Wiki 75630 Denial

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kvogel03

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Hello,

I have billed 37228 RT, 37232 RT, 37224 RT, and 75630 26, XU with Humana Medicare Advantage. Everything was paid but 75630. The insurance reviewed the record stated the documentation didn't meet criteria and will not be reimbursed. The 75630 was done from the same access point as the intervention. There was no prior angiograms done. Any recommends on how to correct this ?
 
kvogel03 said:
Hello,

I have billed 37228 RT, 37232 RT, 37224 RT, and 75630 26, XU with Humana Medicare Advantage. Everything was paid but 75630. The insurance reviewed the record stated the documentation didn't meet criteria and will not be reimbursed. The 75630 was done from the same access point as the intervention. There was no prior angiograms done. Any recommends on how to correct this ?
Click to expand...
What all was in the documentation for code 75630? Did the physician document findings in the aorta plus the bilateral lower extremity exam?
 
If the description on the left leg only describes the iliac and femoral artery, then I would code this as 75710-RT,59
HTH,
Jim
 
ldickerson58 said:
What all was in the documentation for code 75630? Did the physician document findings in the aorta plus the bilateral lower extremity exam?
Click to expand...
The documentation includes Abdominal Aortography show normal abdominal aorta with bifurcation into both iliac arteries. No disease in abdominal. Angiography of both renal arteries and they appear okay. Yes there is dictation for bilateral lower extremity angiogram.
 
So I am going to assume that the report says something like this; The catheter was placed in the abdominal aorta and imaging was performed. The catheter was then moved down to the aortic bifurcation and bilateral lower extremity was performed. If this happened, then code 75625 and 75716-59 along with the intervention codes. If all the imaging was done from one catheter position, then you code 75630.

Thanks,
Jim
 
Jim Pawloski said:
So I am going to assume that the report says something like this; The catheter was placed in the abdominal aorta and imaging was performed. The catheter was then moved down to the aortic bifurcation and bilateral lower extremity was performed. If this happened, then code 75625 and 75716-59 along with the intervention codes. If all the imaging was done from one catheter position, then you code 75630.

Thanks,
Jim
Click to expand...
Okay, thanks for your help.
 
The insurance came back and denied the whole claim after changing the 75630 to 752625 and 75716. Any suggestions ?
 
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