JRhea0715
Contributor
We received a denial from Medicare: EDRC-Invalid Procedure Code Qualifier for Procedure Procedure 2: 37237. Valid Procedure codes can be either ER, HC, IV, or WK.
Here are the diagnosis and procedure codes we submitted on the claim:
I70.219, I65.8
37236-LT, 37237-LT, 35475-59, 75710-26-59, 75962-26
Has anyone seen this before? Any advice? If it helps, I have shared the procedure description below... Thanks for your help, much appreciated.
**HEART CENTER OP NOTE**
PROCEDURES PERFORMED:
1. Aortic arch angiography using digital subtraction technique.
2. Left subclavian angiography using digital subtraction technique.
3. Translesional gradient determination -- proximal left subclavian artery.
4. Percutaneous transluminal angioplasty of the left subclavian artery.
5. Deployment of a 7 x 24 mm Cordis Genesis stent in the proximal left
subclavian artery.
6. Right femoral arteriotomy closure using StarClose vascular closure device.
7. IV conscious sedation.
DESCRIPTION OF PROCEDURE:
Informed consent was obtained. The patient was evaluated preoperatively and
the oropharynx graded Mallampati III. She was brought to the cardiac
catheterization lab where the groins were prepped and draped in standard
sterile fashion. A time-out was observed. The patient identity, the nature of
the procedure, and the conscious sedation plan were discussed and confirmed.
The right femoral artery was entered with a micropuncture needle under 2%
Xylocaine local anesthesia and a 6-French vascular sheath inserted using
sterile Seldinger technique. A 5-French pigtail catheter was advanced around
the arch of the aorta over a 0.035 J-wire and positioned in the aortic arch
under fluoroscopic guidance. Pressure was recorded and 70 units per kilogram
of intravenous heparin were administered. An activated clotting time (ACT) was
performed. Aortic arch angiography was performed in an LAO projection by
injection of 40 mL of Isovue at 20 mL per second. The films were reviewed. The
pigtail catheter was removed over a 0.035 J-wire and replaced with a 5-French
JB1 catheter. The left subclavian artery was selected with this catheter and
angiographic study was performed revealing a hazy nondescript proximal lesion.
The lesion was crossed with a 0.035 angled Glidewire and the JB1 catheter was
then advanced over the Glidewire. Translesional gradient determination was
then undertaken with the finding of a right common femoral pressure of 164/58,
meaned at 99 mmHg and a left subclavian post-lesional pressure of 83/57, meaned
at 70 mmHg yielding a peak translesional gradient of 81 mmHg and a mean
translesional gradient of 29 mmHg. This was judged to be quite significant.
The JB1 catheter was removed over a 0.035 J-wire. The 6-French vascular sheath
was replaced with a 90 cm 6-French Destination sheath with the tip positioned
via the J-wire at the origin of the subclavian artery. The artery was dilated
with a 6 x 20 mm Armada balloon. The lesion was then stented with a 7 x 24 mm
Cordis Genesis stent deployed at nominal pressure. Post-lesional gradient
determination was performed revealing no residual gradient. The sheath and
guidewire were retracted after completion angiography was performed.
Here are the diagnosis and procedure codes we submitted on the claim:
I70.219, I65.8
37236-LT, 37237-LT, 35475-59, 75710-26-59, 75962-26
Has anyone seen this before? Any advice? If it helps, I have shared the procedure description below... Thanks for your help, much appreciated.
**HEART CENTER OP NOTE**
PROCEDURES PERFORMED:
1. Aortic arch angiography using digital subtraction technique.
2. Left subclavian angiography using digital subtraction technique.
3. Translesional gradient determination -- proximal left subclavian artery.
4. Percutaneous transluminal angioplasty of the left subclavian artery.
5. Deployment of a 7 x 24 mm Cordis Genesis stent in the proximal left
subclavian artery.
6. Right femoral arteriotomy closure using StarClose vascular closure device.
7. IV conscious sedation.
DESCRIPTION OF PROCEDURE:
Informed consent was obtained. The patient was evaluated preoperatively and
the oropharynx graded Mallampati III. She was brought to the cardiac
catheterization lab where the groins were prepped and draped in standard
sterile fashion. A time-out was observed. The patient identity, the nature of
the procedure, and the conscious sedation plan were discussed and confirmed.
The right femoral artery was entered with a micropuncture needle under 2%
Xylocaine local anesthesia and a 6-French vascular sheath inserted using
sterile Seldinger technique. A 5-French pigtail catheter was advanced around
the arch of the aorta over a 0.035 J-wire and positioned in the aortic arch
under fluoroscopic guidance. Pressure was recorded and 70 units per kilogram
of intravenous heparin were administered. An activated clotting time (ACT) was
performed. Aortic arch angiography was performed in an LAO projection by
injection of 40 mL of Isovue at 20 mL per second. The films were reviewed. The
pigtail catheter was removed over a 0.035 J-wire and replaced with a 5-French
JB1 catheter. The left subclavian artery was selected with this catheter and
angiographic study was performed revealing a hazy nondescript proximal lesion.
The lesion was crossed with a 0.035 angled Glidewire and the JB1 catheter was
then advanced over the Glidewire. Translesional gradient determination was
then undertaken with the finding of a right common femoral pressure of 164/58,
meaned at 99 mmHg and a left subclavian post-lesional pressure of 83/57, meaned
at 70 mmHg yielding a peak translesional gradient of 81 mmHg and a mean
translesional gradient of 29 mmHg. This was judged to be quite significant.
The JB1 catheter was removed over a 0.035 J-wire. The 6-French vascular sheath
was replaced with a 90 cm 6-French Destination sheath with the tip positioned
via the J-wire at the origin of the subclavian artery. The artery was dilated
with a 6 x 20 mm Armada balloon. The lesion was then stented with a 7 x 24 mm
Cordis Genesis stent deployed at nominal pressure. Post-lesional gradient
determination was performed revealing no residual gradient. The sheath and
guidewire were retracted after completion angiography was performed.