5
AMERICANMEDICALASSOCIATION
CodingResourcesGuide, September 2015
CPT®ProceduralCoding
© 2015DecisionHealth
CPT© 2014AmericanMedicalAssociation.All rights reserved.
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AddOnCode
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Pub 100
NoPub100 references apply.
FacilityRVUs
Global:
XXX
Code
Work
PE
Facility
MP Total Facility
36595 3.59 1.35
.53
6.29
Non-facilityRVUs
Code
Work
PENon-
Facility
MP
TotalNon-
Facility
36595 3.59 1.35
.53
14.88
Modifiers
(PAR)
Mod 50 Mod51 Mod 62 Mod 66 Mod 80
0
2
0
0
0
PlainEnglishDescription
One common complication of a semi-permanent
CVC is the formation of a fibrin sheath at the tip of
the catheter that causes obstruction or reduced flow
through theCVC.A separately reportable venogram
is performed and the existence of a fibrin sheath or
other pericatheter obstructivematerial confirmed.A
separate venous access site is prepped.The vein is
incised and a sheath placed.A guidewire is placed
and a snareguiding catheter introduced over the
guidewire using separately reportable radiological
guidance.The snareguiding catheter is advanced
to the site of the pericatheter obstruction at the tip
of the existingCVC.The guidewire is removed and
a snare advanced to the site of the obstruction.
The fibrin sheath or other obstructivematerial is
mechanically removed by stripping it awaywith the
snare.Patency of theCVC is evaluated by injecting
intravenous fluid.The snare and snareguiding
catheter are removed.The separate venous access
site is closedwith sutures.
Removalofpericatheterobstructive
material from central venousdevice
Central
venous
device
Device to remove
obstruction is
inserted through
separate vein
Obstructive
material
Femoral vein
ICD-9-CMDiagnosticCodes
996.1
Mechanical complication of other vascular
device, implant,and graft
996.62 Infection and inflammatory reaction due to
other vascular device, implant,and graft
996.74 Other complications due to other vascular
device, implant,and graft
V58.81 Fitting and adjustment of vascular catheter
ICD-10-CMDiagnosticCodes
7
T82.828 Fibrosis of vascular prosthetic devices,
implants and grafts
ICD-10-CMCodingNotes
Refer to your ICD-10-CM book for a list of all 7th
character extensions for codes requiring a7th digit
character.For some procedures,only certain7th
characterswill apply.Review the 7th character
descriptions and coding guidelines to ensure that the
appropriate 7th character is assigned.
36595
36595 Mechanical removal of
pericatheter obstructive
material (eg,fibrin sheath)
from central venous device via
separate venous access
(Do not report 36595 in conjunction
with 36593)
(For venous catheterization see36010-
36012)
(For radiological supervisation and
interpretation,use75901)
AMACodingGuideline:
CentralVenousAccessProcedures
To qualify as a central venous access catheter
or device, the tip of the catheter/devicemust
terminate in the subclavian,brachiocephalic
(innominate) or iliac veins, the superior or inferior
vena cava,or the right atrium.The venous access
devicemay be either centrally inserted (jugular,
subclavian, femoral vein or inferior vena cava
catheter entry site) or peripherally inserted (eg,
basilic or cephalic vein).The devicemay be
accessed for use either via exposed catheter
(external to the skin), via a subcutaneous port or
via a subcutaneous pump.
The procedures involving these types of devices
fall into five categories:
1. Insertion (placement of catheter through a
newly established venous access)
2.Repair (fixing devicewithout replacement
of either catheter or port/pump,other than
pharmacologic ormechanical correction of
intracatheter or pericatheter occlusion [see 36595
or 36596])
3.Partial replacement of only the catheter
component associatedwith a port/pump device,
but not entire device
4.Complete replacement of entire device via same
venous access site (complete exchange)
5.Removal of entire device.
