Wiki bundle issue

[jocoffey]

Hi can anyone explain why cpt code 35701-exploration of the carotid artery is
bundled with cpt code 38724-radical neck dissection. Our physicians think we should get credit for both procedures. Please advise
Thank You

 

[catprocode]

I am wondering about CPT 35701 too, our doctor tells me it is a separate procedure than 15757 although I believe they bundle and should not be billed.

Here is the coding tip for 35701 in encoder the reason why I do not think it should be billed

Coding Tips

Report an exploration only if no other service is performed. If the carotid artery is examined through the same incision used for a procedure performed during the same operative session, the exploration is not reported. If the carotid artery is examined and a defect is discovered and repaired, report the repair, not the exploration. For an exploration for postoperative hemorrhage, thrombosis, or infection of the neck, see 35800. For excision of an infected graft of the neck, see 35901. If the procedure is completed through an operating microscope, report 69990 in addition to the primary procedure. However, head gear (e.g., loupes or binoculars) is considered an integral part of this procedure.

 

[CodingKing]

I always cringe when I hear someone say just go with what the doctor says. Just because the doctor says it, doesn't mean its true. Sure they are two different procedures in the CPT book. However, typically exploration of the surgical field is bundled into the open procedure. You cant do a surgery without exploring the surgical field, so its was already considered when setting the reimbursement for the more complex procedure. Ignoring NCCI manual the code description since 2011 says "not followed by surgical repair" so its misreporting whether or not payer follows CCI.

Per NCCI manual chapter V, C.39 :

Open vascular procedures include exploration of the blood vessel. CPT codes 35701, 35721, 35741, and 35761 (“exploration (not followed by surgical repair)...”) should not be reported for a blood vessel on which an open vascular procedure is performed.

You will find similar wording all over the NCCI manual. Here is from the General Section

Chapter I, C.6

Exposure and exploration of the surgical field is integral to an operative procedure and is not separately reportable. For example, an exploratory laparotomy (CPT code 49000) is not separately reportable with an intra-abdominal procedure. If exploration of the surgical field results in additional procedures other than the primary procedure, the additional procedures may generally be reported separately. However, a procedure designated by the CPT code descriptor as a “separate procedure” is not separately reportable if performed in a region anatomically related to the other procedure(s) through the same skin incision, orifice, or surgical approach.

 

[catprocode]

I agree that 35701 does bundle with 38724

However, it does not bundle with 15757 so that makes it a separate procedure if the same artery/vessel was not used in the 15757 procedure.

So would they need to document a separate incision as well?

 

[mitchellde]

However, it does not bundle with 15757 so that makes it a separate procedure if the same artery/vessel was not used in the 15757 procedure.

So would they need to document a separate incision as well?

Could you post a procedure note. Why would your provider be performing a carotid artery exploration with a skin flap repair?

 

[catprocode]

Could you post a procedure note. Why would your provider be performing a carotid artery exploration with a skin flap repair?

I would have to pull schedules in order to find it.

The microvascular anastomosis for the 15757 was performed on arteries other than the carotid and was done for closure.
The carotid was lysed and was not followed by surgical repair.

I am not a doctor, so I can not explain why he is doing this, but these codes do not bundle when I put them in the NCCI edits in encoder

So I am just confused why they would not bundle if I am not supposed to bill these two together?

Any thoughts?

 

[mitchellde]

They are not bundled, but you probably have a medical necessity issue.