Wiki Need help - new to coding cardiovascular

[clgregory]

I have been asked to review the coding of two cardiovascular physicians. The E&M's I can do but when it comes to their surgeries, I am totally lost. I am hoping that someone can help me.

On one op note, the physician is wanting to bill the following codes - 34802, 35226, 34825, 36200, 34812, 75625. When I check the CCI edits on these the 35226 is a component of all the other codes but can be billed with a modifier and the 75625 is a component of 34802 and 34825 but can be billed with a modifier. What am I looking for in the op note in order to bill both of these codes with a modifier? And what modifier am I looking at?

Thank you in advance for the help!

Also, where/what is a good resource for this information as I have a feeling that this is going to be an ongoing thing for me?

Cheryl

 

[Peter Davidyock]

How many devices were deployed?

 

[clgregory]

Peter:

Since I am not sure what I am reading, I have copied and paste the op note below. Hoping this helps. Thank you in advanced for your help.

Cheryl

Patient brought to operating room stable condition and placed in supine position
on the operating table. General endotracheal anesthesia was induced without
incident. The patient was monitored with EKG, pulse oximetry arterial line,
noninvasive blood pressure cuff and bladder catheter. SCD boots were placed. The abdomen and the lower extremities were prepped from the nipples to the knees.
The patient was draped in a sterile fashion. Ioban was used. Bilateral groin
incisions were made with a #10 blade. Electrocautery was used to divide the
tissues through the fascia. The femoral arteries were exposed. The superficial
femoral, profunda femoris and common femoral arteries were doubly encircled with vessel loops. Weitlaner self-retaining retractors were placed. An 18-gauge
needle was inserted in the common femoral artery bilaterally. J-wire was
advanced and 8-French sheaths were placed. A 0.035 Glidewire was advanced from the right femoral artery into the aorta and a 5-French pigtail catheter with
markers was placed. Attempted aortography was unsuccessful due to power injector failure. Handheld injection was obtained. The renal arteries were identified. At this point, the pigtail was advanced over the Glidewire to the level of the aortic arch. The Glidewire was removed and a Lunderquist wire was placed. On the left side, a burn catheter was placed and a Glidewire was used to allow the burn to be placed in the aortic arch. Lunderquist wire was placed. The burn catheter was removed. The 8-French sheath was removed, and a 16-French dilator was advanced. The device was then deployed after insertion over the Lunderquist wire at the level of the renal arteries with the gate opened into the left. The Glidewire was again brought through the pigtail catheter, which was removed. The Glidewire was then withdrawn a burn catheter advanced and was then used to access the gate with the Glidewire. A pigtail catheter was then advanced over the Glidewire was able to spin freely within the graft. The Lunderquist wire and was then advanced. The right side docking limb was then deployed with flared end and landed cephalad to the hypogastric bifurcation. Retrograde injection demonstrated good coaptation. There was no endoleak noted. The remainder the left sided docking limb was deployed. The device was removed. An 80 mm extension limb was then deployed landing cephalad to the hypogastric bifurcation. There was a 2 cm landing zone. Two balloons were advanced, and using a kissing technique
the lower extremity limbs were sealed. A single balloon was used at the level of
the renal arteries. Completion retrograde aortography demonstrated no endoleak.
Subsequent evaluation will be performed via CT scan given the absence of use of the power injector. The patient tolerated procedure well. The devices were
removed and 16-French sheaths placed. After completion of the procedure, the
vascular clamps were applied. The patient had been heparinized with 5000 units of heparin. An additional 2000 units of heparin had been given. The
arteriotomies were repaired with a double-running layer of 6-0 Prolene suture
after being irrigated with heparinized saline. The sutures were tied. The
vessels had been vented and then allowed to be opened into the profunda femoris.
The superficial femoral was then opened last. thrombin and Gelfoam were placed.
Wounds were irrigated with saline. Fascial closure with 2 layers of running 0
Vicryl suture. A layer of running 2-0 Vicryl suture was placed. Skin closure
with staples. Sterile dressings were placed. The patient was awoken in the
operating room. The patient an excellent 2+ dorsalis pedis pulses bilaterally.
The patient was taken in stable condition to the PACU.

 

[Peter Davidyock]

35226 is not reportable. According to their documentation it appears they are trying to bill this for closure, not actually repairing a damaged vessel in the lower extremity.

I would look at 75953 rather than 75625. They have missed the correct code and are attempting to bill for the leak check, or so it seems to me.

Sorry for the delay.