bypass and endarectomy

sherryo35

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Can anyone give me direction on this case.
Doctor does iliofemoral bypass 35665 and popiteal endarectomy 35351.
The doctor went in to do the bypass. These codes do not pass cci, it directs you do bill the 35351. 35665 tells you not to bill for establishing inflow or outflow. So, help, I don't know which one to bill.
Thanks,
 

mshuntley

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Stuart, Fl
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I'm not an expert but both are separate and distinct sites (vessels) and procedures (graft & endarectomy). If the CCI edits don't require a 59 then you should be able to bill both. If you get a denial you should be able to appeal it arguing separate and distinct sites and procedures stating they are not bundled. Some carriers such as BCBS have their own set of edits, so depending on the carrier it might require a 59. BCBS has a procedure code auditing tool on availity.com in which you type the CPT with the modifier and it will tell you if it's allowed or not.

I'll be curious to know what you find out. Let me know how it goes.

Missy
 

mshuntley

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Hey Sherry,
I'm a dork and I like to research so I checked these codes out for you. According to CMS's cci edits 35351 is bundled with 35665 but it has the superscript number 1 next to it which means the modifier 59 is allowed. Which ever code has the ss#1 next to it is the one you will put the 59 on. In this case it's 35665-59, so bill them both and put the 59 on 35665. Here is a list of the super script numbers and what they stand for…

0=not allowed
1=allowed
9=not applicable

I recently discovered you can look up all cci edits on the CMS website, just Google "National Correct Coding Initiatives Edits" or you can type it in the search menu on there website… www.cms.hhs.gov

Let me know if you get a denial with the 59, if so you can defiantly appeal it. Are you anywhere near Stuart, Fl? If so we should see about having a chapter meeting on vascular coding.
 
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