Compliance Question of the Week – Cardiology

I have a question concerning billing of the cardiac stress test. We perform the nuclear stress test in our nuclear medicine department. A cardiologist supervises the stress exam when the patient is on the treadmill. The cardiologist reads the ECG but not the nuclear images, and the nuclear medicine physicians read the nuclear images.

The nuclear medicine department bills CPT codes 78452, 93017 and A9500. Should the cardiologist be billing codes 93016 and 93018 for the supervision of the stress test and ECG read?

Can we bill for a temporary pacemaker (33210) and permanent pacemaker (33208) performed on the same day but at different sessions if modified appropriately?

In the instance when more than one site in the same vessel is treated with percutaneous transluminal coronary thrombectomy (92973), is it appropriate to report for each site treated?

Is the coding of a diagnostic cardiac catheterization different based on the access into the body (for example: radial versus femoral artery)?

If patient has a diagnostic heart cath with intravascular ultrasound (IVUS) one day and then is taken back to have intracoronary stents deployed with IVUS the next day, can IVUS be coded at both sessions?

When it is billed, does For LUMASON® (sulfur hexafluoride lipid-type A microsphere) for injectable suspension, for intravenous use or intravesical use need a separate diagnosis, or is it covered under the primary reason the echo was ordered? Previously (ICD- 9) we used 794.39 (abnormal result of other cardiovascular function study) to bill for any enhancer used during an echo. Should we still be doing this with the new ICD-10 code R94.39 (abnormal result of other cardiovascular function study)?

If a patient is brought to the cardiac cath lab and only bypass grafts were visualized (for example, SVG [saphenous vein graft] to the right coronary artery [RCA], and SVG to the circumflex) with no native coronary arteries being injected or imaged, what is the appropriate CPT procedure code to charge?

One of our cardiologists attempted to cannulate the right radial artery using ultrasound (US) guidance. He says the vessel was well-visualized, and the needle could be seen within the vessel, but there was no return of flow. After several attempts without success, he used the right femoral artery for the exam. Can we bill for the US guidance and the radial puncture?

In the cardiology question of 4-17-17, the provider asked what codes would be assigned for explanting the dual-system permanent pacemaker and implanting and attaching two new leads to the existing pacemaker on the other side of the chest. You stated that codes 33222, 33235 and 33217 would be assigned, but these only cover the relocation of a skin pocket and the electrodes. Based on the question, is the whole pacemaker being removed, relocated, and then re-implanted with two new leads? If so wouldn’t you code 33233, 33235, and 33208?

One of our cardiologists performed the following: a left heart cath w/ coronaries, then a selective left subclavian angiogram to see whether there was a stenosis in the subclavian, and then a selective left internal mammary artery (LIMA) looking at it for a possible grafting site. How would we code this?

We explanted the dual-system permanent pacemaker and then we implanted two new leads and attached them to the existing pacemaker on the other side of the chest. I can’t find one CPT code that captures what we did. Can you offer me insight into how you would code this?

We performed an electrophysiology (EP) study with intracardiac echocardiogram (ICE) and coronary sinus (CS) and left atrial (CS/LA) pacing and ablation for supraventricular tachycardia (SVT). Which code(s) can we report?