Search results

  1. J

    Wiki Insurances paying for contrast usage especially in an outpatient setting

    Does anyone know if insurances are paying for contrast usage, especially in an outpatient setting? Thanks, Jim Pawloski, CIRCC
  2. J

    Wiki Attempted Nephrostomy

    A patient was admitted for sepsis, and a request was made for bilateral nephrostomy. Using ultrasound guidance, a 22 g chiba was used to access the collecting system. Unfortunately, the was no hydronephrosis and after a few attempts, the case was canceled. In a discussion with a fellow coder...
  3. J

    Wiki CT guided Gastrostomy Access Placement

    Patient has had a gastric bypass surgery, now needs a gastrostomy tube insertion. Under CT guidance, access was achieved with a 5 fr. Yueh catheter. The stomach was insufflated, and 4 gastropexy sutures were placed within the remnant stomach. Intraprocedural spot CT images demonstrated there to...
  4. J

    Wiki Y-90 Embolization

    Does anyone know of a registry/ lists of Interventional Radiologists who do Y-90 embolizations? I have a doctor who is performing the procedure, but doesn't say who is the authorized user. So I can't code the treatment codes.
  5. J

    Wiki Hepatic abscess catheter exchange

    Have a patient with a 22 french drainage partially disloged from a hepatic abscess cavity. The catheter was exchanged for three 14 french drainage catheters thru the same access, and placed in different portions of the cavity. My question is do I charge for a catheter exchange once or times...
  6. J

    Wiki Use of Tisselle in a sinus tract

    Has anyone ever coded 20550 for a Therapeutic injection of sinus tract, using a fibrin glue call Tisselle? I had a case where Tisselle was injected into a tract between an abscess pocket and the bowel. Also, can it be used when the physician injects it into the abscess pocket? Thanks, Jim...
  7. J

    Wiki Biliary Drain vs. Abscess Drain

    Pt has a biliary obstruction. A chiba needle in placed in the left biliary duct, and is injected. Choleangiogram was performed showing obstruction of the biliary tree near the central left main biliary duct. No filling of the biliary duct, however, a communication with the abscess is noted. A...
  8. J

    Wiki Coronary Angio vs. Peripheral Angio.

    I have a patient who was going to have a coronary angio from the radial artery approach. However, the catheter could not be advanced past the elbow. Imaging of the arm was performed and an occlusion of the brachial artery was found. What do I code? Is it 93454-74, or do I code 36140 and 75710...
  9. J

    Wiki Cancelled procedure after anesthesia

    How would you code this scenario? Patient brought in the cath lab for a heart catheterization, ordered as a left heart cath. Patient is placed in the exam table and prepped and draped. 10 cc of lidocaine injected over the right femoral artery. Moderate sedation was given. Patient develops...
  10. J

    Wiki Attempted Carotid Stent Placement

    I have a case, where the procedure was ordered as a carotid stent placement. Bilateral Cervicocercical arteriograms (36223-50) were performed along with a 3-d angiogram. The doctor tried to cross the stenosis using multiple wires and wires and microcatheters. Despite prolong measures and and a...
  11. J

    Wiki 2nd Arteriogram after aneurysm clipping

    Patient with known cerebral aneurysm, has a four vessel arteriogram to determine if the aneurysm will be coiled or clipped. The patient has their aneurysm clipped, and a repeat 4 vessel arteriogram was performed on the same day. Same neurointerventional radiologist does both arteriograms...
  12. J

    Wiki Biventricular Pacemaker

    How should this be billed. I want to bill 33214, the techs want to bill 33225 and 33229. Who is right and why? Thanks, Jim Pawloski, CIRCC Procedure Procedure Type Pacemaker:Miscellaneous, VENOGRAM UNILATERAL (75820), PPM UPGRADE (+LV), REMOVAL/RPL PPM GEN MLTPL/BIV (33229), LV LEAD INSRT...
  13. J

    Wiki Proposed CMS Changes for Cardiology in 2015

    Has anyone read about any proposed CMS changes for 2015 for Cardiology (Cath Lab and EP)? I had someone ask me about this and I could not give them an answer. Thanks, Jim Pawloski, CIRCC
  14. J

    Wiki Proposed CMS changes in 2015 for IR

    Has anyone read about any proposed CMS changes for 2015 for IR? I had someone ask me about this and I could not give them an answer. Thanks, Jim Pawloski, CIRCC :confused:
  15. J

