sparker
Guest
Could someone help me understand this?
The report:
The patient has recently been found to have abnormal parameters on both right ventricular shocking lead and LV pace sense lead. She is here to undergo subclavian venography to assess her venous anatomy and access for potential modification of her leads. She is also undergoing fluoroscopic evaluation of the leads and noninvasive programmed stimulation testing of defibrillator.
Procedures:
1. Subclavian venogrpahy
2. Fluoroscopic investigation defibrillator leads
3. Noninvasive program stimulation and evaluation of ICD.
Details:
Sedation administered with versed and fentanyl. Subclavian venography was performed which showed wide patency of subclavian vein. Fluoroscopic evaluation of leads show suggestion of lead fracture of left ventricular epicardial lead at clavicle as well as significant trauma to RV shocking coil also at insertion to subclavian vein, near clavicle. Noninvasive program stimulation performed with high energy shocks through defibrillator. 1.1 joule shock was delivered and deemed normal. 41 joule discharge performed with patient adequately sedated. This showed low impedance and likely insulation compromise to shocking coil. Right atrial and right ventricular pace sense leads were evaluated thoroughly and felt to be normal.
Coding:
36005, 93642.26, 99235.25 75860.26, 71090.26
Medicare paid everything except 36005 and denied bundled. In cpt 36005 says for extremity but on another coding website it tells the physician to bill 75860.26 with 36005 to capture the subclavian venography.
Any help would be greatly appreciated, how it should have been coded and why.
The report:
The patient has recently been found to have abnormal parameters on both right ventricular shocking lead and LV pace sense lead. She is here to undergo subclavian venography to assess her venous anatomy and access for potential modification of her leads. She is also undergoing fluoroscopic evaluation of the leads and noninvasive programmed stimulation testing of defibrillator.
Procedures:
1. Subclavian venogrpahy
2. Fluoroscopic investigation defibrillator leads
3. Noninvasive program stimulation and evaluation of ICD.
Details:
Sedation administered with versed and fentanyl. Subclavian venography was performed which showed wide patency of subclavian vein. Fluoroscopic evaluation of leads show suggestion of lead fracture of left ventricular epicardial lead at clavicle as well as significant trauma to RV shocking coil also at insertion to subclavian vein, near clavicle. Noninvasive program stimulation performed with high energy shocks through defibrillator. 1.1 joule shock was delivered and deemed normal. 41 joule discharge performed with patient adequately sedated. This showed low impedance and likely insulation compromise to shocking coil. Right atrial and right ventricular pace sense leads were evaluated thoroughly and felt to be normal.
Coding:
36005, 93642.26, 99235.25 75860.26, 71090.26
Medicare paid everything except 36005 and denied bundled. In cpt 36005 says for extremity but on another coding website it tells the physician to bill 75860.26 with 36005 to capture the subclavian venography.
Any help would be greatly appreciated, how it should have been coded and why.