Compliance Question of the Week – Cardiology

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?

A diagnostic cardiac catheterization is performed demonstrating two-vessel coronary disease. Due to contrast load, the procedure is staged. A lesion in the LAD is treated by a DES at the initial session and the right coronary lesion is treated at a separate encounter. Can the injection of the coronary arteries during the second encounter be coded and billed with code 93454 (coronary angiography only)?

Can the department charge for pre- and post-TAVR (transcatheter aortic valve replacement) hydration using CPT® 96360 and 96361? The patient sometimes received two hours of pre-hydration and three hours of post-hydration before and after the TAVR scan.

Can we bill the following code more than once for each additional linear ablation performed, or is there a limit to once per session?

93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure).

We were wondering which CPT® code to use for a volumetric computerized tomography (CT) scan of the heart to confirm pacemaker device placement, using contrast. We perform these CT scans after the device implant to check for lead placement/positioning when there have been capture issues.

We treated a patient with a chronic total occlusion (CTO) and attempted to get a balloon across the occlusion. We could not cross it. For hospital billing, do we report 92943-74 or 92920-74?

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)?