When to use New Moderate Conscious Sedation CPT codes in 2017

We have new Cpt codes for moderate conscious sedation in 2017. Yes, old codes for moderate sedation will be deleted from 2017 and we will be using new set of codes for these services. We have already learned about the new CPT codes of 2017 for stent placement.  Also, there are new CPT codes for AV fistula or graft access in 2017 and for the interventional procedure in dialysis circuit. So, let us first checkout the new codes in moderate sedation section and their description in detail.

When to use New Moderate Conscious Sedation CPT codes in 2017


New CPT code for Moderate Sedation


There are 6 new CPT codes for moderate sedation in 2017. These CPT codes are used to report moderate sedation in 15 minutes’ increments. Below is the code description of the new CPT codes in 2017 for moderate sedation.

99151 –   Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age

99152 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older

+99153 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (List separately in addition to code for primary service)

99155Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age

99156 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older

+99157 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (List separately in addition to code for primary service)


When to use CPT code 99151 and 99152


When same physician performing the diagnostic or therapeutic procedure also performs conscious sedation, we can report CPT code 99151 and 99152. If you read the description of these two CPT codes, you will understand the age of the patient will help you to code these procedures. If the patient is younger than 5 years, use CPT code 99151 and when the patient is older than 5 years, use CPT code 99152. Both these CPT codes should not be used together. Also, presence of the independent trained observer to monitor the level of patient consciousness is mandatory for coding CPT code 99151 and 99152. These CPT codes are the initial service codes for first 15 minutes for moderate sedation. For each additional 15 minutes we have separate add-on code, +99153.

When to use CPT code 99155 and 99156


When the moderate sedation is given by physician other than the physician performing the diagnostic and therapeutic services, then we can use CPT code 99155 and 99156. Also, these CPT codes are to be used for initial 15 minutes of services. For patient younger than 5 years use CPT code 99155 and older than 5 years use CPT code 99156. For each additional 15 minutes, use add-on CPT code +99157.







New CPT code changes in 2017 for Diagnostic and Screening mammogram.

Radiology facility has some very important CPT codes in 2017. Yes, this time we have some CPT codes introduced in radiology section. There are no changes in ultrasound, MRI, CT section. But, the screening and diagnostic mammogram has new CPT codes in 2017. Old mammogram codes will not be used from 2017. So, let us learn more about the new CPT codes changes of 2017 for medical coders.

New CPT code changes in 2017 for Diagnostic and Screening mammogram.



New CPT codes in 2017


Major changes in CPT codes has happened in surgery section. If you are an Interventional radiology coder (IVR) you will have to really learn many new codes in 2017. From 2016, the old CPT codes for angioplasty except for lower extremity are deleted. There are new CPTcodes for angioplasty in 2017 for IVR coders. Also, the radiological Supervision and interpretation (RS&I) of angioplasty CPT codes are deleted. The new CPT codes will bundle all the RS&I. As I have mentioned, there are new CPT codes for diagnostic and screening mammogram, so let us check out them.

New CPT code description for Diagnostic and Screening Mammogram


The new CPT codes are has similar code description like old codes. Only, the major difference is the inclusion of CAD (computer-aided detection) code with the mammogram CPT code. So, the old mammogram and CAD codes will get deleted from 2017. The new CPT codes description of mammogram is given below.

77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral

77066 Bilateral

77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

Continue using HCPCS G codes for diagnostic and Screening Mammogram for Medicare patients. You can use G0202, G0204 and G0206 in 2017 as well for mammogram.

Do and Don’t with Diagnostic and Screening Mammogram CPT code


Do not search or use an CAD code with mammogram CPT codes, it is included in the mammogram procedure code.

Use 52 modifier while coding for screening mammogram unilateral (77067-52). Since, we have only bilateral CPT code for screening mammogram, we have to use 52 modifier with CPT code for unilateral exam for reduced services.


Do not use diagnostic and screening mammogram CPT codes together. It is not possible to perform both exam together.  

Best Coding tips for CPT code 37215, 37216, 37217, 37218, 61635 and 61645

If you really want to be more accurate in stent procedure coding, you just need to remember two major points while coding stent placement CPT codes. First, medical coder should not code a separate radiological supervision and interpretation (RS&I) code with the main CPT code. The RS&I codes are included with main Stent placement CPT code. Also, do remember, the angioplasty procedure pre or post deployment, which were earlier coded separately, are also now included in the stent placement CPT codes when performed in same vessel. We have learned a lot about angiography coding, Transcatheter thrombolysis procedure codes or breast incision and excision biopsy, but coding stent procedure is not much from these exams. Interventional radiology (IVR) coders who are frequently stent procedures will be aware of these changes in Stent coding.  Before we go ahead do check the new CPT codes changes for 2017 as well.

