Cardiology Coding Alert

Reader Question:

Break NCCI Edits With Caution

Question: We have a patient with right renal artery stenosis, recurrent diastolic heart failure, and uncontrolled hypertension due to the renal artery stenosis. The physician performed a right renal stent and abdominal aortogram. We reported 36251-RT, 37236-RT, 75625-26-59, and 99152. Insurance paid everything but 37236, claiming the diagnosis was incorrect. Can you help me?

AAPC Forum Subscriber

Answer: You may need I15.1 (Hypertension secondary to other renal disorders) for a secondary diagnosis code. Many payers will require a secondary diagnosis code, along with the renal artery atherosclerosis code. Remember, you can only report I15.1 if the documentation supports it.

Don’t miss: You cannot report 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation) since the renal artery was selected. National Correct Coding Initiative (NCCI) edits bundle 75625 into 36251 (Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral). Since the modifier for this procedure-to-procedure (PTP) edit is 1, you can override the edit, if appropriate, using a modifier, such as modifier 59 or modifiers XE (Separate encounter…), XS (Separate structure…), XP (Separate practitioner…), or XU (Unusual non-overlapping service…). However, you should never use modifier 59 and other NCCI-associated modifiers to bypass an NCCI edit unless you meet the proper criteria for using the modifier. The documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that you use.

Other Articles in this issue of

Cardiology Coding Alert

View All