Wiki Abdominal aortic aneurysm

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tobeornottobeacoder

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I have a patient that has an (AAA) and was billed with 35103 which is a direct repair of aneurysm and a Gore-tex bifurcated graft was used. The description of 35103 says that this repair is with or without the graft. Well a graft was used and the payor is not paying for the graft. According to my CCI edits this graft if payable, but payor is stating it is bundled with 35103. The graft was also billed with mod 59. I want to appeal, but I cant see or find anything that states a graft is included with the repair. Can anyone shed some light on this? Any suggestions on what I should do or where I can look.
Thanks so much.
 
coder2be said:
I have a patient that has an (AAA) and was billed with 35103 which is a direct repair of aneurysm and a Gore-tex bifurcated graft was used. The description of 35103 says that this repair is with or without the graft. Well a graft was used and the payor is not paying for the graft. According to my CCI edits this graft if payable, but payor is stating it is bundled with 35103. The graft was also billed with mod 59. I want to appeal, but I cant see or find anything that states a graft is included with the repair. Can anyone shed some light on this? Any suggestions on what I should do or where I can look.
Thanks so much.
Click to expand...

What code did you use for the graft?
:confused:
 
coder2be said:
for the graft I used 35646 and no it was not endovascular. it was an open procedure
Click to expand...

In the interest of full disclosure, this is not my primary area of expertise. Perhaps you could ask this question on the general surgery forum.

Anyway, even though there is not an active edit that says 35646 can't be billed with 35103, the code description for 35103 includes a graft (if used). It seems you are coding twice for one graft.
Also, 35103 is specifically for ruptured AAA so by exclusion, 35646 is for other diagnosis. The technique for each procedure may be similiar or identical, but the reason is not, just my opinion.

HTH :)
 
Danny is correct. 35646 is for bypass with graft. I wouldn't code that in addition to 35103 since it includes graft for aneurysm repair. If both procedures were performed that is one thing, but code 35646is not meant to be used as the 'graft' portion of 35103.

I see Gore-Tex grafts a lot when my surgeons perform endovascular repair of AAA so I was curious.

HTH
 
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