Compliance Question of the Week – Cardiology

A patient undergoes coronary IVUS in the cath lab. The physician states in his report, “IVUS was used for stent sizing.” No additional information is provided (other than identification of the specific artery evaluated). Is this sufficient documentation to support coding the IVUS?

Which CPT® code would a hospital bill if an inpatient has a PICC placed, but after multiple attempts and repositioning, the surgeon cannot pass the PICC line, which is positioned in the internal jugular vein near its junction with the subclavian vein? Context: The skin is anesthetized with lidocaine, and the brachial vein is accessed to insert the line. Multiple attempts to reposition the line were performed with chest x-rays after each repositioning. The line did not terminate in the subclavian, brachiocephalic, or iliac vein, SVC, IVC, or right atrium. The surgeon wants the hospital to charge CPT codes 36573 and 76937, which are incorrect.

When specifically, can 76376 be used in the echocardiographic setting? Can we use this to 3D image the left atrial appendage? Do we need a specific order for the 3D?

How would you code a procedure where the physician selectively catheterizes the internal carotid artery and performs intracranial carotid imaging, along with imaging of the arch and extracranial carotid arteries, and then selectively catheterizes the internal carotid artery on the opposite side with intracranial imaging?

When do we report 36223 as opposed to 36221 and 36222?

When do we assign 36222 and do we include 36221?

When is code 75898 not separately billed??

When can 90316 and 93018 be billed separately?

What additional procedure may be performed along with a basic 2D echocardiogram of the fetal heart, and how is it coded when medically necessary and documented in the patient record?