36200 and 75716-26

churst21

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can anyone explain to my why certain insurance companies are bundling 36200 and 75716.
 
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36200 is catheter in the aorta. 75716 is bilateral extremity angio with selective cath placement in each extremity artery. 36246,47,48 lower ext or 36215,16 etc for upper ext.
 

jmcpolin

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you can bill both of those codes though when they are doing a runoff and the catheter is moved from the upper aorto to the lower and you would also bill 75625 if there was an aortogram I would appeal it for sure. You would only bill the runoff code 75635 if the catheter does not move in the aorta.
 

Jim Pawloski

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you can bill both of those codes though when they are doing a runoff and the catheter is moved from the upper aorto to the lower and you would also bill 75625 if there was an aortogram I would appeal it for sure. You would only bill the runoff code 75635 if the catheter does not move in the aorta.
If I don't see anything in the report about the renal arteries, I just bill 36200 and 75716. I am assuming that the catheter is placed in the distal abdominal aorta, and contrasted injected. If the renals are described, but not catheter movement for m upper to lower aorta, I would bill the 75635.

HTH,
Jim Pawloski, CIRCC
 

donnajrichmond

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can anyone explain to my why certain insurance companies are bundling 36200 and 75716.
Are they bundling these 2 and paying only one of them? or are they bundling these with other codes that you are also billing?

(some of the responses mention 75635, but that is CTA and should NOT be part of this discussion.)

75716 is not a selective angiogram code, it does NOT include the catheterization and is very frequently done with injection in the aorta (36200). But, if you select one or both of the extremities after the aortic injection, then you would drop 36200. If you do angioplasty, stent, or atherectomy, then you would need a modifier -59 on 75716 if it was a diagnostic angiogram done prior to the revascularization. These codes (37220-37235) include catheterization, so no additional cath code would be allowed (from same access to same leg treated.)
 

churst21

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@ Donna. their paying for the 75716 and not paying for the 36200 by saying its bundled. and the only codes for that day are 36200, 75716, 75625 (which is also paid). This problem has been happening with certain insurances ever since the new revascularization codes for the lower extremities. just curious to know why this may be

ex: catheter placement in proximal abdominal contrast injected images taken. then the catheter was withdrawn to the aortic bifurcation contrast injected images taken bilateral lower extremities. 36200, 75625, 75716. it wouldn't be 75630 because the catheter was withdrawn to the bifurcation. once the catheter moved the code changes.
 

donnajrichmond

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Most likely what has happened is that when they put the revascularization codes in last year and set up their edits, the edits were set across the board and NOT just with the 3722x set of codes.

Have you appealed and/or talked to someone there? If not, that is a first step. If you can write a letter from your doctor to the Medical Director of the payer, that would be good also.
If you have appealed or talked to them and they continue to bundle these, then you should contact any specialty societies that your physicians belong to. The societies, such as ACR and SIR, like to know when these kinds of things are happening so they can help payers understand the correct coding.
 
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