Wiki Do you agree with my Codes??? Provider doesn't

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fhromeo30

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Under roadmap imaging after double flushing, the Envoy catheter was advanced
into the proximal cervical right internal carotid artery where it was
used for 3-D rotational right carotid cerebral angiography. The Envoy
catheter was then connected to heparinized pressurized saline flush
using a Tuohy Borst connector and in line Pall air filter. Working
projections and measurements were obtained of the azygos pericallosal
aneurysm's patent compartment. A 150 cm in length 6 cm distal segment
Excelsior SL 10 microcatheter with two markers in its tip and a 45
degree curve in its tip had 2 curves steamed proximal to its tip. The
Excelsior SL 10 microcatheter was advanced over a 200 cm in length 45
cm distal segment Synchro 14 microguidewire through the Envoy catheter
into the right internal carotid artery, then the right anterior
cerebral artery, and placed in the azygos pericallosal aneurysm. The
Excelsior SL 10 microcatheter was connected to heparinized pressurized
saline flush using a Tuohy Borst connector and in-line Pall air filter
after double flushing. The following coils were placed within the
recurrent azygous pericallosal aneurysm: 2 mm x 2 cm extra soft
Penumbra SMART with deployment started at 10:51, detached at 11:11
with satisfactory compartment framing and no microcatheter kickback
followed by placement of a 1 mm x 1 cm extra soft Penumbra SMART coil
with placement started at 11:18 and detached at 11:27:30, with a small
amount of microcatheter kickback into the parent lumen of the azygos
pericallosal artery. Two limited right carotid cerebral angiograms
were performed after placement of each of the Penumbra SMART coils
using the Envoy catheter. The Excelsior SL 10 microcatheter was
removed over the Synchro-14 microguidewire. Completion right carotid
cerebral angiography was performed using the Envoy catheter.

My provider wants to bill 36224, 76377 (both of which i agree with) 61624, 36217, 36218, 75898 X 3, 75894. I agree with all but the 36218. Can anyone explain why we would bill the 36218?

francine
 
fhromeo30 said:
Under roadmap imaging after double flushing, the Envoy catheter was advanced
into the proximal cervical right internal carotid artery where it was
used for 3-D rotational right carotid cerebral angiography. The Envoy
catheter was then connected to heparinized pressurized saline flush
using a Tuohy Borst connector and in line Pall air filter. Working
projections and measurements were obtained of the azygos pericallosal
aneurysm's patent compartment. A 150 cm in length 6 cm distal segment
Excelsior SL 10 microcatheter with two markers in its tip and a 45
degree curve in its tip had 2 curves steamed proximal to its tip. The
Excelsior SL 10 microcatheter was advanced over a 200 cm in length 45
cm distal segment Synchro 14 microguidewire through the Envoy catheter
into the right internal carotid artery, then the right anterior
cerebral artery, and placed in the azygos pericallosal aneurysm. The
Excelsior SL 10 microcatheter was connected to heparinized pressurized
saline flush using a Tuohy Borst connector and in-line Pall air filter
after double flushing. The following coils were placed within the
recurrent azygous pericallosal aneurysm: 2 mm x 2 cm extra soft
Penumbra SMART with deployment started at 10:51, detached at 11:11
with satisfactory compartment framing and no microcatheter kickback
followed by placement of a 1 mm x 1 cm extra soft Penumbra SMART coil
with placement started at 11:18 and detached at 11:27:30, with a small
amount of microcatheter kickback into the parent lumen of the azygos
pericallosal artery. Two limited right carotid cerebral angiograms
were performed after placement of each of the Penumbra SMART coils
using the Envoy catheter. The Excelsior SL 10 microcatheter was
removed over the Synchro-14 microguidewire. Completion right carotid
cerebral angiography was performed using the Envoy catheter.

My provider wants to bill 36224, 76377 (both of which i agree with) 61624, 36217, 36218, 75898 X 3, 75894. I agree with all but the 36218. Can anyone explain why we would bill the 36218?

francine
Click to expand...