    Wiki Cerebral AVM Embolization

    I have a patient who had a four vessel cerebral arteriogram, an embolization with Onyx embolization material, and then a repeat four vessel arteriogram. The Neuro Interventional Radiologist wants me to bill for the second four vessel arteriogram because he wanted to see if any other vessels...
  16. J

    Wiki Broken Nephrostomy Catheter

    I had a radiologist remove a broken end of a nephrostomy catheter from a patient's flank. I know it not 37197 - intravascular removal of F.B., but do I use a unlisted urinary code for the removal, or does anyone know what code to use. Thanks, Jim Pawloski, CIRCC
  17. J

    Wiki Time frame for when a procedure has to be dictated

    Can anyone answer this question for me? I have a radiologist who has performed a procedure, but has not submitted a report of the procedure. Is there a time limit that the report must be made after the procedure? I have a case that's over a month old and no report at this time. Where can I...
  18. J

    Wiki Subclavian arteriogram and stent placement

    I have a patient who had a right subclavian arteriogram and stent placement from the right radial artery! Do I bill for extremity artery (36140) or catheter in artery- brachial (36120) and 75710 for extremity arteriogram? A different method of performing the intervention. Thanks, Jim...
  19. J

    Wiki Billing Anesthesia with External Cardioversion

    Had anyone billed for a Anesthesia code (especially General Anesthesia) with a External Cardioversion? I have had the question asked of me, and I want to say it's o.k., however I want to make sure I can. Thanks, Jim Pawloski, CIRCC
  20. J

    Wiki Venous thrombolysis

    I'm coding a patient who had venous thrombolysis (catheter) started early in the day in the subclavian vein. The patient is brought down for a "catheter check" later in the day. My question is that because the patient came down in the same day, the lysis check is not billable? The patient...
  21. J

    Wiki Cerebral angio occlusion

    I have a question on a patient who was found to have an occlusion of the left internal carotid. Unfortunately, it covered over a week with four date of services. So here is the "Readers Digest" version. Day one- Left Vertebral angio, Rt Internal Angio where contrast is seen crossing from the...
  22. J

    Wiki Cerebral Arteriogram

    Hi Everyone, I coded a patient for a cerebral arteriogram who had a meningioma. The exam was for blood flow to the tumor which consisted of Bilateral Common Carotids, Bilateral Internal Carotids, Bilateral External Carotids, and Bilateral Vertebrals. Ten days later, the patient has a...
  23. J

    Wiki Recovery Room Charge

    My supervisor was wondering how to charge for "recovery room" time after a procedure. This would be for a hospital setting. Is there a CPT code for this, or do you bill the insurance company as part of the overall charge. Thanks, Jim Pawloski, CIRCC :)
  24. J

    Wiki CT guided embolization of a type II endoleak

    I need an opinion for codes of case below Examination: CT guided embolization of a type II endoleak Clinical History: 79-year-old male status post aortic endovascular stent graft repair for a abdominal aortic aneurysm. Serial CAT scans demonstrates a type II endoleak. Two attempts were...
  25. J

    Wiki Dobutamine and Nicardipine during heart cath

    Is the use of Dobutamine and Nicardipine during a Heart Cath separtately billable (codeable), or bundled into the procedure. Thanks, Jim Pawloski, CIRCC:)
  26. J

    Wiki 3-d reconstructions

    I have a neuro Interventional Radiologist who performs a 3-d angio pre and post aneurysm coiling procedure. The question came up is how many 76377's can you charge? I thought 36733 can only be charged one per procedure. Thanks, Jim Pawloski, CIRCC
  27. J

    Wiki Uretural Stent Exchange

    I have a patient who has a uretural stent with could not be removed from below. So from a percutaneous approach, the kidney was accessed and through a sheath, the uretural stent was removed using an Amplatz snare. A nephrouretural catheter was replaced through the kidney into the bladder. Do...
  28. J

    Wiki 93463 vs. 93024

    I had someone ask me what the difference between these two codes. I e-mail the person the defiinations that I found on the internet. My main questions are when would you use these codes, especially 93463. 93463 Pharmacologic agent administration (e.g., inhaled nitric oxide, intravenous...
  29. J