Best Coding tips for CPT code 37215, 37216, 37217, 37218, 61635 and 61645

Point to remember for coding Stent placement CPT codes


Stent placement codes are coded per vessel and/or per lesion treated. We have learned about lower extremity stent placement cpt codes previously. The same guidelines follows here as well. Even, when the physician is placing multiple stent in a single vessel, we have to assign or report only one CPT code for one single blood vessel.  Same goes with the lesion, even if you encounter multiple lesion or continuous lesion present on two or more vessel, we have to report only one CPT code for stent placement.

All the minor exams from taking access for placing stent to post stent placed angiography procedures, all are included in the stent placement CPT codes. Hence, do not code any minor exam separately. Do not code and angiography or RS&I code separately while coding stent exams.


When to code CPT code 37215 and 37216

Stent placement in Cervical carotid region is report with CPT code 37215 and 37216. Below is the code description of both these codes.

37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection

37216           without distal embolic protection

Both the above CPT codes include angioplasty when performed on same vessel. When a distal embolic protection device is used to remove debris, report CPT code 37215 and when the device is absent use CPT code 37216.

Both 37215 and 37216 include ipsilateral cervical and cerebral diagnostic imaging; however, when imaging is performed of the head/neck vessels on the contralateral side, where a stent is not placed, report diagnostic angiography for imaging of those vessels.

When to code CPT code 37217 and 37218


Stent placement in common carotid artery or the innominate/brachiocephalic artery is reported with CPT code 37217 and 37218. Both, these CPT codes differ in the antegrade and retrograde approach for the placement of the stent in t this region. Below is the code description for both these CPT codes.

37217 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation

37218 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation

Use these codes to report stent placement in the portion of the common carotid artery from its origin, prior to entering the neck. CPT code 37217 and 37218 both includes angioplasty for stent placement when performed in the same vessel. Code 37217 describes stent placement via an open cervical carotid artery exposure. Assign 37218 for stent placement via an open or percutaneous antegrade approach. This is commonly performed via transfemoral access:

The provider may place a stent into the right brachiocephalic/ innominate artery via retrograde access of the ipsilateral brachial or axillary artery. In these instances, report 37236 (instead of 37218) because the procedure was not performed via antegrade approach. Open vessel exposure, closure of vessel, and ipsilateral cervical and cerebral diagnostic imaging are bundled into 37217 and 37218. If imaging is performed of the head/neck vessels on the contralateral side where a stent is not placed, report diagnostic angiography for imaging of those vessels.

When to code CPT code 61635 and 61645


Stent placement in the intracranial region is reported with CPT code 61635 and 61645.

61635 Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed

Code 61635 describes stent placement into an intracranial vessel. Intracranial vessels are within the skull and supply the brain. A portion of the internal carotid artery is considered extracranial, so be careful when selecting a code for stenting of the internal carotid artery.

CPT code 61635 includes all the selective catheterization procedures codes and imaging used for placing the stent. Also the radiological supervision and interpretation are included in CPT code 61635.


If imaging is performed of the head/neck vessels on the contralateral side, where a stent is not placed, report diagnostic angiography of those vessels.

Code 61635 also bundles angioplasty with stent placement in the same vessel. 61645 Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)

Code 61645 describes intracranial thrombectomy and/or infusion.


Do not report 61635 with 61645 for the same vascular territory. CPT 2016 states, “Code 61645 describes endovascular revascularization of thrombotic/embolic occlusion of intracranial arterial vessel(s) via any method, including mechanical thrombectomy (eg, mechanical retrieval device, aspiration catheter) and/or the administration of any agents(s) for the purpose of revascularization …” Report 61645 over 61635 for the same vascular territory.

New CPT code changes in 2017

There are lot of new CPT codes have been introduced in 2017. These new CPT codes should be used for all the reports having date of service 2017. Hence, it is very important to get updated with the new CPT codes. So, I am sharing few CPT codes from 3000 series, which will replace many old deleted codes. So, do learn about them and use them in surgery coding from 2017.

New CPT code changes in 2017


33340 - Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation)

Code 33340 was added to report the repair of a leaking artificial heart valve with the implantation of an synthetic implant. It replaces 0281T.
CPT guidelines state you should not report 33340 in conjunction with 93462 (Left heart catheterization by transseptal puncture through intact septum or by transapical puncture [List separately in addition to code for primary procedure]).

Do not report 33340 in conjunction with certain left heart catheterization procedures unless catheterization of the left ventricle is performed by a non-transseptal approach for indications distinct from the left atrial appendage closure procedure. See guidelines for prohibited procedures.

Do not report 33340 in conjunction with certain right heart catheterization procedures  unless complete right heart catheterization is performed for indications distinct from the left atrial appendage closure procedure. See guidelines for prohibited procedures.