There is no coding distinction between venous
access achieved percutaneously versus by
cutdown or based on catheter size.
For the repair,partial (catheter only) replacement,
complete replacement,or removal of both
catheters (placed from separate venous access
sites) of amulti-catheter device,with orwithout
subcutaneous ports/pumps,use the appropriate
code describing the servicewith a frequency of
two.
2016CPT®CodingEssentials forCardiology
36595
CPT®ProceduralCoding
6
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AddOnCode CPT© 2014AmericanMedicalAssociation.All rights reserved.
©2015DecisionHealth
ICD-10-CMCodingNotes
Refer to your ICD-10-CM book for a list of all 7th
character extensions for codes requiring a 7th digit
character.For some procedures,only certain 7th
characterswill apply.Review the7th character
descriptions and coding guidelines to ensure that the
appropriate 7th character is assigned.
Pub100
No Pub100 references apply.
FacilityRVUs
Global:
XXX
Code
Work
PE
Facility
MP Total Facility
64450 .75
.49
.07
1.31
Non-facilityRVUs
Code
Work
PENon-
Facility
MP
TotalNon-
Facility
64450 .75
1.46
.07
2.28
Modifiers
(PAR)
Mod 50 Mod51 Mod 62 Mod 66 Mod80
1
2
0
0
1
Injection,anestheticagent;
pudendalnerve
Perineum
Huber needle
injection in
pudental nerve
Deep tissue
injection in vulva
ICD-9-CMDiagnosticCodes
185
Malignant neoplasm of prostate
|
236.5
Neoplasm of uncertain behavior
of prostate
|
338.11 Acute pain due to trauma
338.18 Other acute postoperative pain
338.19 Other acute pain
338.21 Chronic pain due to trauma
338.28 Other chronic postoperative pain
338.29 Other chronic pain
338.3
Neoplasm related pain (acute) (chronic)
338.4
Chronic pain syndrome
353.1
Lumbosacral plexus lesions
353.4
Lumbosacral root lesions,not elsewhere
classified
617.3
Endometriosis of pelvic peritoneum
~
618.7
Old laceration ofmuscles of pelvic floor
~
618.83 Pelvicmusclewasting
~
625.5
Pelvic congestion syndrome
~
ICD-10-CMDiagnosticCodes
C76.3
Malignant neoplasm of pelvis
C79.89 Secondarymalignant neoplasm of other
specified sites
G58.8
Other specifiedmononeuropathies
G89.11 Acute pain due to trauma
G89.18 Other acute postprocedural pain
G89.21 Chronic pain due to trauma
G89.28 Other chronic postprocedural pain
G89.29 Other chronic pain
G89.3
Neoplasm related pain (acute) (chronic)
G89.4
Chronic pain syndrome
N80.3
Endometriosis of pelvic peritoneum
N80.4
Endometriosis of rectovaginal septum and
vagina
N94.810 Vulvar vestibulitis
N94.818 Other vulvodynia
N94.819 Vulvodynia,unspecified
N94.89 Other specified conditions associatedwith
female genital organs andmenstrual cycle
O71.89 Other specified obstetric trauma
R10.2
Pelvic and perineal pain
7
S34.6XX Injury of peripheral nerve(s) at abdomen,
lower back and pelvis level
7
S34.8XX Injury of other nerves at abdomen, lower
back and pelvis level
7
S34.9XX Injury of unspecified nerves at abdomen,
lower back and pelvis level
7
S38.03X Crushing injury of vulva
7
S39.848 Other specified injuries of external genitals
7
S39.94X Unspecified injury of external genitals
64430
64430 Injection,anesthetic agent;
pudendal nerve
AMACodingGuideline:
Introduction/InjectionofAnestheticAgent
(NerveBlock),DiagnosticorTherapeutic
(For destruction by neurolytic agent or
chemodenervation, see62280-62282,64600-
64681)
(For epidural or subarachnoid injection, see
62310-62319)
(64479-64487,64490-64495 areunilateral
procedures.Forbilateralprocedures,usemodifier
50)
PlainEnglishDescription
The physician performs a pudendal nerve block
by injecting an anesthetic agent into the nerve.
