Compliance Question of the Week – Cardiology

Can we charge for two kissing balloons when one is for a lesion and one is for protection of a stent but no lesion? The internal iliac had a lesion, and the external iliac had a stent that needed protection. Would the codes be 37220 and 37222?

If a temporary pacemaker lead is inserted during a diagnostic heart cath, is it appropriate to charge for this lead placement if the patient does not leave the procedure room with it (the pacemaker lead)?

This is a follow-up to the answer to last week’s (5-29-2018) cardiology question regarding claims for replacement ICDs (implantable cardioverter defibrillators) that were denied because they didn’t have a modifier. The provider asked whether they could request an adjustment for these, and you replied, “Yes, you may request an adjustment for claims for any date of service for which the replacement ICD was otherwise covered (as long as the claim was denied solely because it lacked a QR modifier).”

Don’t you mean a Q0 modifier (investigational clinical service provided in a clinical research study that is in an approved clinical research study)? We have been using Q0 per CMS direction for two years now—ever since our EP program began placing ICDs, and we have had no issues. Please clarify why you believe a QR still applies.

We have had claims for replacement ICDs denied because they didn’t have a modifier. Can we request an adjustment for these?

Can an endarterectomy be coded separately?

Can you explain the steps involved in ligating and dividing the long saphenous vein and the code choices for this procedure?

When a left heart catheterization is performed with coronary artery angiography but no left ventriculogram is performed, what is the proper coding?

Is there a CPT® code for magnetocardiography?

We are getting conflicting information on split-shared evaluation and management (E & M) visits in the hospital. The Medicare information I have found says that a consult code cannot be split-shared. But our question is this: If the patient has Medicare and we cannot bill the consult code, can that visit be split-shared if the intent was a consult?

What codes should be assigned for the ECG provided during Medicare’s initial preventive physical examination (IPPE)?

In echocardiogram interpretations, I see “LV diastolic dysfunction (pseudonormal filling)” frequently and need some advice as to what would be the correct ICD-10 code.

The 2018 ICD-10 code book takes me to the entries below:
Dysfunction – Heart: I51.89 (other ill-defined heart diseases) or Dysfunction – Ventricular: I51.9 (heart disease, unspecified)
Left: reversible following … I51.81 (Takotsubo syndrome)

A Google search for “pseudonormal filling” give me I50.30—unspecified diastolic (congestive) heart failure, but there is no choice for this in the code book.

For Medicare hospital billing, if a planned PTCA is attempted but the balloon cannot be advanced across the lesion, can we bill for the attempted angioplasty?