33390 - Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension)
Code 33390 is one of two codes replacing 33400 (Valvuloplasty, aortic valve; open, with cardiopulmonary bypass); this code is for a simple valvuloplasty that requires only incision into the valve, removal of excess tissue, and/or simple resuspension of the junction between the two leaves (cusps) of the valve. Per CPT guidelines, do not report 33390 (Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex [e.g., leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty]) in conjunction with 33391.

33391 - Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; complex (eg, leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)
Code 33391  is one of two codes replacing 33400 (Valvuloplasty, aortic valve; open, with cardiopulmonary bypass); this code is for a complex valvuloplasty that involves resecting (removing) or extending the leaflet (cusp) of the valve or shortening of the circumferential ring around the valve (annuloplasty). Per CPT guidelines: Do not report 33391 (Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple [i.e., valvotomy, debridement, debulking, and/or simple commissural resuspension]) in conjunction with 33390.

36456 - Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn
Code 36456 was added to report blood transfusion in a newborn that requires the service of a physician or other qualified healthcare professional.
Per CPT guidelines:Do not report 36456 in conjunction with 36430 (Transfusion, blood or blood components), 36440 (Push transfusion, blood, 2 years or younger), or 36450 (Exchange transfusion, blood; newborn).

36473 - Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated

Code 36473 was added to report the use of mechanical and chemical 
destruction of an incompetent vein; codes for radiofrequency and laser ablation were already available.

CPT guidelines state that you cannot report 36473 in conjunction with certain codes in the same surgical field. See guidelines for prohibited codes.


36474 - Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

Code +36474 was added to report the use of mechanical and chemical destruction of additional incompetent vein(s) through separate access sites; codes for radiofrequency and laser ablation were already available. Per CPT guidelines, use +36474 in conjunction with 36473.

Do not report 36474 more than once per extremity. 

Do not report +36474 in conjunction with certain codes in the same surgical field. See guidelines for prohibited codes

36901- Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report

Code36901 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code to report diagnostic angiography, an imaging technique that uses contrast injection to visualize blood vessels) of the dialysis circuit (vessels involved in the filtration of waste materials from the blood in patients with kidney failure). Radiologic supervision and interpretation is included.

CPT  guidelines state that you cannot report 36901 more than once per operative session. Do not report 36901 in conjunction with 36833 (Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft [separate procedure]) or 3690236906 (Introduction of needle(s) and/or catheter(s), dialysis circuit,...).


36902 - Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

Code 36902 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code to report diagnostic angiography, an imaging technique that uses contrast injection to visualize blood vessels) of the dialysis circuit (vessels involved in the filtration of waste materials from the blood in patients with kidney failure).  This code includes balloon angioplasty as well as radiologic supervision and interpretation. Per CPT  guidelines, do not report 36902 in conjunction with 36903, and do not report 36902 more than once per operative session.

36903 - Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment Code

Code 36903 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code to report diagnostic angiography, an imaging technique that uses contrast injection to visualize blood vessels) of the dialysis circuit (vessels involved in the filtration of waste materials from the blood in patients with kidney failure) with the insertion of an intravascular stent. The code includes radiologic supervision and interpretation. CPT Guidelines state that you cannot report 36903 more than once per operative session. 

Do not report 36903 in conjunction with 36833 (Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft [separate procedure]) or 3690436906 (Introduction of needle(s) and/or catheter(s), dialysis circuit,...). For transluminal balloon angioplasty within central vein(s) when performed through dialysis circuit, use 36907. For transcatheter placement of intravascular stent(s) within central vein(s) when performed through dialysis circuit, use 36908.


36904 - Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)

Code 36904 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code to report thrombectomy and/or thrombolysis of the dialysis circuit. This procedure covers  the introduction of a catheter into a vessel in the dialysis circuit and extracts a blood clot (hematoma) with special instruments (thrombectomy) and/or injects a drug to dissolve the clot (pharmacological thrombolytic injection) and includes diagnostic angiography and radiological supervision and interpretation. 

Per CPT  guidelines, do not report 36904 in conjunction with 36905 or 36906 for a similar procedure with balloon angioplasty and stent placement in a peripheral dialysis segment respectively. Do not report 36904 more than once per operative session

36905 - Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

Code 36905 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code  to report thrombectomy and/or thrombolysis of the dialysis circuit. This procedure covers  the introduction of a catheter into a vessel in the dialysis circuit and extracts a blood clot (hematoma) with special instruments (thrombectomy) and/or injects a drug to dissolve the clot (pharmacological thrombolytic injection) and includes diagnostic angiography and radiological supervision and interpretation. This code also includes balloon angioplasty of a peripheral dialysis segment. CPT  guidelines state that you cannot report 36905 more than once per operative session.

