Case Study:
Selective Vascular Procedures Can Lead Coders Astray
Published on Tue Feb 01, 2000
"Coders need to read through the operative report before billing for a catheter that in fact may not have been performed. Otherwise, they may bill for a procedure that was not done, which can lead to charges of fraud.
In the following operative report, the cardiologist describes bilateral selective renal angiography, which was in fact performed. The procedure note, however, does not confirm that a catheter was placed into the renal arteries, and a coder who doesnt read through the notes carefully might infer otherwise.
Operative Report
Angioplasty/stent placement/arteriograms
Superior mesenteric artery angioplasty and stent placement and bilateral selective renal arteriography
This is a 79-year-old gentleman with abdominal angina and a tight lesion in the superior mesenteric artery.
Procedure: The procedure was performed via the right femoral artery. The right groin was prepped and draped in the usual manner. Xylocaine 2 percent was administered, and a French introducer was placed in the right femoral artery. The patient was systemically heparinized with 4,000 units of heparin and we positioned a ... guiding catheter at the origin of the superior mesenteric artery. Baseline angiograms were performed. An extra support wire [was placed] down the superior mesenteric artery and was pre-dilated using a 5.0 x 20 mm balloon. We then placed a 7 x 10 mm Hurculon stent and dilated the stent up to nine atmospheres. Follow-up angiograms were performed. The balloon dilatation catheter guidewire and guiding catheter were removed. We positioned a ... right diagnostic catheter at the origin of the right and left renal arteries, and performed selective renal arteriography. The diagnostic catheter was removed. The introducer sheath was removed and we deployed an angio-seal device at the right femoral puncture site.
Findings: The baseline angiogram demonstrates an 80-90 percent stenosis at the ostium of the superior mesenteric artery. Following balloon angioplasty and stent placement, this is reduced to 0 percent and there is excellent flow in the superior mesenteric artery. The left renal artery demonstrates a fairly long segment of up to 80 percent stenosis. The right renal artery has a 25 percent stenosis.
Conclusions:
1. Successful percutaneous transluminal angioplasty
and stent placement superior mesenteric artery.
2. Left renal artery stenosis.
3. Right renal artery stenosis.
4. Hypertension.
5. Abdominal angina.
Coding the Procedures
Based on the information provided in this operative report, the following codes should be billed, says Rebecca Sanzone, CPC, assistant billing manager with Mid-Atlantic Cardiology, a 45-member cardiology practice in Baltimore, Md., noting that vascular procedures arent limited like cardiac catheterizations.
The procedures are listed in the order they were performed, not highest-to-lowest based on relative value units (RVU).
36246selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within [...]
