37228-52

amym

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I have coded this procedure as 37228-52 but Medicaid will not cover with this modifier. My physician wants me to bill for cath placement and angiography only. Would that be correct and what codes should I bill?

ATTEMPT AT RIGHT TIBIOPERONEAL TRUNK PTA:

INDICATION: Significant claudication in this 55-year-old male with
defect in the right leg, although both legs are symptomatic. The
patient has to stop several times even going to the grocery store.
Previous arteriogram has identified total occlusion of the popliteal
with visualization of the anterior tibial artery right collateral flow.
This is a short area of occlusion, however even though collateral flow
is present it appears fairly inadequate and it was felt that perhaps
further evaluation with more lateral imaging and attempt at wire
crossing is going to be crucial for possible revascularization.

PROTOCOL: The patient was brought to the cath lab. The left groin was
prepped and draped in the usual fashion. Xylocaine was infiltrated and
OmniFlush catheter was advanced over a guidewire and subsequently a
stiff glide catheter was used to go across and subsequently a 7 French
Terumo destination sheath was then advanced and placed in the
contralateral right SFA following which an 0.014 Quick-Cross catheter
was advanced and then an 0.014 approach wire was then taken along with
it. Careful imaging was done with that magnification of the popliteal
and tibioperoneal trunk. The catheter was advanced and the lesion was
interrogated with wire. There appears to be three distinct collaterals
coming off of a flush occlusion and therefore making it impossible for
any wire movement in forward direction. Lateral imaging confirmed that
there was no area to advance the wire except into the collateral flow
and therefore after a few attempts it was felt that it is reasonable to
stop any further attempts and therefore the entire assembly was removed.

StarClose method was used for closure and no complications occurred.

FINAL IMPRESSION:
Unsuccessful attempt at wiring the chronic total occlusion of the
popliteal artery and tibioperoneal trunk using 0.014 wire and Quick-
Cross catheter.
 

dpeoples

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I have coded this procedure as 37228-52 but Medicaid will not cover with this modifier. My physician wants me to bill for cath placement and angiography only. Would that be correct and what codes should I bill?

ATTEMPT AT RIGHT TIBIOPERONEAL TRUNK PTA:

INDICATION: Significant claudication in this 55-year-old male with
defect in the right leg, although both legs are symptomatic. The
patient has to stop several times even going to the grocery store.
Previous arteriogram has identified total occlusion of the popliteal
with visualization of the anterior tibial artery right collateral flow.
This is a short area of occlusion, however even though collateral flow
is present it appears fairly inadequate and it was felt that perhaps
further evaluation with more lateral imaging and attempt at wire
crossing is going to be crucial for possible revascularization.

PROTOCOL: The patient was brought to the cath lab. The left groin was
prepped and draped in the usual fashion. Xylocaine was infiltrated and
OmniFlush catheter was advanced over a guidewire and subsequently a
stiff glide catheter was used to go across and subsequently a 7 French
Terumo destination sheath was then advanced and placed in the
contralateral right SFA following which an 0.014 Quick-Cross catheter
was advanced and then an 0.014 approach wire was then taken along with
it. Careful imaging was done with that magnification of the popliteal
and tibioperoneal trunk. The catheter was advanced and the lesion was
interrogated with wire. There appears to be three distinct collaterals
coming off of a flush occlusion and therefore making it impossible for
any wire movement in forward direction. Lateral imaging confirmed that
there was no area to advance the wire except into the collateral flow
and therefore after a few attempts it was felt that it is reasonable to
stop any further attempts and therefore the entire assembly was removed.

StarClose method was used for closure and no complications occurred.

FINAL IMPRESSION:
Unsuccessful attempt at wiring the chronic total occlusion of the
popliteal artery and tibioperoneal trunk using 0.014 wire and Quick-
Cross catheter.
I would also just code for the catheter placement and angiography. But I am curious as to why medicaid rejected the modifier?

HTH :)
 

amym

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Provider rep informed me that we are out of luck when it comes to unsuccessful procedures.

Would it be appropriate to code this as 36200, 75716, 75625 or 75630?
 

dpeoples

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Provider rep informed me that we are out of luck when it comes to unsuccessful procedures.

Would it be appropriate to code this as 36200, 75716, 75625 or 75630?

Based on the report I would code:
36247/75710

I would prefer better documentation of catheter placement but could defend placement into the contralateral SFA.

HTH :)
 
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