Denied for DX I70.211

kvogel03

Networker
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Hello everyone,

I have billed 36247 and 75630 26, 59 with DX of I70.211, I70.212, and I70.0. The insurance is Humana Medicare both are being denied for needing additional Diagnosis. I have been researching what additional Diagnosis I need to add. Any suggestions?

Thanks,

Kayla Vogel
 

thomas7331

True Blue
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Without seeing your provider's documentation, and not knowing what Medicare region you're in, it will be hard to recommend any diagnosis codes for you. In the Medicare region where I work, all of the diagnosis codes you list above are on the LCD as supporting medical necessity for 36247 and there isn't any guidance that additional codes are required, but Humana or your region may have policies that differ from this. But of course, even so you can only add a diagnosis that's in your provider's documentation.
 

Jim Pawloski

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Check your catheter code 36247. 75630 is for abdominal aortogram with runoffs, and the catheterization code is usually 36200 - Catheter placement, aorta. 36247 is a 3rd order selective catheterization of a artery below the diaphragm. So the codes do not match up. This should be 36200, 75630-26. No modifier-59. You may want to use the ICD-10 code I70.213 with I70.0 because I70.211, I70.212 are for unilateral extremities and I70.213 is for bilateral extremities.
HTH,
Jim Pawloski, CIRCC
 
Last edited:

kvogel03

Networker
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Ok, Thanks for your input. I used 36247 due to the catheter being placed in the left superficial femoral artery. 75630 Abdominal Aortography due to the report reading it viewed the Aorta, Iliac Artery , and Renal Artery. There was stenosis found in both left and right Iliac Arteries. Would there a better ICD 10 Code for the Iliac Stenosis then I70.213?

Thanks,
Kayla
 
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