Compliance Question of the Week – Cardiology

We have a new vascular surgeon asking us to perform ankle/brachial indices (ABI) plus arterial Doppler of both lower extremities, then have the patient walk on the treadmill and rescan the patient after walking. Is there a code for this?

If we perform a Duplex scan of the renal vasculature and a Duplex scan of the abdomen assessing the mesenteric vasculature, would we assign CPT® code 93975 with one unit or assign 93976 twice with two units?

Our doctor performed selective catheterization and angiography of the external carotid artery to look for the cause of epistaxis. He did not perform a common carotid or internal carotid angiogram. Code 36227 is an add-on code that requires a primary code. What code(s) would be reported when a primary procedure is not performed?

I have a provider who saw a patient with an E/M but also did an isuprel challenge, 93623. Since that is an add-on code, is there anything we can bill for this service? Should I use an unlisted code?

What constitutes a “congenital” disease for echocardiogram?  PFOs (patent foramen ovale) and bicuspid aortic valves are not considered “congenital” for cardiac catheterization, but I wasn’t sure if the same applied to echocardiograms.

In a hospital or outpatient setting who should be billing for Definity when administered for a stress echo with contrast if the office does not own the equipment? Here are the options we’ve come up with:

Physician bills CPT® code 93352
Hospital bills HCPCS code C8930
Both bill Q9957 for the contrast

Is it appropriate to code for the insertion of a temporary pacemaker and a generator change at the same setting?

What electrophysiology code would be reported for atrial flutter ablation?

Is it appropriate to code for the insertion of a temporary pacemaker and a generator change at the same setting?

With calcium scoring, 76376 is bundled; however, 76377 can be assigned with a modifier. My radiologists always do the reformation of images for these studies on a separate workstation. With proper documentation, can I assign the following code on those studied?

76377 3D rendering with interpretation and reporting of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

Can mitral valvuloplasty (92987) be billed with the transseptal puncture code (93462)?

92987 Percutaneous balloon valvuloplasty; mitral valve
+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)

I am looking for the correct codes to assign when our provider documents that bilateral selective carotid artery angiogram and intracerebral artery angiogram were performed followed by selective left subclavian artery and left vertebral artery angiogram. Would the correct coding be CPT® 36223-50 and 36226-LT? Or would it be 36223-50 and 36225-LT?