Pudendal nerve block is used during the second
stage of labor to provide pain relief, for pelvic floor
relaxationwhen forceps delivery is needed,and
to provide anesthesia of the perineum for creation
or repair of an episiotomy.The blockmay be
administered via a transvaginal or transcutaneous
perineal approach.Using a transvaginal approach,
the ischial spine on the first side to be injected is
palpated.AHuber needle is used to limit the depth
of submucosal penetration.The needle is passed
through the sacrospinous ligament and advanced
about 1 cm.The physician ensures that the
needle is in the proper location and that it has not
penetrated the pudendal vessels by pulling back
on the syringe. If blood is aspirated the needle is
reposited.Aspiration is again performed and if no
blood is present, the anesthetic is injected.The
procedure is repeated on the opposite side.Using
a transcutaneous perineal approach, the ischial
tuberosity is palpated and the needle introduced
slightlymedial to the tuberosity.The needle is
advanced approximately 2.5 cm.Aspiration is
performed to ensure that the needle is not in a
blood vessel and then the anesthetic is injected.
The needle iswithdrawn and directed into the
deep superficial tissue of the vulva and anesthetic
is again injected to block the ilioinguinal and
genitofemoral components of the pudendal nerve.
This is repeated on the opposite side.
64430
2016CPT®CodingEssentials forObstetrics andGynecology
CPT®ProceduralCoding
© 2015DecisionHealth
CPT©2014AmericanMedicalAssociation.All rights reserved.
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AddOnCode
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M51.17 Intervertebral disc disorderswith
radiculopathy, lumbosacral region
M51.25 Other int rvertebral disc displacement,
thoracolumbar region
M51.26 Other intervertebral disc displacement,
lumbar region
M51.27 Other intervertebral disc displacement,
lumbosacral region
M51.35 Other intervertebral disc degeneration,
thoracolumbar region
M51.36 Other intervertebral disc degeneration,
lumbar region
M51.37 Other intervertebral disc degeneration,
lumbosacral region
M51.45 Schmorl’s nodes, thoracolumbar region
M51.46 Schmorl’s nodes, lumbar region
M51.47 Schmorl’s nodes, lumbosacral region
M51.85 Other intervertebral disc disorders,
thoracolumbar region
M51.86 Other intervertebral disc disorders, lumbar
region
M51.87 Other intervertebral disc disorders,
lumbosacral region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculop thy, lumbos ral region
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.41 Lumbagowith sciatica, right side
M54.42 Lumbagowith sciatica, left side
M54.5 Low back pain
M54.89 Other dorsalgia
M96.1 Postlaminectomy syndrome,notelsewhere
classified
Pub100
No Pub 100 references apply.
