Wiki Vascular denial 37224

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kvogel03

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Hello,

Here is the report:

A 5 French sheath was placed into the right common femoral artery. After that 5 French Omni Flush catheter was advanced over the wire and positioned on the abdominal aorta. The abdominal aortography was performed. After that, the catheter was repositioned and placed in the distal abdominal aorta. Bilateral iliac artery angiography was performed. The left lower extremity angiography was performed by advancement of RIM catheter in the distal abdominal aorta and wiring the left SFA and advancement of 5 French glide catheter into the SFA. Due to the critical disease in the left SFA proceed with intervention. A 0.035 x 150 cm glide wire with trailblazer from ev3 was used to cross the left 100% occluded SFA. After that the trailblazer was advanced into the distal left SFA which intraluminal position of the wire. Again the lesion was crossed again with 0.035 glide wire extra advantage. 4 x 40 mm armada balloon as was advanced over the wire and inflation was performed at the site of 100% of occlusion of the left SFA. After that the right lower extremity angiography was performed.


I have coded 37224, 36247 59, 75630 26 59, 75710 26 59. Is this coded correctly?

Medicare plus blue is denying 37224 and has paid on the other codes. I have been having lots of issues with this insurance. Any suggestions on how to get this paid? Is anyone else having issues with this ?

Any suggestions would very helpful.

Thanks,


Kayla
 
kvogel03 said:
Hello,

Here is the report:

A 5 French sheath was placed into the right common femoral artery. After that 5 French Omni Flush catheter was advanced over the wire and positioned on the abdominal aorta. The abdominal aortography was performed. After that, the catheter was repositioned and placed in the distal abdominal aorta. Bilateral iliac artery angiography was performed. The left lower extremity angiography was performed by advancement of RIM catheter in the distal abdominal aorta and wiring the left SFA and advancement of 5 French glide catheter into the SFA. Due to the critical disease in the left SFA proceed with intervention. A 0.035 x 150 cm glide wire with trailblazer from ev3 was used to cross the left 100% occluded SFA. After that the trailblazer was advanced into the distal left SFA which intraluminal position of the wire. Again the lesion was crossed again with 0.035 glide wire extra advantage. 4 x 40 mm armada balloon as was advanced over the wire and inflation was performed at the site of 100% of occlusion of the left SFA. After that the right lower extremity angiography was performed.


I have coded 37224, 36247 59, 75630 26 59, 75710 26 59. Is this coded correctly?

Medicare plus blue is denying 37224 and has paid on the other codes. I have been having lots of issues with this insurance. Any suggestions on how to get this paid? Is anyone else having issues with this ?

Any suggestions would very helpful.

Thanks,


Kayla
Click to expand...

First, 36247 is bundled into 37224. Second, you should have billed 75625 for the aortogram. 756530 is part of 75710, so that can't be billed. Also, you need the modifier for what leg had the intervention.
HTH,
Jim Pawloski, CIRCC
 
I agree with Jim on 36247 bundled under 37224. I would suggest to code 75716-26,59, since the catheter was repositioned and placed in the distal abdominal aorta. Bilateral iliac artery angiography was performed. Even if only one artery imaged, you need to code for that, provided that the surgeon should mention the result of the imaged artery.
The reason 36247 bundled under 37224, , the catheter placement is the basic step for any revascularization procedure. You can code the highest level of intervention performed in a given vessel. If there are no intervention performed just the cath placement and angiography, then you can code for cath pacement based on the number of bifurcations crossed.
 
Mohamedsaad.Hasan said:
I agree with Jim on 36247 bundled under 37224. I would suggest to code 75716-26,59, since the catheter was repositioned and placed in the distal abdominal aorta. Bilateral iliac artery angiography was performed. Even if only one artery imaged, you need to code for that, provided that the surgeon should mention the result of the imaged artery.
The reason 36247 bundled under 37224, , the catheter placement is the basic step for any revascularization procedure. You can code the highest level of intervention performed in a given vessel. If there are no intervention performed just the cath placement and angiography, then you can code for cath pacement based on the number of bifurcations crossed.
Click to expand...

Since the complete report was not posted, I would not jump to code 75716 since we don't know exactly what was imaged. Since only one leg had an intervention, imaging of the other leg may be incidental and not coded for.

Jim Pawloski, CIRCC
 
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