Category I Code examples
Surgery Code 37298
Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel.
Clinical example
A 79-year-old male, who has diabetes mellitus and is not a candidate for open surgical reconstruction, presents with extensive ischemic wounds on his right third and fourth toes. Diagnostic studies reveal an occlusion of the dorsalis pedis artery in the midfoot with reconstitution into a patent pedal arch, which is treated with balloon angioplasty.
Description of procedure
Cannulate a suitable access vessel either percutaneously or via open exposure and manipulate a catheter and guidewire into the occluded dorsalis pedis artery using fluoroscopic guidance. Perform angiography and obtain roadmapping images to assess vessel size and confirm anatomy. Establish a stable sheath access within an infrapopliteal vessel to cross the occlusion area with a guidewire using advanced techniques. Exchange wires and catheters to create a stable staging platform suitable for performing the intervention. Advance and position an appropriately sized angioplasty balloon catheter to the occlusion area using fluoroscopic guidance, and dilate the lesion by inflating the balloon to the appropriate pressure and time for lesion dilation. Remove or pull back the balloon over the wire and obtain follow-up images with contrast injection to determine if a flow-limiting dissection has occurred. Treat all segments of occlusion within the same dorsalis pedis segment with appropriately sized balloon(s). Once a satisfactory result has been shown with the absence of extravasation and flow-limiting dissection, confirm vessel patency and remove the wire and sheath. Obtain hemostasis, and close the arteriotomy using manual pressure, application of an arterial closure device, or suture for standard surgical closure of the puncture.
Surgery Code 37299 (child code to 37298, add-on code)
complex lesion, each additional vessel (List separately in addition to code for primary procedure).
Clinical example
A 79-year-old male, who has diabetes mellitus and extensive ischemic wounds on his right third and fourth toes and is not a candidate for open surgical reconstruction, presents with occlusions of the dorsalis pedis artery and medial plantar branch of the posterior tibial artery in the midfoot with reconstitution into a patent pedal arch during an endovascular treatment. After a separately reported angioplasty of an occlusion of the dorsalis pedis, an additional angioplasty of an occlusion in the medial plantar branch of the posterior tibial artery is performed. [Note: This is an add-on service. Only consider the additional work related to treating the occlusion in the medial plantar artery.]
Description of procedure
Sheath access that is stable in an infrapopliteal vessel was already established. Begin with the manipulation of a catheter and guidewire into the diseased medial plantar artery using fluoroscopic guidance. Using advanced techniques, cross the occlusion. Perform angiography and obtain roadmapping images to assess vessel size and confirm anatomy. Exchange wires and catheters to create a stable staging platform suitable for performing the intervention. Advance and position an appropriately sized angioplasty balloon catheter to the area of occlusion using fluoroscopic guidance, and dilate the lesion by inflating the balloon to the appropriate pressure and time. Remove or pull back the balloon over the wire and obtain follow-up images with contrast injection to determine if a flow-limiting dissection has occurred. Treat all segments of occlusion within the same medial plantar segment with appropriately sized balloon(s). Perform completion angiography to confirm vessel patency, satisfactory treatment result, and absence of extravasation, embolization, and flow-limiting dissection.
Medicine code 92628
Evaluation for hearing aid candidacy, unilateral or bilateral, including review and integration of audiologic function tests, assessment, and interpretation of hearing needs (e.g., speech-in-noise, suprathreshold hearing measures), discussion of candidacy results, counseling on treatment options with report, and, when performed, assessment of cognitive and communication status; first 30 minutes.
Clinical example
A 69-year-old male presents with a diagnosis of moderate, bilateral sensorineural hearing loss. His primary complaint is a hearing problem that makes it increasingly difficult to communicate with his spouse, other family members, and at work meetings. He is referred for an evaluation to determine hearing-aid candidacy.
Description of procedure
The qualified healthcare professional (QHP) reviews the patient’s medical record, including any communications and/or treatments from the referring physician or other QHP, diagnostic audiologic evaluations, relevant comorbidities, and other psychosocial factors that may direct strategies for the patient’s care plan. Obtain a focused medical history from the patient and/or his family or caregiver, including relevant comorbidities, present or previous experience with hearing technology, perception of the hearing deficit and its effects on functional communication, and treatment goals. If indicated, administer formal questionnaires to further assess communication status, typical listening environments, patient well-being, and psychosocial factors that may direct strategies for hearing-amplification treatment. Perform an otoscopic examination. The QHP chooses and completes any additional testing necessary to determine the patient’s loudness-discomfort levels, speech-in-noise ability, cognitive and communication status, and other tests as appropriate. The QHP synthesizes relevant medical history, diagnostic audiologic evaluation, communication needs, and additional test results to formulate a hearing-technology candidacy recommendation and treatment plan. The QHP describes the patient’s current diagnostic audiologic test results and explains how those results might affect the patient’s communication function, as well as the results of the hearing-aid candidacy determination evaluation, to the patient and/or his family or caregiver. The QHP provides an overview of the recommended care plan and hearing-device treatment options, if needed. The QHP responds to any additional questions from the patient and/or his family or caregiver. The QHP prepares a report on the candidacy-evaluation and counseling outcomes and documents the encounter in the medical record. If indicated, provide the patient and/or his family or caregiver with information on hearing-aid candidacy selection services.
