Cardiology Coding Alert

Question: We frequently perform percutaneous angioplasty of dialysis grafts, but Medicare will not pay for arterial angioplasty (35475) and venous angioplasty (35476). These are two different sites. How should I report these services to get properly reimbursed?

Mississippi Subscriber

Answer: The carrier should reimburse for the procedure when you use the mentioned codes: 35475 (Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel) or 35476 ( venous). However, you should ensure that you are using the proper diagnosis codes. If you report 35475 or 35476 linked with a diagnosis for dialysis (e.g., renal failure), the carrier will not reimburse for the service because the diagnosis does not support the procedure's medical necessity. On the other hand, if you report the diagnosis of 996.73 (Other complications of internal [biological] [synthetic] prosthetic device, implant, and graft; due to renal dialysis device, implant, and graft), you more clearly show medical necessity.

And, you can contact your carrier's Medicare director and request information concerning how to code for this situation.