Wiki Cpt 37221 - I have a claim

[coders_rock!]

I have a claim where MD billed:

36120
75716 (26)
36200
37221
36245

37221 was the only code that was paid. Are the others eligible for payment? Why or why not?

 

[OliviaPrice]

Per the CPT book for code 37221 under the section "Endovascular Revascularization (Open or Percutaneous, Transcatheter) 2nd paragraph:
"These lower extremity endovascular revascularization codes all include the work of accessing and selectively catheterizing the vessel, traversing the lesion, radiological supervision and interpretation directly related to the intervention(s) performed....."

36120 & 36200 are non-selective cath placement codes which are automatically lost once you go selective 36245, unless they are from different access sites in which case you would need to use modifiers to unbundle the services.

36245 is lost once a peripheral intervention is performed, unless the intervention & diagnostic angio were performed from different access sites in which case you would need to use modifiers to unbundle the services.

The 75716-26 should be separately payable if it is for a diagnostic angio not part of the intervention, some carriers may require a modifier.

It's difficult to say if the coding is correct without seeing the report.