Do not report 36905 in conjunction with 36904 (Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit,...), which does not include balloon angioplasty or stent placement or with 36906 (Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit,...with transcatheter placement of intravascular stent(s), peripheral dialysis segment,...).


36906 - Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit Code

Code 36906  is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code  to report thrombectomy and/or thrombolysis of the dialysis circuit. This procedure covers  the introduction of a catheter into a vessel in the dialysis circuit and extracts a blood clot (hematoma) with special instruments (thrombectomy) and/or injects a drug to dissolve the clot (pharmacological thrombolytic injection) and includes diagnostic angiography and radiological supervision and interpretation. This code also includes intravascular stent placement in a peripheral dialysis segment.

CPT guidelines instruct you to not report 36906 in conjunction with 36901-36903 (Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit,...), 36904 (Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method,...) 36905 (Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method,...balloon angioplasty, peripheral dialysis segment,...).
Do not report 36906 more than once per operative session.

36907 - Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)
Code +36907 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code in addition to a code for the primary procedure to report transluminal balloon angioplasty on the central dialysis segment. It includes imaging and radiological supervision and interpretation. 

CPT  guidelines state that you should report 36907 once for all angioplasty performed within the central dialysis segment. Use 36907 in conjunction with arteriovenous procedures 3681836833, diagnostic angiography of dialysis circuit procedures (36901-36903), and percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit procedures (36904-36906). 

Do not report 36907 in conjunction with 36908 (Transcatheter placement of intravascular stent(s), central dialysis segment...)


36908 - Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)

Code +36908 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code in addition to a code for the primary procedure to report transcatheter placement of an intravascular stent in the central dialysis segment. It includes imaging and radiological supervision and interpretation.

CPT  guidelines state that you should report 36908 only once for all stenting performed within the central dialysis segment. Use 36908 in conjunction with arteriovenous procedures 3681836833, diagnostic angiography of dialysis circuit procedures (36901-36903), and percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit procedures (36904-36906). 

Do not report 36908 in conjunction with 36907 (Transluminal balloon angioplasty, central dialysis segment,...)

36909 - Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)

Code +36909 is one of several new codes for diagnostic and therapeutic procedures performed on the dialysis circuit; use this code to report permanent endovascular occlusion or embolization to deliberately occlude (block) the dialysis circuit due to a malfunction. Radiological supervision and interpretation for any imaging procedure required to carry out the embolization or occlusion is included with this code. 

CPT  guidelines state that 36909 includes all permanent vascular occlusions within the dialysis circuit and may only be reported once per encounter per day. Report 36909 in conjunction with diagnostic angiography of dialysis circuit procedures (36901-36903), and percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit procedures (36904-36906). For open ligation/occlusion in dialysis access, use 37607 (Ligation or banding of angioaccess arteriovenous fistula).


37246 - Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
Code 37246 is one of two new codes for transluminal balloon angioplasty procedures on arteries other than intracranial arteries or those in the extremities, heart, lungs, and dialysis circuit. The procedure includes all imaging guidance and diagnostic imaging necessary to carry out the angioplasty and all radiological supervision and interpretation (RS&I). 

Transluminal balloon angioplasty (TBA) is a surgical procedure in which the provider passes a catheter with a balloon at its tip to an area of obstruction or narrowing in a blood vessel; he inflates the balloon, which flattens the plaque and intima (the innermost layer of the wall of a vessel) back up against the wall and increases the diameter of the lumen (open interior of the vessel). CPT  guidelines instruct you to use add-on code +37247 in conjunction with 37246 to report each additional artery. 

Do not report 37246 and 37247 in conjunction with 37215-37218 and 37236-37237 (Transcatheter placement of intravascular stent[s],...), 37220-37235 (Revascularization, endovascular, open or percutaneous...) when performed in the same artery during the same operative session.

Do not report 37246 and 37247 in conjunction with 34841-34848 for angioplasty[ies] performed, when placing bare metal or covered stents into the visceral branches within the endoprosthesis target zone. For transluminal balloon angioplasty in a dialysis circuit performed through the circuit, see 36902-36908. For transluminal balloon angioplasty in an intracranial artery, see 61630 and 61635; for coronary artery, see 92920-92944; and for pulmonary artery, see 92997 and 92998.


37247 - Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)

Code +37247 is one of two new codes for transluminal balloon angioplasty procedures on arteries other than intracranial arteries or those in the extremities, heart, lungs, and dialysis circuit. Use this code in addition to the primary code (37246) for each additional artery treated with transluminal balloon angioplasty. The procedure includes all imaging guidance and diagnostic imaging necessary to carry out the angioplasty and all radiological supervision and interpretation (RS&I).  

CPT  guidelines instruct you to use add-on code +37247 in conjunction with 37246 (Transluminal balloon angioplasty,... initial artery) to report each additional artery.

