Wiki Would you add mod 74

[suela923@aol.com]

Would adding a Modifier 74 tp 37225 be appropriate?

Thanks!
Sue

Procedure: Right leg angiogram and attempt at crossing chronic total occlusion of the distal SFA.

Indication: Claudication.

Results: Patient was identified and brought to the vascular unit. The left groin was prepped and draped in the usual sterile fashion; 2% lidocaine was used to infiltrate the skin over the left femoral artery. An angiographic needle, wire, and 6-French Ansell sheath were then placed. Using a selective catheter the sheath was negotiated up and over the aortic bifurcation with its tip in the right common femoral artery. The patient had a prior diagnostic study showing chronic total occlusion of the distal right SFA. This procedure is an attempt at intervention. I attempted to cross the chronic total occlusion in the distal SFA with various guidewires including an angled Glidewire, a Choice PT wire, and a 0.25 g weighted tip wire. I also attempted to cross the occlusion with a frontrunner device. Due to dense calcific disease these were all unsuccessful attempts. There was no change in the angiographic appearance of the patient's occlusion. Given the inability to cross the occlusion I aborted the procedure. The sheath was removed and pressure was held for 10 minutes without hematoma. Patient tolerated the procedure well and left in stable condition.


Result Impression
Chronic total occlusion of the right SFA. Inability to cross lesion with various endovascular techniques. Patient has failed endovascular therapy and will therefore be referred for surgical management.

 

[suela923@aol.com]

Second request for help!!

Really could use some feedback on this...thanks! Sue

Would adding a Modifier 74 tp 37225 be appropriate?

Thanks!
Sue

Procedure: Right leg angiogram and attempt at crossing chronic total occlusion of the distal SFA.

Indication: Claudication.

Results: Patient was identified and brought to the vascular unit. The left groin was prepped and draped in the usual sterile fashion; 2% lidocaine was used to infiltrate the skin over the left femoral artery. An angiographic needle, wire, and 6-French Ansell sheath were then placed. Using a selective catheter the sheath was negotiated up and over the aortic bifurcation with its tip in the right common femoral artery. The patient had a prior diagnostic study showing chronic total occlusion of the distal right SFA. This procedure is an attempt at intervention. I attempted to cross the chronic total occlusion in the distal SFA with various guidewires including an angled Glidewire, a Choice PT wire, and a 0.25 g weighted tip wire. I also attempted to cross the occlusion with a frontrunner device. Due to dense calcific disease these were all unsuccessful attempts. There was no change in the angiographic appearance of the patient's occlusion. Given the inability to cross the occlusion I aborted the procedure. The sheath was removed and pressure was held for 10 minutes without hematoma. Patient tolerated the procedure well and left in stable condition.


Result Impression
Chronic total occlusion of the right SFA. Inability to cross lesion with various endovascular techniques. Patient has failed endovascular therapy and will therefore be referred for surgical management.

 

[jkayser]

Modifier 74 would be correct if you are billing a discontinued procedure for an Out-Patient Hospital/Ambulatory Surgery Center. If you are billing for the physician, modifier 53 would be correct.

The alternate choice would be modifier 52 for reduced services. This code is appropriate for both Out-patient Hospital /Ambulatory Surgery Center and physicians. Since the patient tolerated the procedure well per the op report, this modifier would be appropriate.

The hierarchy of codes for the femoral/popliteal vascular territory ranges from 37224 through 37227. Since the procedure did not get beyond the failed attempt to cross the lesion, 37224 would be appropriate along with the modifier.

The payer will need the records to determine reimbursement.

I hope this is helpful.

Jean Kayser CPC CIRCC

 

[suela923@aol.com]

Thank you Jean, it is very helpful. I am biling for OPH/ASC so 74 it is!