Wiki Cardiac Rehab Dx Code

[twcfpc]

I'm being told to use dx code 996.72 for all 93797 & 98 (cardiac rehab). 996.72 states Other Complications due to other cardiac device, implant, and graft.

Patients have undergone CAGB or PTCA but are not having complications from it so I disagree with the use of 996.72. My providers are stating this is the code that they have "always" used and it gets the claim paid.

Most of the patients in question have CAD so I am wanting to code as: 414.01 - Coronary atherosclerosis of native coronary artery.
V15.1 - Surgery to heart and great vessels

Am I on the right track? Sure could use some advise.

Thanks

 

[jlb102780]

I'm being told to use dx code 996.72 for all 93797 & 98 (cardiac rehab). 996.72 states Other Complications due to other cardiac device, implant, and graft.

Patients have undergone CAGB or PTCA but are not having complications from it so I disagree with the use of 996.72. My providers are stating this is the code that they have "always" used and it gets the claim paid.

Most of the patients in question have CAD so I am wanting to code as: 414.01 - Coronary atherosclerosis of native coronary artery.
V15.1 - Surgery to heart and great vessels

Am I on the right track? Sure could use some advise.

Thanks

yes, you are on the right track. I have never used 996.72. If I were you I would look on your local Medicare's LCD list. If the pt has CAD and they have undergone CABG or PTCA, I would use 414.01 with V45.81 (CABG) or V45.82 (PTCA).

Hope that helps

 

[twcfpc]

Thanks Jammie. Those postprocedural status codes you gave feel right to me. I knew better codes where out there but they just wouldn't come to me. I have had no luck finding a LCD for cardiac rehab. I found NCDs but they were not helping me with the dx. I am also going to ask to see the orginal orders and any other documentation my provider was give by the ordering physician.

Thanks again.