# Angioplasty - 35476



## prabha (Sep 17, 2010)

Can we code CPT 35476 twice for the below procedure as angiopasty is done both at the stent(35476) and brachiocephalic vein(35476)?


      The patient's right arm was prepped and draped in the usual
      sterile manner and locally anesthetized with lidocaine.  The AV
      graft was accessed antegrade with a micropuncture set.  A 7-French
      vascular sheath was placed.  Contrast was injected and digital
      subtraction angiography was performed.  Angiography was performed
      of the entire AV fistula and central venous outflow.

      FINDINGS:
      There are focal moderate stenoses in the venous limb of the shunt,
      at the peripheral and central ends of the stent.  There is a
      moderate stenosis centrally at the brachial cephalic vein, without
      significant change from the prior study, pre-intervention.

      INTERVENTION:
      Angioplasty was performed at the peripheral and central portion of
      the existing stent with a 9-mm diameter conquest balloon.
      Completion angiography demonstrated good angiographic results.

      Angioplasty was then performed at the brachiocephalic vein
      stenosis with a 14-mm Atlas balloon.  Completion angiography
      demonstrated a fair- good result.

      At the end of the procedure the vascular sheath was removed and
      hemostasis was achieved with manual compression.  A sterile
      dressing was applied.  The patient tolerated the procedure well
      and left the department in stable condition. 

      IMPRESSION:
      Moderate stenosis at the peripheral and central edge of the
      existing venous anastamotic stent.  Angioplasty to 9 mm with good
      angiographic result.

      Moderate stenosis at the right brachiocephalic vein.
      Angioplastied to 14 mm with fair-good angiographic result.  No
      immediate complications.


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## dpeoples (Sep 20, 2010)

prabha said:


> Can we code CPT 35476 twice for the below procedure as angiopasty is done both at the stent(35476) and brachiocephalic vein(35476)?
> 
> 
> The patient's right arm was prepped and draped in the usual
> ...




Yes you can, and should IMO.

HTH


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## prabha (Sep 21, 2010)

But I am getting denial with 35476 from Medicare stating that they will pay for CPT 35476 only once per day or it should hold a bilateral modifier(50).In the above mentioned case, we cannot append modifier 50 & also we should bill it twice...What are your thoughts on this??


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## Grintwig (Sep 22, 2010)

Have you tried filing an appeal? You could send notes then so that they could see that using the code twice was justifiable.


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## dpeoples (Sep 22, 2010)

prabha said:


> But I am getting denial with 35476 from Medicare stating that they will pay for CPT 35476 only once per day or it should hold a bilateral modifier(50).In the above mentioned case, we cannot append modifier 50 & also we should bill it twice...What are your thoughts on this??




You could try using modifier 59 for the brachiocephalic venoplasty and assign modifier 459.2 (venous stricture). You might also ask the payor if modifier 76 is more applicable. And of course be prepared to file and appeal and send the report. 

HTH


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## prabha (Sep 22, 2010)

Thanks....I will try an appeal...


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