Wiki Cerebral angio occlusion

[Jim Pawloski]

I have a question on a patient who was found to have an occlusion of the left internal carotid. Unfortunately, it covered over a week with four date of services. So here is the "Readers Digest" version.
Day one- Left Vertebral angio, Rt Internal Angio where contrast is seen crossing from the right side to the left side of the internal carotid artery. Lt Common carotid injection shows slow to no flow of the internal carotid artery. Procedure complete.
Day two- Bilateral Internal angio. performed. Balloon Occlusion Test in Right Carotid performed Lt Common Carotid injected. Micro-catheter passed occlusion into M1 segment of carotid artery. Imaging of M1 segment performed. Wingspan stent placed in supraclinoid portion of lt internal carotid artery,
Day three- Right vertebral and bilateral Internal arteries imaged. Angioplasty of Lt Internal Carotid performed.
Day four - Bilateral internal carotids and Lt vertebral catheterized and imaged. 3-d imaging
of lt internal carotid performed.

This is what I billed:
Day 1
36224-rt
36223-lt
36226-lt

Day 2
61623-rt
61635-lt
36228-lt

Day 3
36226-rt
61630-lt
36228-lt

Day 4
36224-rt
36224-lt
36226-lt
76377

Each procedure was performed 5 days apart.
Should a diagnositc angio be billed in determine if there was any change in flow from the right cerebral to the left cerebral?
Thanks,
Jim Pawloski, CIRCC

 

[dpeoples]

I have a question on a patient who was found to have an occlusion of the left internal carotid. Unfortunately, it covered over a week with four date of services. So here is the "Readers Digest" version.
Day one- Left Vertebral angio, Rt Internal Angio where contrast is seen crossing from the right side to the left side of the internal carotid artery. Lt Common carotid injection shows slow to no flow of the internal carotid artery. Procedure complete.
Day two- Bilateral Internal angio. performed. Balloon Occlusion Test in Right Carotid performed Lt Common Carotid injected. Micro-catheter passed occlusion into M1 segment of carotid artery. Imaging of M1 segment performed. Wingspan stent placed in supraclinoid portion of lt internal carotid artery,
Day three- Right vertebral and bilateral Internal arteries imaged. Angioplasty of Lt Internal Carotid performed.
Day four - Bilateral internal carotids and Lt vertebral catheterized and imaged. 3-d imaging
of lt internal carotid performed.

This is what I billed:
Day 1
36224-rt
36223-lt
36226-lt

Day 2
61623-rt
61635-lt
36228-lt

Day 3
36226-rt
61630-lt
36228-lt

Day 4
36224-rt
36224-lt
36226-lt
76377

Each procedure was performed 5 days apart.
Should a diagnositc angio be billed in determine if there was any change in flow from the right cerebral to the left cerebral?
Thanks,
Jim Pawloski, CIRCC

Hi Jim,
I don't think I would bill for a diagnostic exam on day 2 (the 1st intervention), but I do think a followup from the day 2 procedure is warranted on day 3, even though it is not a true "diagnostic" test. Since there was another intervention on day 3, another follow up is warranted for day 4. I will also add, the documentation really should show the medical neccessity for follow up exams, due to the nature of the condition.

I don't think an indefinate number should be billed, but it is difficult to draw a line where they should stop. You can be sure the payor will want documentation for the frequency of exams.

HTH

 

[Jim Pawloski]

Hi Jim,
I don't think I would bill for a diagnostic exam on day 2 (the 1st intervention), but I do think a followup from the day 2 procedure is warranted on day 3, even though it is not a true "diagnostic" test. Since there was another intervention on day 3, another follow up is warranted for day 4. I will also add, the documentation really should show the medical neccessity for follow up exams, due to the nature of the condition.

I don't think an indefinate number should be billed, but it is difficult to draw a line where they should stop. You can be sure the payor will want documentation for the frequency of exams.

HTH

Hi Danny,
Thanks for you help! I didn't want to bill a diagnostic exam on day 2, but the following exams had me stumped if I could do a diagnostic exam or not. I didn't want to but the doctor was questioning me about the "follow-up".
Thank you,
Jim