# reviewing 36245-59



## nancy.anselmo@ccrheart.com (Aug 9, 2011)

We are getting reviewed all of a sudden from a local ins. This is what is coded:
93459-26
36245-59
36215-59
75710-26-59
75650-26-59 
the claims are being reviewed for the 36245-59. Does anyone else have this problem and am I coding correctly? Thank uou for your help w/this Nancy


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## dpeoples (Aug 9, 2011)

n.anselmo@yahoo.com said:


> We are getting reviewed all of a sudden from a local ins. This is what is coded:
> 93459-26
> 36245-59
> 36215-59
> ...




This is an unusual coding scenario with a heart cath. In this particular case, what vessel does 36245 represent? and is there separate medical necessity for that selection and injection?


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## nancy.anselmo@ccrheart.com (Aug 10, 2011)

The 36245 is  billed w/the iliac angiography 75710 and w/every cath done w/75710 I send in the cath report. When we switched to the new codes for caths that is how we were told to bill. Is this correct?


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## dpeoples (Aug 10, 2011)

n.anselmo@yahoo.com said:


> The 36245 is  billed w/the iliac angiography 75710 and w/every cath done w/75710 I send in the cath report. When we switched to the new codes for caths that is how we were told to bill. Is this correct?



If the iliac (lower extremity) angiography is of the access site, not only is 36245 incorrect, 75710 is not separately billable. Can you provide a report?


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## nancy.anselmo@ccrheart.com (Aug 11, 2011)

Procedure: LHC, SCA, left ventriculography, iliac angiography

History of present illness: history of hypertension, reported atrial arrhythmias & lonstanding mitral valve prolapse that had symptoms consistent w/SOB on exertion. Pt states he does not have the energy he used to. Pt had recent ecocardiogram that demonstrated bileaflet mitral valve prolapse w/severe regurgitation & left atrial enlargement. In the context of these symptoms, heis referred for diagnostic angiography as a prelude to mitral valve repair. He also had mild-to-moderate tricuspid regurgitation w/evidence of moderate pulmonary hypertension w/estimated pulmonary artery systolic pressure of 50mmHg.

Right common femoral artery was accessed using modified Seldinger technique in which a 6 French 11cm sheath was placed without complication. A JL4 & JR4 diagnostic catheter was used to perform selective coronary angiography and a pigtail catheter for left ventriculography to assess left ventricular end diastolic pressure and transaortic gradient. at the conclusion of the procedure, iliac angiography was performed. There was no evidence of significant disease in the external iliac, femoral, SFA or deep profunda w/appropriate placement of the arteriotomy site sutible for percutaneous closure. An Angio-Seal device was deployed without complication.


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## Jess1125 (Aug 11, 2011)

n.anselmo@yahoo.com said:


> Procedure: LHC, SCA, left ventriculography, iliac angiography
> 
> History of present illness: history of hypertension, reported atrial arrhythmias & lonstanding mitral valve prolapse that had symptoms consistent w/SOB on exertion. Pt states he does not have the energy he used to. Pt had recent ecocardiogram that demonstrated bileaflet mitral valve prolapse w/severe regurgitation & left atrial enlargement. In the context of these symptoms, heis referred for diagnostic angiography as a prelude to mitral valve repair. He also had mild-to-moderate tricuspid regurgitation w/evidence of moderate pulmonary hypertension w/estimated pulmonary artery systolic pressure of 50mmHg.
> 
> Right common femoral artery was accessed using modified Seldinger technique in which a 6 French 11cm sheath was placed without complication. A JL4 & JR4 diagnostic catheter was used to perform selective coronary angiography and a pigtail catheter for left ventriculography to assess left ventricular end diastolic pressure and transaortic gradient. at the conclusion of the procedure, iliac angiography was performed. There was no evidence of significant disease in the external iliac, femoral, SFA or deep profunda w/appropriate placement of the arteriotomy site sutible for percutaneous closure. An Angio-Seal device was deployed without complication.



Your 36245 and 75710 aren't separately billable here. Angiogram is just being done to see if the Angio-Seal device can be placed. 

From the NCCI manual:
18. Placement of an occlusive device such as an angio seal or vascular plug into an arterial or venous access site after cardiac catheterization or other diagnostic or interventional procedure should be reported with HCPCS code G0269. A physician should not separately report an associated imaging code such as CPT code 75710 or HCPCS code G0278.

Jessica CPC, CCC


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## dpeoples (Aug 11, 2011)

n.anselmo@yahoo.com said:


> Procedure: LHC, SCA, left ventriculography, iliac angiography
> 
> History of present illness: history of hypertension, reported atrial arrhythmias & lonstanding mitral valve prolapse that had symptoms consistent w/SOB on exertion. Pt states he does not have the energy he used to. Pt had recent ecocardiogram that demonstrated bileaflet mitral valve prolapse w/severe regurgitation & left atrial enlargement. In the context of these symptoms, heis referred for diagnostic angiography as a prelude to mitral valve repair. He also had mild-to-moderate tricuspid regurgitation w/evidence of moderate pulmonary hypertension w/estimated pulmonary artery systolic pressure of 50mmHg.
> 
> Right common femoral artery was accessed using modified Seldinger technique in which a 6 French 11cm sheath was placed without complication. A JL4 & JR4 diagnostic catheter was used to perform selective coronary angiography and a pigtail catheter for left ventriculography to assess left ventricular end diastolic pressure and transaortic gradient. at the conclusion of the procedure, iliac angiography was performed. There was no evidence of significant disease in the external iliac, femoral, SFA or deep profunda w/appropriate placement of the arteriotomy site sutible for percutaneous closure. An Angio-Seal device was deployed without complication.