37248 - Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein

Code 37248 is one of two new codes for transluminal balloon angioplasty procedures on the veins, except for veins of the dialysis circuit. The procedure includes all imaging guidance and diagnostic imaging necessary to carry out the angioplasty and all radiological supervision and interpretation (RS&I). 

Transluminal balloon angioplasty (TBA) is a surgical procedure in which the provider passes a catheter with a balloon at its tip to an area of obstruction or narrowing in a blood vessel; he inflates the balloon, which flattens the plaque and intima (the innermost layer of the wall of a vessel) back up against the wall and increases the diameter of the lumen (open interior of the vessel). 
CPT  guidelines instruct you to use +37249 in conjunction with 37248 to report treatment of additional veins. 

Do not report 37248 and 37249 in conjunction with 37238 or 37239 (Transcatheter placement of an intravascular stent(s), ...), initial vein and additional vein respectively, when performed in the same vein during the same operative session


37249 - Transluminal balloon angioplasty (except dialysis circuit), open or 
percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure)

Code +37249 is one of two new codes for transluminal balloon angioplasty (TBA) procedures on the veins, except for veins of the dialysis circuit. Report this code in addition to the code for the primary procedure (37248) for each additional vein treated. The procedure includes all imaging guidance and diagnostic imaging necessary to carry out the angioplasty and all radiological supervision and interpretation (RS&I); do not report this code for a TBA on lower extremity, intracranial, coronary, or pulmonary arteries or the dialysis circuit. CPT  guidelines instruct you to use +37249 in conjunction with 37248 to report treatment of additional veins. 

Do not report 37248 and 37249 in conjunction with 37238 or 37239 (Transcatheter placement of an intravascular stent(s), ...), initial vein and additional vein respectively, when performed in the same vein during the same operative session


Sample report for Inpatient Coding Training


Sample Report 1- Inpatient Coding Training


PROCEDURE: Esophagogastroduodenoscopy with esophageal dilation.

INDICATIONS:  Dysphagia history of esophageal stricture weight loss nausea.

INSTRUMENTS: Olympus video upper endoscope.

MEDICATIONS: Versed 2  mg IV and Demerol 25 mg IV.

PHYSICAL EXAMINATION: GENERAL: The patient was in no distress. VITAL SIGNS: Stable.
CHEST: Clear  CARDIAC: Regular rate and rhythm. ABDOMEN: [Nondistended,
nontender]. NEUROLOGIC: The patient was alert and oriented.

DESCRIPTION OF PROCEDURE: Mr. Goodwin was placed in a left lateral position and IV sedation
was given in small incremental doses for the patient's comfort for moderate sedation. The throat was anesthetized with
Cetacaine spray.The endoscope was advanced without difficulty into the duodenum.

ESOPHAGUS: Esophagus the GE junction was  well distended. The
distal esophagus was not inflamed.  The esophagus was slightly tortuous..

STOMACH: [Stomach had minimal scattered erythema present hiatal hernia was present

DUODENUM: The duodenum was normal.

The endoscope was removed and Mr. Goodwin was placed in a sitting position.  A 50 and 52 French Maloney dilator was passed in the stomach with no resistance.  There was no blood on withdrawal of the dilators.
The patient tolerated the procedure well.

IMPRESSION:
1.  Empiric esophageal dilation to 50 French
2.  Gastritis
3. Slightly tortuous esophagus

ICD 10 PCS code0D758ZZ (dilation of Esophagus)
Dilation of Esophagus, Via Natural or Artificial Opening Endoscopic

Sample report for Inpatient Coding Training



Sample Report 2 - Inpatient Coding training 


Knee Replacement

PREOPERATIVE DIAGNOSIS:  Right knee degenerative arthritis.

POSTOPERATIVE DIAGNOSIS:  Right knee degenerative arthritis.

PROCEDURE PERFORMED:  Right total knee replacement.


ANESTHESIA: General endotracheal anesthesia.

TOURNIQUET TIME:  61 minutes.

IV FLUIDS: Crystalloids

ESTIMATED BLOOD LOSS:  100 ml.

SPECIMENS: None.

COMPLICATIONS: None.

IMPLANTS:
1. Titanium Stryker total knee replacement system size 6 femoral component, CR.
2. CR tibial base plate with a titanium stem size 7.
3. A 32-mm asymmetric polyethylene insert patella.
4. 11 mm polyethylene insert


BRIEF HISTORY: JAMES HUBERT HARRIS JR is a 65 year-old M patient.  Patient had complaints of right knee  pain.  X-rays showed evidence of advanced right knee tricompartmental osteoarthritis.  Patient had prior of sleep tried activity modification, physical therapy, oral anti-inflammatory medication as well as intra-articular cortisone steroid injection.  The patient understood that the risks involved in surgery include, but are not limited to risk of infection, damage to the nerve, blood vessel, need for further surgery, continued pain, DVT, pulmonary embolism, stroke, and even death. The patient volunteered an informed consent. The patient was seen on the day of surgery in preop holding area.  Surgical site was marked. The patient was then wheeled back into the operating room.

