Question

should these be reported single-chamber pacemaker, dual-chamber pacemaker, or biventricular pacemaker?

A physician performs an open transluminal balloon angioplasty of both the left and right iliac artery. How should this service be reported?

2. A radiologist provides radiologic supervision and interpretation for a venous percutaneous transluminal balloon angioplasty (PTA). How should the radiologist’s professional services be reported?

3. A venous blood sample was obtained from an adult patient during an office visit by the nurse. What CPT code may be used to report for obtaining the blood sample?

Answer 1

1.OPEN TRANSLUMINAL BALLOON ANGIOPLASTY OF BOTH THE LEFT AND RIGHT ILIAC ARTERY  

• Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a "balloon" at the end of it. When the tube is in place, it inflates to open the blood vessel, or artery, so that normal blood flow is restored.

• The left and right common iliac arteries are the terminal branches of the abdominal aorta. They give off small branches to surrounding structures before dividing into the internal and external iliac artery.

• Peripheral artery disease (PAD) is a significant medical problem, particularly among the elderly population because it is associated with a significantly elevated risk of cardiovascular disease morbidity and mortality.Elderly patients who undergo surgical intervention have higher post operative mortality.Hence, percutaneous transluminal angioplasty (PTA) has become an accepted alternative to bypass surgery in patients with PAD.

2.Venous Percutaneous Transluminal balloon Angioplasty (PTA)

Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a "balloon" at the end of it. When the tube is in place, it inflates to open the blood vessel, or artery, so that normal blood flow is restored.

NECESSITY

Fatty deposits can build up in your blood vessels, reducing blood flow and in some cases, blocking it completely. The biggest danger from fat build up is that pieces may break off, form clots, and cause a heart attack or stroke. The PTA can open blocked arteries and reduce these risks.

PROCEDURE

The radiologist will insert a balloon-type catheter into an artery in your groin or arm. The doctor will inflate the balloon several times, for about one minute each time, in order to "push" the fatty deposits against the artery wall. The technologists working with the doctor will take X-ray pictures to make sure the blockage is opened. When blood is flowing freely through the artery, the balloon catheter is taken out.

EXPECTATIONS

Before the procedure:

• The procedure may be performed immediately after your diagnostic leg arteriogram, which was used to find the fatty build-up, or it may be done the following day.
• You may need to be admitted to the hospital for overnight observation.

During the procedure:

1. The balloon catheter is guided to the exact site of the blockage. The balloon is then inflated slowly with a pump that is filled with dye, which lets your doctor see the artery on a special monitor screen.
2. The balloon may be inflated several times, 30 to 60 seconds each time, until the blockage is opened.
3. You may have some discomfort when the balloon is inflated. It will go away when the balloon is deflated. Let your the doctor know if you feel discomfort.
4. The balloon is taken out and pictures are made to make sure the blood is flowing smoothly. If not, the balloon will be used again.
5. The catheter and wire are removed once the pictures show that blood is flowing well.
6. A small tube called a sheath may stay in the artery, connected to a monitoring system, after the procedure for two to four hours. In some cases, it may stay in overnight. This is to make sure the blood is flowing smoothly.
7. The procedure takes about an hour and a half.

After the procedure:

1. You may go to the recovery area or to your hospital room.
2. You must lie flat on your back while the sheath is in place. The head of the bed may be tilted up a little to help you rest. You will be able to bend the other leg to relieve pressure on your back, or the nurse may roll you on your side. If you feel back pain, your doctor can prescribe medication to make you comfortable.
3. When it is safe to remove the sheath, the doctor or nurse will apply pressure to the area for 20 to 30 minutes. A sand bag and dressing may be applied after this.
4. You must stay in bed for another twelve hours. Within a few hours, the nurse will raise the head of the bed a little higher for your comfort.
5. Most patients go home the next day.

3.Common Procedural Technology (CPT codes) are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services and Venous blood is the specimen of choice for most routine laboratory tests. The blood is obtained by direct puncture to a vein, most often located in the antecubital area of the arm or the back (top) of the hand.

• Codes 36415 and 36416 are for the collection of blood for lab testing. 36415 Collection of venous blood by venipuncture 36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick).