiccated ethanol into the abdominal wall seroma via previously placed drain. […]

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC If a diagnostic abdominal angiogram and bilateral runoff is performed (2 cath positions) (36200, 75716) and then the physician decides to do an intervention in the contralateral leg, do we need to drop CPT code 36200 (catheter placement for the diagnostic exam) or do we […]