I don't mean to alarm you or be overly critical, but the only code I would have used for this case is 93458, I do not see any indication that grafts were injected or imaged to justify 93459. I also do not see an interpretation of the arch to justify 75650, and the ipsilateral lower extremity angiography is for the closure device placement and should not be billed separately. I also do not understand coding 36215?

HTH


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## theresa.dix@tennova.com (Aug 11, 2011)

dpeoples said:


> I don't mean to alarm you or be overly critical, but the only code I would have used for this case is 93458, I do not see any indication that grafts were injected or imaged to justify 93459. I also do not see an interpretation of the arch to justify 75650, and the ipsilateral lower extremity angiography is for the closure device placement and should not be billed separately. I also do not understand coding 36215?
> 
> HTH




Danny is absolutely correct.


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## nancy.anselmo@ccrheart.com (Aug 12, 2011)

I apologize, after I got to read your response last night, I realized that I put in the wrong pt's cath report for the senerio I was trying to get answers for. I hope to get time today today. Thank you all Nancy


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## theresa.dix@tennova.com (Aug 12, 2011)

n.anselmo@yahoo.com said:


> I apologize, after I got to read your response last night, I realized that I put in the wrong pt's cath report for the senerio I was trying to get answers for. I hope to get time today today. Thank you all Nancy





Nancy,
 thank goodness.  look forward to seeing the "real" report


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## nancy.anselmo@ccrheart.com (Aug 12, 2011)

History: CAD status post coronary artery bypass grafting in 1994 w/LIMA to LAD, vein graft to RCA. vein graft to OM1 &OM2 w/subsequent percutaeous interventions w/Cypher stent to the distal RCA, balloon angioplasty of the proximal circumflex, as well as stenting of the mid cicumflex, stenting of the vein graft to the RCA & stenting of the mid PDA, also w/history of hypertension, diabetes & dyslipidemia who presented w/2-3 months of intermittent exertional angina, nitro responsive. Stroke in April. Exercise treadmill testing w/marked decrease from previous performance. There were no wall motion abnormalities or EKG changes, however, w/systomatic presentation referred for diagnostic angiography.
PROCEDURE: Right common femoral artery access was obtained using modified Seldinger technique of which a 6 French 11 cm sheath was placed w/o complication. JL4 & JR4 diagnostic catheters, as well as an IMA catheter were used to perform selective coronary angiography, left ventriculography & subclavian angiography. At the conclusion of the procedure, iliac angiography was performed & did not demonstrate any significant disease in the external iliac, common femoral artery, SFA or deep profunda w/appropriate placement at arteriotomy site sutible for percutaneous closure. An Angio-Seal devise was deployed w/o complication.

If more information is needed let me know Thanks Nancy


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## Jess1125 (Aug 12, 2011)

n.anselmo@yahoo.com said:


> History: CAD status post coronary artery bypass grafting in 1994 w/LIMA to LAD, vein graft to RCA. vein graft to OM1 &OM2 w/subsequent percutaeous interventions w/Cypher stent to the distal RCA, balloon angioplasty of the proximal circumflex, as well as stenting of the mid cicumflex, stenting of the vein graft to the RCA & stenting of the mid PDA, also w/history of hypertension, diabetes & dyslipidemia who presented w/2-3 months of intermittent exertional angina, nitro responsive. Stroke in April. Exercise treadmill testing w/marked decrease from previous performance. There were no wall motion abnormalities or EKG changes, however, w/systomatic presentation referred for diagnostic angiography.
> PROCEDURE: Right common femoral artery access was obtained using modified Seldinger technique of which a 6 French 11 cm sheath was placed w/o complication. JL4 & JR4 diagnostic catheters, as well as an IMA catheter were used to perform selective coronary angiography, left ventriculography & subclavian angiography. At the conclusion of the procedure, iliac angiography was performed & did not demonstrate any significant disease in the external iliac, common femoral artery, SFA or deep profunda w/appropriate placement at arteriotomy site sutible for percutaneous closure. An Angio-Seal devise was deployed w/o complication.
> 
> If more information is needed let me know Thanks Nancy



You just have the 93459-26 here. 

And I still stand by what I said in prior thread that the 36245-59 and 75710 is NOT billable here. Only doing the extremity angio to see if the Angio-Seal device could be placed. 

Jessica CPC, CCC


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## Kathy B. (Aug 14, 2011)

*Medicare Billing*

I recently joined a cardiology practice.  The biller said that I should only bill ONE diagnosis code for any office visit or procedure as this was part of the new rules.  However, I researched this on the CMS website, and, as of 6/2011, it states to use up to 4 diagnosis codes.  Any assistance in this regard is appreciated.


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