DESCRIPTION OF THE PROCEDURE: The patient was placed supine on the operating table. General endotracheal anesthesia was administered. Proper time-out was performed. 2 g of IV Ancef were given.  Right lower extremity tourniquet above the knee was applied.  Right lower extremity was scrubbed with Betadine brush followed by prep with ChloraPrep. We started with a midline approach. Skin and deep fascia were incised. Medial and lateral flaps were created. We then performed a medial parapatellar arthrotomy. The patella was everted.  Examination of the knee showed advanced tricompartmental osteoarthritis. We then proceeded with the preparation of the distal femur. Intramedullary femoral cutting guide was used. This was set at 5 degrees of valgus. After making the distal femoral cut, the distal femur was sized at size 6. We then used a size 6 cutting block and made the anterior femur, posterior femur, anterior chamfer, and posterior chamfer cuts.  We then proceeded with the preparation of the proximal tibia. The medial and lateral menisci as well as anterior cruciate ligaments were taken down. We performed recess of the posterior cruciate ligaments. The proximal tibial cut was made using the extramedullary tibial cutting guide. We then used a spacer to see our flexion and extension gaps, and these were symmetric.  We then sized the proximal tibia at size 7. We used a size 7 tibial preparation guide and prepared the proximal tibia. We then trailed with size 6 femur, size 7 tibia and found adequate stability.  We then proceeded with the preparation of the patella. Patella was sized down to size 14 mm remaining patella. We then used an eccentric patellar trial. We used a 11-mm poly insert trial.  The knee was carried through range of motion, and the knee was stable with good mechanical axis. We then proceeded with removal of the trial components. The bone cut area was irrigated with normal saline. We then used bone cement to fix the tibial component with the stem. This was followed by placement of the femoral component and the patellar component. The cement was allowed to settle.  Excess cement was removed. The 11-mm tibial polyethylene insert was used. The tourniquet was released. Hemostasis was achieved. The wound was closed in layers. A 1/8-inch Hemovac drain was used. The patient tolerated procedure very well and was taken to the recovery room in a stable condition.

DISPOSITION: The patient would be admitted to the Orthopedic Service. The patient would be starting on continuous passive motion machine in the recovery room. The patient would then start physical therapy this afternoon. The patient would be started on [Aspirin 325mg Bid]  starting tomorrow.

ICD 10 PCS code – 
0SRC0J9 Replacement of Right Knee Joint with Synthetic Substitute, Cemented, Open Approach


Sample Report 3 - Inpatient Coding Training 


PREOPERATIVE DIAGNOSIS:  Left knee end-stage degenerative joint disease.

POSTOPERATIVE DIAGNOSIS:  Left knee end-stage degenerative joint disease.

PROCEDURE:  Left total knee arthroplasty.

FINDINGS:  End-stage tricompartmental osteoarthritis.

SPECIMENS REMOVED: Portions of the distal femur, proximal tibia, and posterior patella.

EBL:  50 mL.

ANESTHESIA: General.

COMPLICATIONS: None.

TOURNIQUET TIME:  46 minutes at 250 mmHg.

IMPLANTS: Stryker Triathlon total knee system, metal size 3. Tibial base plate; metallic size 2 cruciate retaining femur; size 3 x 13 mm deep dish polyethylene insert; 29 x 9 mm asymmetric patella button.

SIGNIFICANT HISTORY, INDICATIONS, AND CONSENT:  Rhonda is a 58-year-old female with longstanding history of left knee pain recalcitrant to conservative treatment secondary to osteoarthritis. After discussing risks, benefits, and alternatives of non-operative treatment and operative intervention, the patient wished to proceed with surgical intervention and consent was obtained with potential benefits of improved knee pain and improved function.

OPERATION IN DETAIL: The patient was seen in the preop holding area. The left lower extremity was signed. Consent was reviewed, questions were answered, H and P updated. SCD was placed on the right lower extremity. The patient was taken to the operative room, placed in supine position on the operative table, anesthesia placed monitoring devices and performed intubation. Tourniquet was placed high on the left lower extremity with the left lower extremity being sterilely prepped and draped in the usual orthopedic fashion. Time-out was performed. The patient received prophylactic
antibiotics. Consensus was reached amongst participants in the OR suite.

