Wiki Need IR help please!

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Would anyone be able to help me with the coding on this? I'm new to IR coding and at a loss. Thank you in advance!

I originally thought 37238-LT, 75825, 37252, 37253, 37253, 76937, but have been told there's a claim edit that 76937 is an invalid add on code, as well as 37238 and 75827 might be incidental to one another (pretty sure I just need to add the 59 mod).

HISTORY: Chronic left lower extremity swelling, heaviness, discomfort, and nonhealing ulcer in the lateral calf.
SUMMARY OF PROCEDURES:
1. Ultrasound-guided access of the left great saphenous vein with direct puncture system, 9 French sheath.
2. Venogram of the left common femoral vein, iliac veins and lower inferior vena cava.
3. Intravascular ultrasound of the common femoral vein, iliac veins and lower inferior vena cava.
4. Placement of self expendable 16 mm stent spanning left iliac veins.
5. Balloon angioplasty of the left iliac veins.
6. Completion venogram and intravascular ultrasound.
TECHNIQUE AND FINDINGS:
The nature the procedure was discussed with the patient and her daughter, with the benefits, alternatives, and possible
complications, and written informed consent was obtained. Patient was placed supine on the angiography table.
Monitored anesthesia care was provided by anesthesiology service. Timeout was performed. The left groin was
prepared and draped in the sterile fashion. An ultrasound image of the patent great saphenous vein was stored for the
record. The skin and the deeper subcutis soft tissues were infiltrated with 1% lidocaine. Under direct sonographic
guidance, with moderate puncture system, access was obtained in the upper segment of the great saphenous vein, a
few centimeters below the saphenofemoral junction. The access was serially dilated to accommodate placement of a 9
French, 10 cm sheath. Through the sheath, venogram of the left common femoral vein through the inferior vena cava
was performed. This demonstrated patency of the common femoral vein, external iliac vein and common iliac vein, as
well as patency of the visualized infrarenal inferior vena cava. However, there was filling defect, consistent with
overlying external stenosis of the left common femoral vein, with a few transpelvic collaterals showing some flow
impedance through the left common iliac vein. For better visualization, intravascular ultrasound catheter was inserted
and the left common femoral vein through the inferior vena cava was investigated. This demonstrated again patency,
with no evidence of acute thrombotic occlusion. However the left external iliac vein was diffusely smaller in caliber
compared to the left common femoral vein. There was stenosis of the left common, from the overlying contralateral
common iliac artery, causing 65% luminal stenosis. This was consistent with May Thurner anatomy. Given the
symptomatology, and marrow then 60% luminal stenosis of the common iliac vein, we decided to proceed with stent
placement. Appropriate measurements were based on intravascular ultrasound. A 16 mm x 150 mm stent was placed in
the left common iliac vein through the mid external iliac vein, and an additional 16 mm x 80 mm stent was placed in
the mid to distal external iliac vein, overlapping by 2-3 cm. The stent was molded with a 16 mm balloon. Completion
venogram of the left patellofemoral veins demonstrated significantly improved luminal diameter and brisk in-line
flow, with no signs of extravasation. Intravascular ultrasound was then reinserted, and this demonstrated significantly
improved luminal diameter of the stented left iliac veins. No further interventions were deemed necessary at this time.
The sheath was removed over the guidewire. Manual compression was maintained for complete stasis. A sterile
dressing was applied. Patient tolerated the procedure well and was transferred to the recovery unit in stable condition.
 
Nicole,
Watch out for bundling, locating &counting vessels use modifiers such as 59 or XS, 22, 25 or laterality Rt or Lt and dx codes which are giving best details not unspecified .
Here are some examples of interventional radiology (IR) procedures and their associated CPT codes:
  • Neck soft tissue: CPT code 70360
  • Pharynx: CPT code 74210
  • Lumbosacral spine bending: CPT code 72120
  • Pelvis complete: CPT code 72190
  • Pelvis limited: CPT code 72170
  • Lumbosacral spine 6 VWS with bending: CPT code 72114
Some common IR procedures include:
Check in back of CPT manual ...Angiography, Balloon angioplasty or stenting, Chemo embolization, Cholecystostomy, Drain insertions, Embolization's, and Thrombolysis. Also with diagnosis codes ensure do not abuse Excludes 1 Rules
I hope helped you some what
Lady T
 
Hi Nicole,
76937 doesn't have enough information to code for it. 75820-LT,59 should have been coded instead of 75825 as the IVC gram was not a complete study. The IVUS was performed as a pull-back exam, so you can code 37252, but not 37253. The stent code looks good to me, as long as you enter it as a single unit of charge.
HTH,
Jim
 
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