Thank you very much everybody. A couple of disclosures, but none have to do anything to do with this talk. So the pulmonary stent codes, which we got last year, are 33900, which is a PA stent code normal native connection in one side. 902 is normal native connection and bilateral. I'm sorry, 01 is bilateral. 33902 is PA stent abnormal native connection with abnormal defined as defined in stent placement with the pulmonary arteries, PDA, within a surgical shunt or a post-surgical connection of some sort. And then 33903 is same abnormal connection, but bilateral. 33904 is percutaneous PA vascularization by stent normal or abnormal, but additional vessel in addition to the initial lesions, so separate from the initial. So that should be in addition to what are the other 33900 codes. So what is included, what's not? So what's included in the code is access, catheter and wire manipulation, angiography to guide the procedure, any related angioplasty, so if you wanted to dilate the lesion prior post-stent placement, additional stent to the same lesion, so if you wanted to put a second, and obviously post-dilation and post-dilation angiograms. What is not included is the angiogram prior to intervention, a full diagnostic study if no prior study is performed or available or the prior study is inadequate to really guide the intervention, angiograms unrelated to the intervention, and again angioplasty of other lesions. So it's like a lot of these things kind of bundled and there's a couple things that aren't bundled, so you got to make sure you check all those boxes. So this is an example of a 33900. This is a patient with native branch pulmonary artery stenosis, and both the right and left pulmonary arteries you see are small on the left panel. On the right panel we put a stent in the right pulmonary artery, so that's a 33900. If we decided to stop in this case and not proceed, that would be the intervention code for this patient, but as you can also see the left pulmonary artery needs help as well, and so we put a stent in both right and left pulmonary arteries, so this becomes a 33901 for this procedure. So abnormal native connections, unilateral versus bilateral. So on the panel, the first two pictures is a patient from left to right, is a patient with single ventricle anatomy following a glen shunt with left pulmonary artery stenosis, and the stent was placed in that left pulmonary artery, that narrowed left pulmonary artery. 33903 is a patient with tetralogy flow with AV septal defect and an RVDPA conduit. The patient has undergone surgical repair, but has bilateral branch PA stenosis and underwent simultaneous placement of stents in the right and left pulmonary arteries, making it 33903. So each additional stent can be in a patient with or without normal connections, but it's in addition again to the initially placed stent. So this is an example of a patient with transposition who's undergone an arterial switch operation, excuse me, who has a stent there in the proximal right pulmonary artery, but you see sub-segmental stenosis of both the right upper lobe and the mid-RPA distal, and underwent placement of stents in that right upper lobe and the mid-RPA. So that's 33904, which would be built twice in this case. So for PDA stents, remember that PDA counts as an abnormal connection, just like a shunt, and a 33902 is how we bill for a PDA stent, a single PDA stent or a single PDA stent to a isolated pulmonary artery. This is a patient with pulmonary atresia with major aortopulmonary collateral to the right lung and then a left pulmonary artery fed only by a left ductus. So that left ductus winds up being a 33902 for this intervention. This is a little more complicated stent case. So this is a baby in whom we wound up putting a stent from the ductus into the right pulmonary artery and then went through that first stent and into the left and put in a second stent. So this winds up being again a patient with pulmonary atresia with stents both to the right and then through the right into the left, so a 33903, so bilateral for abnormal native connections. So this is a plagiarized but wonderful diagram that Sergio Bartekian made and actually used in his presentation last year that just helps you understand the cornucopia of different combos you can have here. And just as an example, a single stent into this is a surgical shunt that goes into one of the pulmonary arteries that counts as abnormal native connection unilateral. If the stent goes into the PA, that's B. It's also abnormal native connection unilateral. And C is the first stent plus a stent into three or four, so into the other branch pulmonary artery. So that's an abnormal native connection bilateral, et cetera, et cetera. And really what we're trying to account for is the work of wire placement in the first pulmonary artery and then having to go over to the other side to do other work. But I thought this was a great diagram and Sergio let me borrow it for today. So that's all I have. Thank you very much.

coding

pulmonary stent procedures

33900

abnormal connections

PDA stents

icd

cpt

billing