Wiki Cathplacemt Code when LHC and Carotid Angio performed same session

[Chlrtrep]

I am seeking some opinions and advice.

I code procedures for the Cath Lab and IR in a the hospital setting. I am looking for advice for Abdominal Aortagram Bilateral Extremity and Carotid angiograms from the same access site, in the same setting by the same physician. I have been getting requests from the Revenue Management Department the Medicare claims are not processing due to missing surgical codes. Apparently when the account is billed there is a Medicare error that is activated that states procedures are missing surgical codes and specifies CPT code 75725 and 75716. I am being asked to asked the surgical code in order for the bill to be processed. I feel this is not appropriate.

The procedure that this comes up with is when Abdominal Aortagram with Bilateral Extremities is performed at the same time of carotid angiograms. (or just a thoracic arch or great vessels).

This is was is coded.

75625
75716
36223-50
36225

Sometimes
75716
75725
36221


RMD is requesting that I add 36200 in order to process the bill.

I believe CPT code 36200 is part of the other codes (36221,36223,36225) and by adding 36200 with a charging/coding double. Has anyone else experienced this or am I misunderstanding the situation.

The procedure consists of femoral access. Pigtail to level or renals with Abdominal Aortagram, then catheter moved to the area above iliac bifurcation with Bilateral lower extremity Angiogram from iliacs to the feet. Then the catheter is move to the to each subclavian/innominate for the carotid/vertebral angiograms.

I would appreciate your thoughts.... This facility is using 3M encoder software I have requested what message they are received for this software but have not received a reply back yet.

 

[Jim Pawloski]

I am seeking some opinions and advice.

I code procedures for the Cath Lab and IR in a the hospital setting. I am looking for advice for Abdominal Aortagram Bilateral Extremity and Carotid angiograms from the same access site, in the same setting by the same physician. I have been getting requests from the Revenue Management Department the Medicare claims are not processing due to missing surgical codes. Apparently when the account is billed there is a Medicare error that is activated that states procedures are missing surgical codes and specifies CPT code 75725 and 75716. I am being asked to asked the surgical code in order for the bill to be processed. I feel this is not appropriate.

The procedure that this comes up with is when Abdominal Aortagram with Bilateral Extremities is performed at the same time of carotid angiograms. (or just a thoracic arch or great vessels).

This is was is coded.

75625
75716
36223-50
36225

Sometimes
75716
75725
36221


RMD is requesting that I add 36200 in order to process the bill.

I believe CPT code 36200 is part of the other codes (36221,36223,36225) and by adding 36200 with a charging/coding double. Has anyone else experienced this or am I misunderstanding the situation.

The procedure consists of femoral access. Pigtail to level or renals with Abdominal Aortagram, then catheter moved to the area above iliac bifurcation with Bilateral lower extremity Angiogram from iliacs to the feet. Then the catheter is move to the to each subclavian/innominate for the carotid/vertebral angiograms.

I would appreciate your thoughts.... This facility is using 3M encoder software I have requested what message they are received for this software but have not received a reply back yet.

Your first case should be 36223-50 which is your surgical code, along with 75625 and 75716.
With the second case, 36221 would be the surgical code with 75625 and 75716.
HTH,
Jim Pawloski, CIRCC

 

[Chlrtrep]

Your first case should be 36223-50 which is your surgical code, along with 75625 and 75716.
With the second case, 36221 would be the surgical code with 75625 and 75716.
HTH,
Jim Pawloski, CIRCC

Okay thanks for your response. So you seem to agree with my thoughts. I have tried to explain that the surgical codes are already present. However they refuse to bill without 36200. They referencing the edit message below which they receive in the 3M software

"Edit: 3614-3M-Interventional Radiology procedure is coded- Ensure that the surgical intervention is also coded"

I have tried to explain in several different ways that the code is included with the other procedure however they feel that because of this edit an additional surgical code is required.

I am at a loss.

 

[Jim Pawloski]

Okay thanks for your response. So you seem to agree with my thoughts. I have tried to explain that the surgical codes are already present. However they refuse to bill without 36200. They referencing the edit message below which they receive in the 3M software

"Edit: 3614-3M-Interventional Radiology procedure is coded- Ensure that the surgical intervention is also coded"

I have tried to explain in several different ways that the code is included with the other procedure however they feel that because of this edit an additional surgical code is required.

I am at a loss.

I would tell them that 36221-36228 are selective codes in the cervicocerebral and they bundled catheterization codes. 36200, 36215,36216, and 36217 are bundled into the cerebral codes along with S&I codes.
HTH,
Jim