Wiki Need as many opinions as possible!

[suela923@aol.com]

I need as many opinions as possible...I feel that the angiograms should not be billed as we knew there were fibroids. It is clearly stated in patient's H&P that she presents with symptomactic enlarged fibroid uterus and we tentatively elected to peform UAE. Patient wants to review all her options before proceeding. MRI was also done with results recommending patient as candidate for UAE. One of the techs is stating that the doctor needed to visualize the common and internal iliac as diagnostic to this procedure so I should bill for 75736 x 2 and 75774. Please weigh in on this everyone!!
Thanks.
Sue


IR EMBO FOR TUMOR, ORGAN INFARCTION OR ISCHEMIA

Bilateral uterine artery embolization

History: Uterine bleeding with pelvic fullness and discomfort. Urinary frequency. Known uterine fibroids.

Technique: Timeout performed. Skin over right groin prepped and draped sterilely. 2% lidocaine used as local anesthetic. Moderate sedation also administered. Micropuncture needle was used to access right common femoral artery. 6-French sheath placed. Rim catheter used to select the left common iliac artery. Arteriogram performed. Using roadmapping technique, uterine artery was selected on the left and diagnostic arteriogram performed. There are no prior catheter based arteriograms. Decision to intervene based on today's study. Embolization then performed using 500-700 micro and 700-900 micro embospheres. Near arterial stasis achieved.

Right hypogastric artery selected. Arteriogram performed. There are no prior catheter based arteriograms. Decision to intervene was based on today's study. Right uterine artery selected and a diagnostic arteriogram was performed. Embolization performed using 500-700 micro and 700-900 micro embospheres. Near arterial stasis achieved.

Hemostasis achieved at right groin puncture site. EXOSEAL closure device utilized. No complications.

Findings: Left common iliac artery arteriogram shows filling of the common iliac artery, external iliac artery, and internal iliac artery. 2 IUDs are in place. The anterior division appears to arise from the main posterior division branch. Uterine artery arises from the anterior division. It is small and tortuous supplying the uterus. Embolization was performed without complication. Near arterial stasis achieved.

Right hypogastric artery arteriogram shows filling of anterior and posterior divisions. The uterine artery is enlarged and tortuous. Uterine artery arises from the anterior division. Uterine artery arteriogram shows an enlarged uterine artery supplying an enlarged fibroid uterus. Embolization was performed as described above. No complications. Near arterial stasis achieved.

IMPRESSION:


Successful and uncomplicated bilateral uterine artery embolization for symptomatic fibroids.

 

[margaret fahy]

I would say that since dr. clearly states that the decision to intervene was made after the angiograms, and that there were no prior catheter-based studies, these are billable.
If they were for roadmapping only, then no....but it seems to me that the angiograms were necessary for dr. to make decision to intervene.
Margie

 

[suela923@aol.com]

I guess what I am questioning is that the doctor knew going in that he was going to do a UAE so werethe angiograms diagnostic at that point or were they just part of the procedure? I know he stated that decision was made but I still feel a bit uncomfortable billing these as diagnostic.

 

[dpeoples]

That is a good question, one that I ask often. But, the documentation is sufficient IMO to code these angiograms as diagnostic. Even though the condition was known, there was obvioulsly some question (to the patient and the refering doctor by implication) as to the severity. The MRI (probably not an MRA) does not preclude another diagnostic test. As for the tech, they are an invaluble source of info, but you are probably not billing for them. Always code from the documented report(s), not from verbal information.

HTH

 

[suela923@aol.com]

Thanks Danny. After reviewing this case with my boss I felt much more comfortable with billing for the angiograms.

 

[roseqseven]

CPT's for UFE (your coded procedure) vs UAE?

36247 x2 Rt & LT uterine/pudendal selection
75736 x2 RS&I(s)
37243 Uterine Fibroid Embolization

vs.

36247 x2 Rt & LT uterine/pudendal selection
75736 x2 RS&I(s)
37244 Uterine Artery Embolization for post partum hemorrhage

Are these codes correct with/without modifier 59?