Esmarch was used to exsanguinate the limb. Tourniquet raised to 250 mmHg. Standard anterior approach to the knee was performed incising sharply through skin and then performed a medial parapatellar arthrotomy. The superficial MCL was carefully released  subperiosteally of the proximal tibia medially. We then released anterior soft tissue structures, everted the patella and gently flexed the knee, being careful to avoid injury to the patellar tendon distally. Next, intramedullary guide was placed within the femur intramedullary canal. We then performed a distal femoral cut removing 8 mm, 5 degrees valgus.

After a distal cut was made, this was sized using a posterior condyle referencing system to be a size 2 femur, size to cutting block was placed and distal femoral cuts were made in standard fashion. ACL was removed and PCL gently retracted.  End-stage tricompartmental osteoarthritis with severe medial arthrosis and varus malalignment was noted.

Extramedullary guide was placed for a tibial cut, which was perpendicular to the tibia and in line with the tibial crest. Once this was placed, we removed 7 from the high side with 2 mm removed from the more worn plateau. After tibial cut was made, we checked our alignment and found this to be quite appropriate. We then performed flexion-extension gap measuring, and again addressed our soft tissue balancing to appropriately balance the knee.  The knee had laxity laterally and so the deep MCL was trephinated and a larger polyethylene insert sized.  Our tibial baseplate was sized and rotated in line with the medial 1/3 of the tibial tubercle. This was provisionally pinned and attention turned to our patella cut. Our patella was then sized, removing approximately 7 mm of bone after measuring 21 mm. 14 remained, this was sized to a 29 mm patella and the patella was drilled.  Components were placed and provisional implants were found to be acceptable in regards to range of motion and ligamentous stability  throughout the motion arc.  We then performed our fin cut and drilled our femoral implant. Provisional implants were then removed.  The cut surfaces were then thoroughly irrigated and dried for cementation.

Cementation was being mixed on the back table while we injected Exparel within the deep structures of the knee being careful to aspirate prior to injection. 0.25% Marcaine was also injected at this time in standard fashion. We then began cementation of our tibial, femoral, and patellar components in standard fashion. After these were cemented and held until cement had hardened, excess cement was removed.  Range of motion and stability were found to be appropriate. We then allowed tourniquet to be released and immaculate hemostasis was performed with Bovie cautery.  Medial parapatellar arthrotomy was closed at the superomedial border of the patella with #1 Ethibond in an interrupted fashion. The remainder of the arthrotomy closed with #1 Vicryl in a watertight closure. We used 2-0 Vicryl for subcutaneous closure and staples for skin. Sterile soft tissue dressing was placed. The patient was placed in the TED hose aroused by Anesthesia and taken to postanesthesia care in stable condition.

PLAN: The patient will be admitted to Orthopedic Service. Begin CPM in the PACU. Radiographs will be taken in the PACU. 24 hours perioperative antibiotics will be given with 14 days of DVT chemoprophylaxis, and physical therapy beginning this evening

ICD 10 PCS code: 
0SRD0J9 Replacement of Left Knee Joint with Synthetic Substitute, Cemented, Open Approach


 Sample Report 4 - Inpatient Coding training


PREOPERATIVE DIAGNOSIS: term IUP, failure to progress
POSTOPERATIVE DIAGNOSIS: term IUP, failure to progress
PROCEDURE: primary low transverse cesarean section

ANESTHESIA: spinal
ESTIMATED BLOOD LOSS:600 ml
COMPLICATIONS:none
DRAINS:foley to gravity
SPECIMENS:placenta to path
FINDING: viable female infant
INDICATIONS FOR PROCEDURE: lack of cervical change, inability to rupture membranes
DESCRIPTION OF PROCEDURE:


PREOPERATIVE DIAGNOSIS: A [39.6]-week gestation

POSTOPERATIVE DIAGNOSIS: A [39.6]-week gestation

PROCEDURE: Primary low-transverse cesarean section.


ANESTHESIA: [spinal]

COMPLICATIONS: None.

ESTIMATED BLOOD LOSS: 600 mL.

FINDINGS: Live-born [female] infant, Apgars [8] at 1, [9] at 5, [7] pounds [3] ounces.  Clear fluid and intact placenta. Normal uterus, ovaries, and fallopian tubes bilaterally.