Medicine code 92920
Percutaneous transluminal coronary angioplasty, single major coronary artery and/or its branch(es).
Clinical example
A 68-year-old female presents with unstable angina. Coronary arteriography demonstrates diffusely diseased coronary arteries with 90% lesions in both the mid and distal parts of a tortuous left anterior descending artery. The vessel diameter is smaller than the smallest available stent. Percutaneous coronary intervention is performed.
Description of procedure
Obtain percutaneous arterial access, typically through the femoral artery or the radial artery. Perform angiography of the access site as needed to assess the anatomy of the access vessel and confirm the appropriate location of the access site. Place and flush a sheath. Administer intra-arterial vasodilators. Pass an appropriate guiding catheter under fluoroscopic guidance to the ascending aorta, engage it into the coronary ostium, and reposition as needed to prevent pressure damping. Confirm the appropriate antiplatelet therapy treatment and administer anticoagulation. Confirm therapeutic anticoagulation by testing activated clotting time (ACT). Administer additional anticoagulation as needed.
Perform multiple coronary injections in different views to assess the target lesion(s). Use a coronary guidewire to cross the target lesion(s) and confirm its distal position in the artery. Advance the coronary dilation balloon over the guidewire to the lesion and perform dilation until adequate. Then pull it back into the guide. Perform angiography in multiple views. If the lesion is not fully expanded, repeat the angioplasty procedure using larger or less compliant balloons as needed, and perform a repeat angiography. The entire process of coronary artery imaging, guidewire placement, and balloon inflation may be repeated at multiple stenotic sites in separate locations within the coronary artery or its branches. At the end of the procedure, disengage and remove the guide catheter. Remove the sheath and achieve hemostasis using an appropriate technique. If a vascular closure device cannot be used with femoral access, suture the sheath in place for subsequent removal once the ACT level falls to a safe level for manual compression.
Pathology/laboratory examples
Chemistry code 83884
Neurofilament light chain (NfL).
Clinical example
A 38-year-old female, who has an established diagnosis of multiple sclerosis, is referred to a neurologist to monitor disease activity. A blood sample is obtained for neurofilament light chain (NfL) testing.
Description of procedure
Test sample for NfL chain by quantitative immunoassay. Report results.
Chemistry code 86581
Streptococcus pneumoniae antibody (IgG), serotypes, multiplex immunoassay, quantitative.
Clinical example
A 6-year-old female presents with a history of recurrent ear infections, bronchitis, and pneumonia. A pneumococcal vaccine is administered and follow-up levels of Streptococcus pneumoniae antibody (IgG) serotypes are requested to assess for potential immunodeficiency.
Description of procedure
Test the patient’s serum by multiplex immunoassay. Report the quantitative results.
MAAA code 81524
Oncology (central nervous system tumor), DNA methylation analysis of at least 10,000 methylation sites, utilizing DNA extracted from formalin-fixed tumor tissue, algorithm(s) reported as probability of matching a reference tumor family and class, and MGMT (O-6-methylguanine-DNA methyltransferase) promoter methylation status, if performed.
Clinical example
A 20-year-old female presents with a brain tumor that cannot be histologically classified. Tissue is submitted to better define the tumor type using the DNA methylation classifier.
Description of procedure
Perform tumor methylation analysis on DNA extracted from the tumor tissue. Process the DNA methylation profiling data based on the tumor classifier and generate a classification score that indicates a probability of a match to one of the tumor classes of the central nervous system. Generate and submit a report to the ordering provider.
Microbiology code 87183
carbapenem resistance genes (e.g., blaKPC, blaNDM, blaVIM, blaOXA-48, blaIMP), amplified probe technique, per isolate.
Clinical example
A 75-year-old male, who is from a nursing home facility, is admitted with a fever and buttock cellulitis associated with a decubitus ulcer. A blood culture yielded a gram-negative bacillus. Gene testing for carbapenem-resistance is ordered.
Description of procedure
Pure bacterial isolate undergoes bacterial DNA extraction and purification, followed by polymerase chain reaction for target amplification and detection. Report the carbapenem-resistance gene test results.
Digital Pathology Digitization Procedures code 0751T (add-on code)
Digitization of glass microscope slides for level II, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure).
Clinical example
A 48-year-old female’s ventral hernia specimen is examined. Glass microscope slide digitization is performed. [Note: This is an add-on code. Only consider the additional work related to 0751T glass microscope slide digitization.]
Description of procedure
Scan glass microscope slides using a digital slide imaging system and store the images.
