Wiki Coding CPT Code 36475

[Babsss]

Hi,
I am new to coding these and having problems getting them paid. The physician goes through all the correct steps that Medicare requires. The diagnosis code I believe is the problem. I have had some one else look at them and he thought that Medicare of Alabama only required one code. I used I83.892 ( Chronic venous hypertension w/other complications) and still denied. I am at a total loss. I am open to a phone call. HELP

 

[michellepilcher]

1. Medicare will consider interventional treatment of varicose veins (only with techniques outlined in this local coverage determination (LCD) and only under the conditions described wherein) medically necessary if the patient remains symptomatic after a 6-8 week trial of conservative therapy. In the presence of advanced skin changes, ulceration or bleeding, the need for a conservative therapy period may be waived. In cases where such complications are present, the medical record must include detailed documentation of the nature and extent of the complications. Based on recent literature, combination therapy (the use of compression and surgery) has been shown to decrease 12 month ulcer recurrence rates and therefore may be considered in patients with chronic venous ulcers. Components of the conservative therapy include, but are not limited to:

• weight reduction
• a daily exercise plan

• periodic leg elevation, and

• the use of graduated compression stockings

The conservative therapy must be documented in the medical record. Conservative treatment may slow down progression of disease or may demonstrate (if symptoms reduced) that treating the disease may eliminate the symptoms.


Maybe MCR is expecting the complication dx codes?

 

[Babsss]

36475

I don't normally get to see the documentation. I pulled the LCD on this and used the ICD 10 code that was appropriate for the patient's condition and expectable to Medicare. Do you think I should send in the documentation to show the steps were followed before doing this procedure?

 

[Jessyc09]

What exactly is Medicare denying it for ?

 

[Babsss]

36475

Info furnished doesn't substantiate need. I am so at a loss. The physician is not allowed to do any more until this is figured out. Any thought is appreciated.

 

[cgaston]

I don't normally get to see the documentation. I pulled the LCD on this and used the ICD 10 code that was appropriate for the patient's condition and expectable to Medicare. Do you think I should send in the documentation to show the steps were followed before doing this procedure?

I think you should appeal with notes from previous visits proving that the provider did try conservative measures before scheduling the surgery.

 

[Babsss]

36475

Thanks, I will do that. There was gentleman out of Colorado trying to help me, but it did not work either.