75630 Denial

Alfaro33

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Previous coder submitted charges below. Insurance denial reason: 75630 26 59 denied for modifier ON THIS SERVICE ON THE SAME DAY IS NOT SUPPORTED BY THE INFORMATION SUBMITTED ON THE CLAIM.
I believe it is a bundling issue, co-worker feels codes and modifiers are warranted and may actually be a diagnosis issue based on First Coast LCD. Any suggestion?

37224, 36215-59, 75600-26, 75630-26-59, 75710-26-59

Dx I70.212

Indication
Patient is a 68 Years M who presented with PAD. Risks and benefits were discussed and informed consent was obtained for angiogram possible intervention. This patient had a prior left femoral to popliteal artery bypass to exclude a popliteal aneurysm in the remote past he developed stenosis at the distal anastomosis and in the superficial femoral artery proximal to the bypass. He was taken to the operating room today for angiogram and possible intervention. He also history of coronary artery bypass graft surgery remotely and secondary to a LIMA bypass the decision was also made to perform arch angiogram to evaluate the great vessels.

Operation
arch angiogram
left subclavian angiogram
aorto-ilio-femoral angiogram
left popliteal angiogplasty
left SFA angioplasty

Anesthesia

local/MAC

Estimated Blood Loss
[5 ml]

Findings
Aorta: patent

right common iliac: patent (stent in place)
right internal iliac: patent
right external iliac: patent
right CFA: patent
right PFA: patent
right SFA: patent


left common iliac: patent (stent in place)
left internal iliac: patent
left external iliac: patent
left CFA: patent
left PFA: patent
left SFA: severe stenosis above the fem-pop bypass in the native SFA
left pop: patent (severe stenosis at the distal anastomosis of the fem-pop bypass
left AT: patent
left PT: patent
left peroneal: patent

Type 1 arch
no significant stenosis of the great vessels was seen although motion artifact was present

Specimen(s)
none

Complications
none

Technique
Access was gained in the common femoral artery and flush catheter was placed into the aorta. A aort-ilio-fem angiogram with bilateral lower extremity runoff was performed in the standard fashion.

Please see above for findings.

Due to the lesions identified and the patient's symptoms the decision was made to perform intervention.

A 6F sheath up and over sheath was placed in the standard fashion and the patient was given systemic heparin. The SFA and popliteal lesions were crossed with a wire and catheter and then treated. The stenosis at the distal anastomosis was treated with a 3 mm plain angioplasty balloon followed by a 4 mm drug-eluting balloon. The lesion in the native superficial femoral artery proximal to the bypass was treated with a 5 mm drug eluting angioplasty balloon followed by 6 mm drug eluting angioplasty balloon.

Completion angiogram was performed and revealed and excellent result with no residual stenosis. The wires, catheters, and sheath was removed and the femoral was closed using a [mynx] device. Access was gained the left common femoral artery and a 5 French sheath was placed. A pigtail catheter was placed into the aortic arch and arch angiogram was performed in a standard fashion. The left subclavian artery was selected out using V Tek catheter and a 2nd order diagnostic angiogram was performed in the standard fashion. There appeared to be no stenosis of the great vessels or the subclavian artery although there was moderate motion artifact present

Patient tolerated the procedure well.
 

Jim Pawloski

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To quote Dr. Zielske, "Code 75630 requires imaging of the abdominal aorta, not just the distal most aspect of the aorta. The distal most portion of the aorta is incidentally and routinely seen when a pigtail catheter is injected at the level of the aortic bifurcation for the purpose of lower extremity angiography and is part of the code 75716." (Z health publishing, Diagnostic & Interventional Cardiovascular Coding Reference, Pg. 299, bullet no. 9). That is why you can't code 75630. Also, you can't code 36215 or 75600 because the code for the arch is 36221. What should be coded is 37224--LT, 36221-59, 75716-59

HTH,
Jim Pawloski, CIRCC
 

Alfaro33

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To quote Dr. Zielske, "Code 75630 requires imaging of the abdominal aorta, not just the distal most aspect of the aorta. The distal most portion of the aorta is incidentally and routinely seen when a pigtail catheter is injected at the level of the aortic bifurcation for the purpose of lower extremity angiography and is part of the code 75716." (Z health publishing, Diagnostic & Interventional Cardiovascular Coding Reference, Pg. 299, bullet no. 9). That is why you can't code 75630. Also, you can't code 36215 or 75600 because the code for the arch is 36221. What should be coded is 37224--LT, 36221-59, 75716-59

HTH,
Jim Pawloski, CIRCC

Thank you so much!! I see now what you referenced in Z health and will be using that :)
 
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