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Wiki Denials Vascular Procedure

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kvogel03

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This is the scenario 36200,75630 26 59, and 75716 26 59 was done and then the patient came back a few days later and had a staged procedure 37221 58 RT, 37220 58 59 LT, and 37224 58 LT. The only codes that have been paid on both claims are 37221 58 RT and 37224 58 LT. I am not sure why the ins is denying everything else. Any suggestions would be greatly appreciated. Thank you.
 
kvogel03 said:
This is the scenario 36200,75630 26 59, and 75716 26 59 was done and then the patient came back a few days later and had a staged procedure 37221 58 RT, 37220 58 59 LT, and 37224 58 LT. The only codes that have been paid on both claims are 37221 58 RT and 37224 58 LT. I am not sure why the ins is denying everything else. Any suggestions would be greatly appreciated. Thank you.
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Without seeing the report it is difficult to say what codes are correct or not. However I can tell you a couple things I do see questionable just by looking at the codes. 75630 and 75716 would never be coded together. Need to review where the cath placements where for the angio and correct coding. 37220 was done on the right and 37221 was done on the left, this is correct and should not of denied as long as the documentation supports this. Not sure about use of the 58 modifier; did the previous procedure have a 90 day global and was this performed within the global? Lower extremity intervention codes do not have 90 day global.
 
I will review the reports and check for correct coding. Why should 75630 and 75716 never be coded together? There wasn't a procedure done prior to it that had a global period. I used the 58 modifier because they staged the second procedure which was done 7 days later. The use of 58 modifier was a mistake on my part.

Thanks,

Kayla
 
kvogel03 said:
I will review the reports and check for correct coding. Why should 75630 and 75716 never be coded together? There wasn't a procedure done prior to it that had a global period. I used the 58 modifier because they staged the second procedure which was done 7 days later. The use of 58 modifier was a mistake on my part.

Thanks,

Kayla
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75630 basically includes 75710 or 75716. 75630 is used to describe a SINGLE cath placement in the arota with extremity run-off. See below link for some case examples:

http://evtoday.com/2011/06/case-examples-for-lower-extremity-coding?center=123

https://www.codingstrategies.com/pdf/Aortic Diagram.pdf
 
Thanks, for the information. I have reviewed the material. I am still working on the previous denial.

In the meantime I have received another denial on 75716 as a bundled. It was billed with 36247, 75630, and 75716. So, this goes along with what you were saying before at with the 75630 because it is includes the extremity run off. I have been coding them together without any issues up until now. If a 75625 was done could I code the 75716 or 75710 ?
 
kvogel03 said:
Thanks, for the information. I have reviewed the material. I am still working on the previous denial.

In the meantime I have received another denial on 75716 as a bundled. It was billed with 36247, 75630, and 75716. So, this goes along with what you were saying before at with the 75630 because it is includes the extremity run off. I have been coding them together without any issues up until now. If a 75625 was done could I code the 75716 or 75710 ?
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Yes it is denied because 75630 and 75716 can not be coded together and there is a CCI edit. 75630 is for single cath placement in the aorta with extremity run off.

75625 – Aortography, abdominal, by serialography, radiological supervision and interpretation
75630 – Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation
75710 – Angiography, extremity, unilateral, radiological supervision and interpretation
75716 – Angiography, extremity, bilateral, radiological supervision and interpretation

So if the provider moved the cath twice for example; in the aorta for aortagram and then moved to the bifurcation for bi-lateral lower extremity complete study then yes it would 75625 & 75716. If instead of documenting a bilateral lower extremitie the provider only documented the aortagram and left lower extremity study 75625 & 75710 would be used.

I think you should check out Zhealth publishing if you are coding these studies. There is an e-learning course for $50.00 that I think you would find extremely helpful for this area of coding. Also includes a short test and the end and CEU.
http://zhealthpublishing.com/coding-products/elearning-courses
[h=2]2017 - CPT Coding for Abdominal Aortography and Lower Extremity Angiography[/h]Learn More about this Product
This course includes coding instructions for imaging of the abdominal aorta and the extremity arteries whether performed in combination or separately. Both selective and non-selective imaging procedures are explained in detail. Numerous actual case examples are presented to assist in coding from the physician documentation.

Hope this helps :)

Misty Sebert CPC, CCC, CCVTC
 
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