Cardiology Coding Alert

Question: We recently billed 37202 for transcatheter therapy during stent and angioplasty procedures, but Medicare rejected this as not medically necessary. What is the correct use of this code?

Pennsylvania Subscriber

Answer: According to version 9.0 of the National Correct Coding Initiative (NCCI), 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type [e.g., spasmolytic, vasoconstrictive]) is a component of the comprehensive code for intracoronary stent placement (92980, Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel). Code 37202 is also included in the comprehensive code for angioplasty (92982, Percutaneous transluminal coronary balloon angioplasty). Essentially, 37202 is considered a component of both 92980 and 92982, and you should not bill it separately. This may be why you received a denial for lack of medical necessity.

Also, your Medicare carrier may have a local medical review policy for covered diagnoses for 37202. You should review this policy, and if the operative note supports documentation for medical necessity, you may want to appeal the denial.

NCCI indicates by the superscript number 1 that you may use modifier -59 (Distinct procedural service) if the operative report supports using this modifier with 37202. Depending on your local Medicare carrier's guidelines, you may be able to resubmit the bill with modifier -59 or submit an appeal with the appropriate operative-note documentation.