Neurosurgery Coding Alert

Question: One of our neurosurgeons performs interventional endovascular procedures. Recently we have been getting a rash of denials from multiple payers for either 35475 (transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel) or 37205 (transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel). How can I get paid for these?

Georgia Subscriber

Answer: Until recently, balloon angioplasty was approved by Medicare primarily for arteries of the heart and arms, but not for intracranial uses. However, HCFA has recently announced that it will cover percutaneous transluminal angioplasty (PTA) of the carotid artery when performed with the placement of a carotid stent, as a stroke-prevention measure. The current standard of care for obstructed carotid arteries is carotid endarterectomy, a surgical procedure that involves opening the artery and manually removing the plaque. (Since 1995, HCFA has permitted its private contractors to provide coverage for newly developed equipment undergoing trials that have been awarded an investigational device exemption [IDE]. An IDE from the FDA permits a device to be shipped lawfully for clinical trials of the device without complying with special controls or having marketing clearance. The purpose of an IDE is to encourage the discovery and development of devices intended for human use while protecting the public health.)

For the HCFA news release describing this development, access: www.hcfa.gov/news/pr2001/pr010320.htm

For the Medicare coverage decision, access: www. hcfa.gov/coverage/8b3-nn.htm.

Citing this recent development to local carriers should help to get neurosurgical PTA claims paid provided they are for stroke prevention. Check with carriers to see what codes they want. Code 37799 (unlisted procedure, vascular surgery) was suggested by Medicare in the Medicare Coverage Issues Manual. Your coding may now be approved depending on local carrier and individual state requirements.