FacilityRVUs
Global:
000
Code
Work
PE
Facility
MP Total Facility
62284 1.54
.78
.18
2.5
Non-facilityRVUs
Code
Work
PENon-
Facility
MP
TotalNon-
Facility
62284 1.54
3.49
.18
5.21
Modifiers
(PAR)
Mod50 Mod51 Mod 62 Mod 66 Mod 80
0
2
0
0
1
ICD-9-CMDiagnosticCodes
721.3
Lumbosacral spondylosiswithout
myelopathy
721.42 Spondylosiswithmyelopathy, lumbar
region
721.6
Ankylosing vertebral hyperostosis
722.10 Displacement of lumbar intervertebral disc
withoutmyelopathy
722.2
Displacement of intervertebral disc, site
unspecified,withoutmyelopathy
722.32 Schmorl’s nodes, lumbar region
722.51 Degeneration of thoracic or thoracolumbar
intervertebral disc
722.52 Degeneration of lumbar or lumbosacral
intervertebral disc
722.73 Intervertebral disc disorderwith
myelopathy, lumbar region
722.83 Postlaminectomy syndrome, lumbar region
722.93 Otherandunspecifieddiscdisorder, lumbar
region
724.02 Spinal stenosis, lumbar region,without
neurogenic claudication
724.03 Spinal stenosis, lumbar region,with
neurogenic claudication
724.2
Lumbago
724.3
Sciatica
724.4
Thoracic or lumbosacral neuritis or
radiculitis,unspecified
724.5
Backache,unspecified
756.11 Spondylolysis, lumbosacral region
756.12 Spondylolisthesis
ICD-10-CMDiagnosticCodes
M43.05 Spondylolysis, thoracolumbar region
M43.06 Spondylolysis, lumbar region
M43.07 Spondylolysis, lumbosacral region
M43.15 Spondylolisthesis, thoracolumbar region
M43.16 Spondylolisthesis, lumbar region
M43.17 Spondylolisthesis, lumbosacral region
M47.15 Other spondylosiswithmyelopathy,
thoracolumbar region
M47.16 Other spondylosiswithmyelopathy, lumbar
region
M47.25 Other spondylosiswith radiculopathy,
thoracolumbar region
M47.26 Other spondylosiswith radiculopathy,
lumbar region
M47.27 Other spondylosiswith radiculopathy,
lumbosacral region
M47.815 Spondylosiswithoutmyelopathy or
radiculopathy, thoracolumbar region
M47.816 Spondylosiswithoutmyelopathy or
radiculopathy, lumbar region
M47.817 Spondylosiswithoutmyelopathy or
radiculopathy, lumbosacral region
M48.15 Ankylosing hyperostosis [Forestier],
thoracolumbar region
M48.16 Ankylosing hyperostosis [Forestier], lumbar
region
M48.17 Ankylosing hyperostosis [Forestier],
lumbosacral region
M51.05 Intervertebral disc disorderswith
myelopathy, thoracolumbar region
M51.06 Intervertebral disc disorderswith
myelopathy, lumbar region
M51.15 Intervertebral disc disorderswith
radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorderswith
radiculopathy, lumbar region
62284
s
62284 Injection procedure for
myelography and/or
computed tomography,
lumbar (other thanC1-C2 and
posterior fossa)
(Do not report62284 in conjunction
with62302,62303,62304,62305,
72240,72255,72265,72270)
(When both62284 and72240,
72255,72265,72270 are
performed by the same physician or
other qualified health care professional
formyelography, see62302,62303,
62304,62305)
(For injection procedure atC1-C2,
use61055)
(For radiological supervision and
interpretation, seeRadiology)
AMACodingGuideline:
Spineand spinal cord
(For application of caliper or tongs,use 20660)
(For treatment of fracture or dislocation of spine, see
22305-22327)
PlainEnglishDescription
The spinal canal (subarachnoid space) is injected
with contrastmaterial to visualize structures
including the spinal cord and spinal nerve roots
for separately reportablemyelography and/or
computed tomography (CT).This code is used to
report injection procedures of the lumbar region of
the spine.The patient is placed face-down on the
examination table.The spine is visualized using
separately reportable fluoroscopy.The skin over
the planned injection site,usually the lower lumbar
spine, is cleansed and a local anesthetic is injected.
The patientmay be repositioned if needed on the
side or in a sitting position.A needle is then inserted
into the subarachnoid space and contrastmaterial is
then injected and observed as itmoves through the
subarachnoid space enhancing visualization of the
spinal cord,nerve roots,and surrounding soft tissues.
The spinal canal (subarachnoid space) is injectedwith contrast
material to visualize the spinal cordand nerve roots.
Injectionprocedure formyelography/CT
X-Ray
machine
Injectiondye
2016CPT®CodingEssentials forOrthopedics (Upper andSpine)
62284
