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I'm not sure who else to go to with my issue and I'm hoping you can help or direct me. We had a patient that had coil embolization done endovascular. The patient had coil occlusions RIMA/LIMA and left thoracic. We charged for 2 coil's using 37204 as per our cardiology coder because the procedure was not open and done endovascular, therefore we are allowed to charge for 2 and not code based on operative site, which if it were open it would be charged for 1. He said based on the maneuvering of the embolization process we can charge for 2 separate sites.
One of our coders who did coding for cardiology said that based on Dr. Z, this is correct and we can charge for 2. I looked through AAPC web posts, etc and can not find this information anywhere, so now I'm starting to lean toward agreeing with the Nurse reviewer who is denying the appeal. I also want to mention that the procedure was done on a 3 yr old child as I work for Boston Children's.
Can someone help? I want to be able to present to the Nurse reviewer if we can charge per site and not operative field mainly for children. If I can present the documentation the Nurse reviewer would update their policy and procedures to allow this type of charging when our patient's come in for this type of procedure. Please let me know if you need additonal information.
One of our coders who did coding for cardiology said that based on Dr. Z, this is correct and we can charge for 2. I looked through AAPC web posts, etc and can not find this information anywhere, so now I'm starting to lean toward agreeing with the Nurse reviewer who is denying the appeal. I also want to mention that the procedure was done on a 3 yr old child as I work for Boston Children's.
Can someone help? I want to be able to present to the Nurse reviewer if we can charge per site and not operative field mainly for children. If I can present the documentation the Nurse reviewer would update their policy and procedures to allow this type of charging when our patient's come in for this type of procedure. Please let me know if you need additonal information.