Need help in figuring out why when we bill 36147 and 35475/6 during the same session, we receive payment on some cases and a denial for others. We add modifier 59 to the 35475 or 35476 and it is still denied. Any help you can provide would be greatly appreciated.
Here is an example of an op report:
PROCEDURES PERFORMED:
1. Right forearm fistulogram.
2. Right peripheral venous angioplasty.
3. Right radial artery balloon angioplasty with catheter introduction x2.
INDICATIONS FOR THE PROCEDURE: This 83-year-old male is well known to me. I have been managing his access for many years. We were notified that his fistula had become thrombotic; however, on examination, there seemed to be areas of stenoses within the fistula and some reduced inflows, but there was no evidence of thrombus.
PROCEDURE IN DETAIL: The patient was taken to the XXXXX and sterilely prepped and draped in standard fashion. After infiltration with 1% lidocaine, a needle, a wire, and a short 6-French sheath were inserted in the direction of the antecubital fossa. Aliquots of diluted Visipaque were utilized to visualize the fistula, and there seemed to be a 95% stenosis approximately measuring 3 cm medial to the antecubital fossa. A 6 mm balloon was passed across this lesion, and upon insufflating the lesion, a reflux study was done which showed arterial narrowing across the initial arterial segment of 85% to 90%. Following insufflation in the venous end, a second sheath was passed in the direction of the wrist. A 5 mm balloon was passed across this lesion, and serial insufflations were performed here as well. The completion study showed markedly improved flow. Catheters and wires and sheaths were removed. Pressure was held to the exit site until hemostasis was achieved. The patient tolerated the procedure well. He seemed to have a good quality thrill and bruit in the recovery area. All counts were verified.
Physician Coded this case as follows:
36147
36148
35475
35476
75962
75978
We received denial for the 35475 & 35476 codes
Here is an example of an op report:
PROCEDURES PERFORMED:
1. Right forearm fistulogram.
2. Right peripheral venous angioplasty.
3. Right radial artery balloon angioplasty with catheter introduction x2.
INDICATIONS FOR THE PROCEDURE: This 83-year-old male is well known to me. I have been managing his access for many years. We were notified that his fistula had become thrombotic; however, on examination, there seemed to be areas of stenoses within the fistula and some reduced inflows, but there was no evidence of thrombus.
PROCEDURE IN DETAIL: The patient was taken to the XXXXX and sterilely prepped and draped in standard fashion. After infiltration with 1% lidocaine, a needle, a wire, and a short 6-French sheath were inserted in the direction of the antecubital fossa. Aliquots of diluted Visipaque were utilized to visualize the fistula, and there seemed to be a 95% stenosis approximately measuring 3 cm medial to the antecubital fossa. A 6 mm balloon was passed across this lesion, and upon insufflating the lesion, a reflux study was done which showed arterial narrowing across the initial arterial segment of 85% to 90%. Following insufflation in the venous end, a second sheath was passed in the direction of the wrist. A 5 mm balloon was passed across this lesion, and serial insufflations were performed here as well. The completion study showed markedly improved flow. Catheters and wires and sheaths were removed. Pressure was held to the exit site until hemostasis was achieved. The patient tolerated the procedure well. He seemed to have a good quality thrill and bruit in the recovery area. All counts were verified.
Physician Coded this case as follows:
36147
36148
35475
35476
75962
75978
We received denial for the 35475 & 35476 codes
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