apogoreski
New
I am a coder for a Vascular Surgery office that performs procedures in the hospital and also in their angio suite. We are having a discussion and trying to decide the correct billing and documentation standards for S&I codes not listed as included with the CPT codes. For example, if we are performing a endovascular repair of an infrarenal abdominal aortic aneurysm using a prosthesis with 2 docking limbs the base code would be 34803. In my coding companion it states that the S&I code of 75952 is to be reported separately (which we are doing). The question we are having is what the documentation requirements are for S&I procedures performed intraoperatively. Does the dictation/report have to be separate or can it be in the body of the operative report for the procedure performed? Our doctors usually do something like this:
OPERATIVE FINDINGS:
Preoperatively, the patient presented with severe limited left lower extremity claudication symptoms. Noninvasive study showed severe infrarenal occlusive disease. The patient presented now for a diagnostic arteriogram and possible intervention.
Aortoiliac region: There were single renal arteries bilaterally which appeared widely patent. The abdominal aorta appeared widely patent. It branched normally into the common iliac arteries. On the right-hand side, the common iliac artery branched normally into the hypogastric and external iliac artery, which was patent to the groin level. On the left side, the left common iliac artery was patent at its origin. There was a high-grade stenosis of approximately 80% just prior to the bifurcation to the hypogastric artery. Distally, the external iliac artery was patent to the groin level.
Left leg: The left common femoral, superficial femoral and profunda were patent at the groin level. The left superficial femoral artery occluded in its middle third. It then reconstituted in an above-knee popliteal artery, which was patent across the knee joint with three-vessel runoff consisting of anterior tibial, posterior tibial and peroneal to the foot and ankle region.
Intraprocedurally, from a right-sided approach, we were able to cross both the left common iliac artery lesion, as well as the left superficial femoral artery occlusion. Treatment consisted of a combination of balloon angioplasty and stent placement of the left superficial femoral and popliteal artery using a 5 mm angioplasty balloon along with a stent placement consisting of a 6 x 80 self-expanding Zilver stent, which was placed in the superficial femoral artery in the proximal popliteal artery. Final completion showed excellent treatment of the SFA segment with a widely patent system, with good flow through the SFA segment and continued runoff to the foot and ankle region. In addition, we treated the left common iliac artery lesion with a combination of balloon angioplasty and stent placement utilizing an 8 x 36 balloon-expandable stent. This was used to treat the common iliac artery with an excellent placement and a widely patent left iliac system.
Then go on to dictate the technique of the procedure. There is NOT a separate report being done, just the information above in the op note. Is that sufficient? And does anyone have any documentation to support their answer? We found this information from the Medicare Claims Processing Manual, Ch 13..
80 - Supervision and Interpretation (S&I) Codes and Interventional Radiology (Rev. 1, 10-01-03)
80.1 - Physician Presence (Rev. 1, 10-01-03)
Radiologic supervision and interpretation (S&I) codes are used to describe the personal supervision of the performance of the radiologic portion of a procedure by one or more physicians and the interpretation of the findings. In order to bill for the supervision aspect of the procedure, the physician must be present during its performance. This kind of personal supervision of the performance of the procedure is a service to an individual beneficiary and differs from the type of general supervision of the radiologic procedures performed in a hospital for which FIs pay the costs as physician services to the hospital. The interpretation of the procedure may be performed later by another physician. In situations in which a cardiologist, for example, bills for the supervision (the “S”) of the S&I code, and a radiologist bills for the interpretation (the “I”) of the code, both physicians should use a “-52” modifier indicating a reduced service, e.g., only one of supervision and/or interpretation. Payment for the fragmented S&I code is no more than if a single physician furnished both aspects of the procedure.
So we are trying to make sure that since we are NOT billing with a 52 modifier (just a 26 in the inpatient/hospital setting) that this is correct since our doctors dictate findings w/in their op notes.
Any insight would be GREAT!
OPERATIVE FINDINGS:
Preoperatively, the patient presented with severe limited left lower extremity claudication symptoms. Noninvasive study showed severe infrarenal occlusive disease. The patient presented now for a diagnostic arteriogram and possible intervention.
Aortoiliac region: There were single renal arteries bilaterally which appeared widely patent. The abdominal aorta appeared widely patent. It branched normally into the common iliac arteries. On the right-hand side, the common iliac artery branched normally into the hypogastric and external iliac artery, which was patent to the groin level. On the left side, the left common iliac artery was patent at its origin. There was a high-grade stenosis of approximately 80% just prior to the bifurcation to the hypogastric artery. Distally, the external iliac artery was patent to the groin level.
Left leg: The left common femoral, superficial femoral and profunda were patent at the groin level. The left superficial femoral artery occluded in its middle third. It then reconstituted in an above-knee popliteal artery, which was patent across the knee joint with three-vessel runoff consisting of anterior tibial, posterior tibial and peroneal to the foot and ankle region.
Intraprocedurally, from a right-sided approach, we were able to cross both the left common iliac artery lesion, as well as the left superficial femoral artery occlusion. Treatment consisted of a combination of balloon angioplasty and stent placement of the left superficial femoral and popliteal artery using a 5 mm angioplasty balloon along with a stent placement consisting of a 6 x 80 self-expanding Zilver stent, which was placed in the superficial femoral artery in the proximal popliteal artery. Final completion showed excellent treatment of the SFA segment with a widely patent system, with good flow through the SFA segment and continued runoff to the foot and ankle region. In addition, we treated the left common iliac artery lesion with a combination of balloon angioplasty and stent placement utilizing an 8 x 36 balloon-expandable stent. This was used to treat the common iliac artery with an excellent placement and a widely patent left iliac system.
Then go on to dictate the technique of the procedure. There is NOT a separate report being done, just the information above in the op note. Is that sufficient? And does anyone have any documentation to support their answer? We found this information from the Medicare Claims Processing Manual, Ch 13..
80 - Supervision and Interpretation (S&I) Codes and Interventional Radiology (Rev. 1, 10-01-03)
80.1 - Physician Presence (Rev. 1, 10-01-03)
Radiologic supervision and interpretation (S&I) codes are used to describe the personal supervision of the performance of the radiologic portion of a procedure by one or more physicians and the interpretation of the findings. In order to bill for the supervision aspect of the procedure, the physician must be present during its performance. This kind of personal supervision of the performance of the procedure is a service to an individual beneficiary and differs from the type of general supervision of the radiologic procedures performed in a hospital for which FIs pay the costs as physician services to the hospital. The interpretation of the procedure may be performed later by another physician. In situations in which a cardiologist, for example, bills for the supervision (the “S”) of the S&I code, and a radiologist bills for the interpretation (the “I”) of the code, both physicians should use a “-52” modifier indicating a reduced service, e.g., only one of supervision and/or interpretation. Payment for the fragmented S&I code is no more than if a single physician furnished both aspects of the procedure.
So we are trying to make sure that since we are NOT billing with a 52 modifier (just a 26 in the inpatient/hospital setting) that this is correct since our doctors dictate findings w/in their op notes.
Any insight would be GREAT!
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