Alfaro33
Networker
Previous coder submitted charges below. Insurance denial reason: 75630 26 59 denied for modifier ON THIS SERVICE ON THE SAME DAY IS NOT SUPPORTED BY THE INFORMATION SUBMITTED ON THE CLAIM.
I believe it is a bundling issue, co-worker feels codes and modifiers are warranted and may actually be a diagnosis issue based on First Coast LCD. Any suggestion?
37224, 36215-59, 75600-26, 75630-26-59, 75710-26-59
Dx I70.212
Indication
Patient is a 68 Years M who presented with PAD. Risks and benefits were discussed and informed consent was obtained for angiogram possible intervention. This patient had a prior left femoral to popliteal artery bypass to exclude a popliteal aneurysm in the remote past he developed stenosis at the distal anastomosis and in the superficial femoral artery proximal to the bypass. He was taken to the operating room today for angiogram and possible intervention. He also history of coronary artery bypass graft surgery remotely and secondary to a LIMA bypass the decision was also made to perform arch angiogram to evaluate the great vessels.
Operation
arch angiogram
left subclavian angiogram
aorto-ilio-femoral angiogram
left popliteal angiogplasty
left SFA angioplasty
Anesthesia
local/MAC
Estimated Blood Loss
[5 ml]
Findings
Aorta: patent
right common iliac: patent (stent in place)
right internal iliac: patent
right external iliac: patent
right CFA: patent
right PFA: patent
right SFA: patent
left common iliac: patent (stent in place)
left internal iliac: patent
left external iliac: patent
left CFA: patent
left PFA: patent
left SFA: severe stenosis above the fem-pop bypass in the native SFA
left pop: patent (severe stenosis at the distal anastomosis of the fem-pop bypass
left AT: patent
left PT: patent
left peroneal: patent
Type 1 arch
no significant stenosis of the great vessels was seen although motion artifact was present
Specimen(s)
none
Complications
none
Technique
Access was gained in the common femoral artery and flush catheter was placed into the aorta. A aort-ilio-fem angiogram with bilateral lower extremity runoff was performed in the standard fashion.
Please see above for findings.
Due to the lesions identified and the patient's symptoms the decision was made to perform intervention.
A 6F sheath up and over sheath was placed in the standard fashion and the patient was given systemic heparin. The SFA and popliteal lesions were crossed with a wire and catheter and then treated. The stenosis at the distal anastomosis was treated with a 3 mm plain angioplasty balloon followed by a 4 mm drug-eluting balloon. The lesion in the native superficial femoral artery proximal to the bypass was treated with a 5 mm drug eluting angioplasty balloon followed by 6 mm drug eluting angioplasty balloon.
Completion angiogram was performed and revealed and excellent result with no residual stenosis. The wires, catheters, and sheath was removed and the femoral was closed using a [mynx] device. Access was gained the left common femoral artery and a 5 French sheath was placed. A pigtail catheter was placed into the aortic arch and arch angiogram was performed in a standard fashion. The left subclavian artery was selected out using V Tek catheter and a 2nd order diagnostic angiogram was performed in the standard fashion. There appeared to be no stenosis of the great vessels or the subclavian artery although there was moderate motion artifact present
Patient tolerated the procedure well.
I believe it is a bundling issue, co-worker feels codes and modifiers are warranted and may actually be a diagnosis issue based on First Coast LCD. Any suggestion?
37224, 36215-59, 75600-26, 75630-26-59, 75710-26-59
Dx I70.212
Indication
Patient is a 68 Years M who presented with PAD. Risks and benefits were discussed and informed consent was obtained for angiogram possible intervention. This patient had a prior left femoral to popliteal artery bypass to exclude a popliteal aneurysm in the remote past he developed stenosis at the distal anastomosis and in the superficial femoral artery proximal to the bypass. He was taken to the operating room today for angiogram and possible intervention. He also history of coronary artery bypass graft surgery remotely and secondary to a LIMA bypass the decision was also made to perform arch angiogram to evaluate the great vessels.
Operation
arch angiogram
left subclavian angiogram
aorto-ilio-femoral angiogram
left popliteal angiogplasty
left SFA angioplasty
Anesthesia
local/MAC
Estimated Blood Loss
[5 ml]
Findings
Aorta: patent
right common iliac: patent (stent in place)
right internal iliac: patent
right external iliac: patent
right CFA: patent
right PFA: patent
right SFA: patent
left common iliac: patent (stent in place)
left internal iliac: patent
left external iliac: patent
left CFA: patent
left PFA: patent
left SFA: severe stenosis above the fem-pop bypass in the native SFA
left pop: patent (severe stenosis at the distal anastomosis of the fem-pop bypass
left AT: patent
left PT: patent
left peroneal: patent
Type 1 arch
no significant stenosis of the great vessels was seen although motion artifact was present
Specimen(s)
none
Complications
none
Technique
Access was gained in the common femoral artery and flush catheter was placed into the aorta. A aort-ilio-fem angiogram with bilateral lower extremity runoff was performed in the standard fashion.
Please see above for findings.
Due to the lesions identified and the patient's symptoms the decision was made to perform intervention.
A 6F sheath up and over sheath was placed in the standard fashion and the patient was given systemic heparin. The SFA and popliteal lesions were crossed with a wire and catheter and then treated. The stenosis at the distal anastomosis was treated with a 3 mm plain angioplasty balloon followed by a 4 mm drug-eluting balloon. The lesion in the native superficial femoral artery proximal to the bypass was treated with a 5 mm drug eluting angioplasty balloon followed by 6 mm drug eluting angioplasty balloon.
Completion angiogram was performed and revealed and excellent result with no residual stenosis. The wires, catheters, and sheath was removed and the femoral was closed using a [mynx] device. Access was gained the left common femoral artery and a 5 French sheath was placed. A pigtail catheter was placed into the aortic arch and arch angiogram was performed in a standard fashion. The left subclavian artery was selected out using V Tek catheter and a 2nd order diagnostic angiogram was performed in the standard fashion. There appeared to be no stenosis of the great vessels or the subclavian artery although there was moderate motion artifact present
Patient tolerated the procedure well.