PROCEDURE IN DETAIL: The patient was taken to the operating room and after adequate spinal anesthesia was achieved, she was prepped and draped as a sterile field. A Foley catheter had been previously placed. A Pfannenstiel incision was made 2 fingerbreadths above the pubic symphysis and
carried down to the fascia sharply. The fascia was incised in midline with a scalpel and extended laterally with Mayo scissors. The fascia was dissected off the underlying rectus muscles sharply. The rectus muscles were separated. The peritoneum was isolated and entered. The peritoneal incision was extended superiorly and inferiorly with Metzenbaum scissors, bladder blade was placed.
The peritoneum overlying the lower uterine segment was incised with Metzenbaum scissors to creat a  bladder flap behind on which the bladder blade was placed. A 1 centimeter incision was made in lower uterine segment with a scalpel and extended laterally in a blunt fashion. The infant was
delivered from the vertex presentation and suctioned on the maternal abdomen. The umbilical cord was clamped and cut. The baby was handed off to the awaiting pediatrician. The placenta was manually delivered and the uterus was externalized. The uterine cavity was wiped clean with a lap pad and noted to be devoid of any retained placental fragments. The uterine incision was closed with a running locking #1 chromic suture and a second #1 imbricating running suture. The uterus was then returned to the abdomen and irrigated with copious amounts of sterile saline, hemostasis was noted to be adequate at that time. A wedge of interceed was placed over the uterine incision.
The rectus muscles and peritoneum were reapproximated using running 2-0 vicryl sutures. The rectus fascia was closed with a running 0 Vicryl suture.
Subcutaneous tissue was closed with running 2-0 vicryl suture. The skin incision was closed with a subcuticular 4-0 moncryl suture. Once sponge and instrument counts were correct x3. The patient was taken to the LDRP in stable condition. The baby was also brought to the LDRP. 

IVF: 2100 ml
UOP 550 ml

ICD 10 PCS:
 10D00Z1 – Extraction of Products of Conception, Low Cervical, Open Approach
3E033VJ –  Introduction of Other Hormone into Peripheral Vein, Percutaneous Approach 
3E0P7GC - Introduce of Oth Therap Subst into Fem Reprod, Via Opening

  

Sample Report 5 - Inpatient Coding training 


PREOPERATIVE DIAGNOSIS:
1. Fibroid uterus
2. Menorrhagia

POSTOPERATIVE DIAGNOSIS: Same

PROCEDURE: Total abdominal hysterectomy and bilateral salpingectomy

ANESTHESIA: General.

COMPLICATIONS: None.

ESTIMATED BLOOD LOSS:  650 mL.

URINE OUTPUT: 500 mL of clear urine drained at the end of procedure.

SPECIMEN: Uterus, cervix and bilateral tubes, specimen weighed greater than 1078 g

PROCEDURE IN DETAIL: The patient was taken to the operating room, where she was prepped and draped in a sterile fashion. A Pfannenstiel skin incision was made through an old C-section scar and carried through to the underlying layer of fascia. The fascia was incised in the midline and this incision was extended laterally with the use of the Mayo scissors. The superior aspect of the
fascial incision was grasped with Kocher clamps, tented up, and the rectus muscles were dissected off bluntly and with the Mayo's. This procedure was repeated on the anterior aspect of the fascial incision. The muscles and peritoneum were separated in the midline using hemostats and entered
Sharply using the Metzenbaum scissors. This incision was extended superiorly and inferiorly with the use of the Metzenbaum scissors. Once intraperitoneal position had been verified, the specimen was palpated and noted to
be a large bulky fibroid uterus.  The uterus was delivered through the abdominal cavity.  Due to the size of the uterus it was not possible to place a self-retaining retractor. The ovaries were inspected and noted to be normal in appearance. The utero-ovarian ligaments were clamped, cut, and suture ligated, and the uterus was freed from the ovaries bilaterally.  The tube on the right side remained attached to the specimen however tube on the left side had to be cut from the specimen due to visualization.  The broad ligament was clamped, cut, and suture ligated sequentially and the bladder flap was created anteriorly. The cervix was sequentially clamped, cut, and ligated.  Right angle clamps were placed was the bottom of the cervix and this area was cut and suture ligated.  The edge of the cervix was noted on the left side so the cervix was hugged using the Jorgenson scissors and the specimen was amputated from the vaginal cuff. The vaginal cuff was closed using #0 Vicryl and figure-of-eight stitches.  Attention was then turned to the left tube and this was removed after clamping cutting and suture-ligated, and then the pelvis was irrigated.  There appeared to be a small area of bleeding on the right side so to visualize this the bowels were packed away with moist lap sponges.  There is noted to be bleeding on the right ovary.  This area was made hemostatic using figure-of-eight stitches.  After good hemostasis was noted, the moist lap sponges were removed from the abdominal cavity, and the sponge count was correct.  Ureters were palpated bilaterally to be intact.  The peritoneum was closed using 2 0 Vicryl in a running fashion.  The fascia was closed using #0 PDS in a running fashion, subcutaneous tissue was closed using 3 0 plain gut in a running fashion.  The skin was closed using 4 0 Monocryl in a subcuticular stitch with Dermabond on top.  The procedure was ended and the patient was brought to recovery room in stable condition.

ICD 10 PCS
0UT90ZZ  Resection of Uterus, Open Approach
0UTC0ZZ  Resection of Cervix, Open Approach
0UT70ZZ   Resection of Bilateral Fallopian Tubes, Open Approach