Wiki Denial of 75726 and 7516

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pygreen

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I have received a denial from a Medicare Advantage Plan for codes 75625 and 75716 as invalid codes N56: Procedure code billed is not correct/valid for the services billed or the date of service billed.
Below is portions of the OP note related to these procedures.

Preoperative Diagnoses:
Claudication with ankle brachial index of 0.4 bilaterally, diabetes mellitus, chronic kidney disease, coronary disease, hepatitis C, alcoholism

Preoperative Diagnoses:
Claudication with ankle brachial index of 0.4 bilaterally, diabetes mellitus, chronic kidney disease, coronary disease, hepatitis C, alcoholism

OPERATION:
1. Aortoiliac angiography with interpretation
2. Bilateral selective runoff angiography with interpretation
3. Attempted crossing of left superior femoral artery chronic total occlusion without success.

....The artery was cannulated percutaneously and a 4-French sheath was secured using Seldinger technique. A Storq wire was taken up into the aorta under fluoroscopy and an Omni Flush catheter was taken to the L1 level. An AP aortogram was performed and interpreted by me. The catheter was repositioned in the distal aorta and bilateral oblique iliac angiograms were performed and interpreted by me. He was not holding still very well and I decided to do selective angiography because I was sure he would not hold still for an automated runoff. I used the Omni Flush. I selected to catheterize over to the left common femoral artery. From here, stepwise runoff angiography down the left lower extremity was performed and interpreted by me. I replaced the Storq wire and removed the catheter and then through the sheath, I did stepwise runoff angiography down the right lower extremity and interpreted these images There was a small rub of patent SFA on his left side. This was the site of his prior saphenectomy and so I decided to try to cross this TASC C chronic total occlusion. The sheath was exchanged for a 6-French, 45-cm sheath. I catheterized the occluded superficial femoral artery with Rubicon and a stiff angled Glidewire and was able to advance to the popliteal where the artery was patent again. I tried multiple different wires, including 0.014 Miracle Brush 6 and the Storq and the stiff Guide, but could not get back into the true lumen. I did not want to persist too much and risk damaging this target for a distal bypass if necessary. After several minutes of fluoro time, I decide to stop this effort.

Any suggestions as to why the above codes 75726 and 75716 would be denied as not correct would be greatly appreciated.

Thanks.
 
pygreen said:
I have received a denial from a Medicare Advantage Plan for codes 75625 and 75716 as invalid codes N56: Procedure code billed is not correct/valid for the services billed or the date of service billed.
Below is portions of the OP note related to these procedures.

Preoperative Diagnoses:
Claudication with ankle brachial index of 0.4 bilaterally, diabetes mellitus, chronic kidney disease, coronary disease, hepatitis C, alcoholism

Preoperative Diagnoses:
Claudication with ankle brachial index of 0.4 bilaterally, diabetes mellitus, chronic kidney disease, coronary disease, hepatitis C, alcoholism

OPERATION:
1. Aortoiliac angiography with interpretation
2. Bilateral selective runoff angiography with interpretation
3. Attempted crossing of left superior femoral artery chronic total occlusion without success.

....The artery was cannulated percutaneously and a 4-French sheath was secured using Seldinger technique. A Storq wire was taken up into the aorta under fluoroscopy and an Omni Flush catheter was taken to the L1 level. An AP aortogram was performed and interpreted by me. The catheter was repositioned in the distal aorta and bilateral oblique iliac angiograms were performed and interpreted by me. He was not holding still very well and I decided to do selective angiography because I was sure he would not hold still for an automated runoff. I used the Omni Flush. I selected to catheterize over to the left common femoral artery. From here, stepwise runoff angiography down the left lower extremity was performed and interpreted by me. I replaced the Storq wire and removed the catheter and then through the sheath, I did stepwise runoff angiography down the right lower extremity and interpreted these images There was a small rub of patent SFA on his left side. This was the site of his prior saphenectomy and so I decided to try to cross this TASC C chronic total occlusion. The sheath was exchanged for a 6-French, 45-cm sheath. I catheterized the occluded superficial femoral artery with Rubicon and a stiff angled Glidewire and was able to advance to the popliteal where the artery was patent again. I tried multiple different wires, including 0.014 Miracle Brush 6 and the Storq and the stiff Guide, but could not get back into the true lumen. I did not want to persist too much and risk damaging this target for a distal bypass if necessary. After several minutes of fluoro time, I decide to stop this effort.

Any suggestions as to why the above codes 75726 and 75716 would be denied as not correct would be greatly appreciated.

Thanks.
Click to expand...

If this is the complete report, there is not a description of the abdominal aorta. Are the renal arteries patient? What does the lower extremities look like? This report describes what he did , but what did he find? That needs to be described to get the above codes.
HTH,
Jim Pawloski, CIRCC
 
Hi Jim, Good to hear from you. Sorry, I didn't post the entire note due to length. Here are the findings:

Findings:
1. Aorta is calcified without any focal stenosis and bilateral inguinal arteries are widely patent.
2. The iliacs are diseased bilaterally of moderate severity with no focal stenosis and no flow-limiting stenosis in either the common or external iliac calcific stenosis.
3. The common femorals are patent bilaterally and the profunda femoral arteries are patent bilaterally.
4. The bilateral superficial femoral arteries are chronically occluded from the origin to the above-knee popliteal.
5. The bilateral popliteal arteries are patent, as are the trifurcations and small tibial arteries bilaterally.


He did mention that "The catheter was repositioned in the distal aorta and bilateral iliac angiograms were performed and interpreted by me".
 
pygreen said:
Hi Jim, Good to hear from you. Sorry, I didn't post the entire note due to length. Here are the findings:

Findings:
1. Aorta is calcified without any focal stenosis and bilateral inguinal arteries are widely patent.
2. The iliacs are diseased bilaterally of moderate severity with no focal stenosis and no flow-limiting stenosis in either the common or external iliac calcific stenosis.
3. The common femorals are patent bilaterally and the profunda femoral arteries are patent bilaterally.
4. The bilateral superficial femoral arteries are chronically occluded from the origin to the above-knee popliteal.
5. The bilateral popliteal arteries are patent, as are the trifurcations and small tibial arteries bilaterally.


He did mention that "The catheter was repositioned in the distal aorta and bilateral iliac angiograms were performed and interpreted by me".
Click to expand...

What I see is in the title of the procedure, the doctor says aortoiliac imaging, and not abdominal aortogram, bilateral lower extremity arteriogram. So I think the insurance company is saying you didn't do a complete abdominal aortogram and just a bilateral lower extremity arteriogram. That probably why they are not paying 75625. A addendum is probably what is needed to correct the error.

Hope that helps,
Jim Pawloski, CIRCC:D
 
The insurance company does not see the report (unless you sent it to them) so that would not be the reason for the denial. Did you also bill a select cath placement code? I think the finding of the aortogram is weak but the dictation does say the cath was at the L1 level which is high enough for an aortogram and that an AP image was obtained.
 
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