    Wiki Abdominal Aortogram

    I went to a seminar, and I thought I heard that to bill for an aortogram (75625 or 75630), the renals have to be described in the findings. Is that correct, because I have had some reports that do not describe the renals but the lower abdominal aorta and the iliacs?
  30. J

    Wiki Chronic Total Occlusion of a coronary artery

    I need a little help. I have been asked about chronic total occlusion of a coronary artery and the attempt to open the artery. A lot of equipment and time is involved in the attempt to open the artery. I thinking of using the angioplasty charge and adding modifier -52 for reduced services...
  31. J

    Wiki Attempted PTCA

    O.K. everybody I need a little help, An attempted PTCA was performed, but was unsuccessful because of tortuousity. The doctor worked in trying to get the balloon down past the lesion for a couple of hours. So I said to bill the angioplasty with the modifier -52. Coders tell me that they...
  32. J

    Wiki Follow-up phone call by physician, post procedure

    Hello everybody, I need a opinion on this. The radiologists that I work for, want to bill for calling patients on the phone, following up on a procedure. Is this follow-up phone call a billable procedure, i.e E&M? Thanks, Jim Pawloski, CIRCC ;)
  33. J

    Wiki Catheter codes during stent placement

    Hello everyone, I looking for some help. A patient had a Lt SFA stent placement from the right femoral access, using a long sheath. He then pulled the long sheath out of the left leg, and made an exchange for a short sheath and performed a stent placement in the right common iliac artery. I...
  34. J

    Wiki Separate procedures at different hospitals

    Hello everybody!, I have a question for everybody. A patient has a heart cath at one hospital, and is transferred to a different hospital for a cardiac interventional procedure. Doctor states that information in the interventional report, and what was found in the diagnostic procedure. Do...
  35. J

    Wiki Dialysis Access System

    Hello everyone, Does anyone know what equipment uses the HCPCS code C1881 - Dialysis Access System (implantable)? I'm having trouble with billing department in using Angiodynamics Dura-Flow Long Term Dialysis Catheter. Angiodynamics says to use C1881 for equipment billing, but 36558 wants...
  36. J

    Wiki Angioplasty vs. Atherectomy

    Hello everyone, I have a case that is giving me trouble. A patient had a angioplasty of the proximal SFA, with suboptimal results. The physician then performed a atherectomy on that lesion. After that, the physician did an atherectomy on a distal SFA lesion, with suboptimal results. An...
  37. J

    Wiki U/s vascular studies of extremities

    Hello everyone, I had asked a short time ago about coding a unilateral extremity arterial vascular study. Danny Peoples answered my question in using modifier -52 for this. Now the hospital that I work for is asking what code to use if an upper extremity and lower extremity arterial vascular...
  38. J

    Wiki Angioplasty vs. stent

    I had a dictation where the physician performed an angioplasty on the lt subclavian and lt renal artery. In the dictation, it is stated that because of a suboptimal results, a stent was placed. With that said, can both the PTA and stent be charged. I thought it was if there is a dissection or...
  39. J

    Wiki Arterial studies in Vascular Lab

    Hello everybody, I was given this question, and I need someone opinion. If a non-invasive lower extremity arterial study that consists of measuriing pulse waveforms at multiple sites, do I use 93923? And is that unilateral or bilateral study. If it is done at only one site (ankle/brachial...
  40. J

    Wiki Jetstream Atherectomy Catheter

    Has anyone coded a procedure using the Jetstream G2 catheter? A rep. stated the catheter can be used for atherectomy or thrombectomy. Both procedures use a different C-code, so I looking for some help. Can I use two different c-codes for the same piece of equipment? Thanks, Jim Pawloski CIRCC
  41. J

    Wiki Failed Heart Cath

    I'm reading a cardiac dictation in which the Cardiologist try to do a heart cath from the right arm. The patient's anatomy had the Innomiate artery coming off the decending part of the thoracic aorta, so he could not get the proper angle to get to the coronaries. I was thinking of 93508 with a...
  42. J

    Wiki CIRCC looking for remote work

    I am a Registered Cardiovascular-Interventional Radiology Technologist and have just recently passed the CIRCC exam. I am looking for part-time remote work coding for Interventional Cardiology and Interventional Radiology. I can reached by e-mail at tricia-jimp@ameritech.net or...
Top