Hi Francine,
I disagree with the code 36224, as I see by this report that this is not a diagnostic arteriogram. If it was, you can not bill for the catheter placement as catheter placements are bundled into 36224. As for 36218, it is used when a separate 2nd or third order selective of that vascular family is selected. For example, if the anterior cerebral artery was selected, then the middle cerebral artery was selected, anterior would be coded 36217, the middle would be coded 36218. So what should be billed is 61624, 36217-RT, 75894, 75894 x 3.
HTH,
Jim Pawloski, CIRCC
 
Under roadmap imaging after double flushing, the Envoy catheter was advanced into the proximal cervical right internal carotid artery where it was used for 3-D rotational right carotid cerebral angiography. The Envoy catheter was then connected to heparinized pressurized saline flush using a Tuohy Borst connector and in line Pall air filter. Working projections and measurements were obtained of the azygos pericallosal aneurysm's patent compartment. A 150 cm in length 6 cm distal segment
Excelsior SL 10 microcatheter with two markers in its tip and a 45degree curve in its tip had 2 curves steamed proximal to its tip. The Excelsior SL 10 microcatheter was advanced over a 200 cm in length 45 m distal segment Synchro 14 microguidewire through the Envoy catheter into the right internal carotid artery, then the right anterior cerebral artery, and placed in the azygos pericallosal aneurysm. The Excelsior SL 10 microcatheter was connected to heparinized pressurized saline flush using a Tuohy Borst connector and in-line Pall air filter after double flushing. The following coils were placed within therecurrent azygous pericallosal aneurysm: 2 mm x 2 cm extra soft Penumbra SMART with deployment started at 10:51, detached at 11:11 with satisfactory compartment framing and no microcatheter kickback followed by placement of a 1 mm x 1 cm extra soft Penumbra SMART coil with placement started at 11:18 and detached at 11:27:30, with a small amount of microcatheter kickback into the parent lumen of the azygos pericallosal artery. Two limited right carotid cerebral angiograms were performed after placement of each of the Penumbra SMART coils using the Envoy catheter. The Excelsior SL 10 microcatheter was removed over the Synchro-14 microguidewire. Completion right carotid cerebral angiography was performed using the Envoy catheter.

My provider wants to bill 36224, 76377 (both of which i agree with) 61624, 36217, 36218, 75898 X 3, 75894. I agree with all but the 36218. Can anyone explain why we would bill the 36218?

francine



I would code 36224, 76377 and 61624, 75894 and 75898 x3. you could bill 36228 with a 52 modifier. I would not code 36217 or 36218. Those codes, as stated by Jeff from Medlearn, are for extremity or extracranial vessels. if you have an intracranial vessel, you would append the modifier -52 to indicate either just imaging or vessel selection.
 
christoff9 said:
Under roadmap imaging after double flushing, the Envoy catheter was advanced into the proximal cervical right internal carotid artery where it was used for 3-D rotational right carotid cerebral angiography. The Envoy catheter was then connected to heparinized pressurized saline flush using a Tuohy Borst connector and in line Pall air filter. Working projections and measurements were obtained of the azygos pericallosal aneurysm's patent compartment. A 150 cm in length 6 cm distal segment
Excelsior SL 10 microcatheter with two markers in its tip and a 45degree curve in its tip had 2 curves steamed proximal to its tip. The Excelsior SL 10 microcatheter was advanced over a 200 cm in length 45 m distal segment Synchro 14 microguidewire through the Envoy catheter into the right internal carotid artery, then the right anterior cerebral artery, and placed in the azygos pericallosal aneurysm. The Excelsior SL 10 microcatheter was connected to heparinized pressurized saline flush using a Tuohy Borst connector and in-line Pall air filter after double flushing. The following coils were placed within therecurrent azygous pericallosal aneurysm: 2 mm x 2 cm extra soft Penumbra SMART with deployment started at 10:51, detached at 11:11 with satisfactory compartment framing and no microcatheter kickback followed by placement of a 1 mm x 1 cm extra soft Penumbra SMART coil with placement started at 11:18 and detached at 11:27:30, with a small amount of microcatheter kickback into the parent lumen of the azygos pericallosal artery. Two limited right carotid cerebral angiograms were performed after placement of each of the Penumbra SMART coils using the Envoy catheter. The Excelsior SL 10 microcatheter was removed over the Synchro-14 microguidewire. Completion right carotid cerebral angiography was performed using the Envoy catheter.

My provider wants to bill 36224, 76377 (both of which i agree with) 61624, 36217, 36218, 75898 X 3, 75894. I agree with all but the 36218. Can anyone explain why we would bill the 36218?

francine



I would code 36224, 76377 and 61624, 75894 and 75898 x3. you could bill 36228 with a 52 modifier. I would not code 36217 or 36218. Those codes, as stated by Jeff from Medlearn, are for extremity or extracranial vessels. if you have an intracranial vessel, you would append the modifier -52 to indicate either just imaging or vessel selection.
Click to expand...

Hi Francine,
If this was a diagnostic cerebral arteriogram, then I would agree with the 36224. But it an interventional procedure and you are allowed to bill for catheter position. The catheter was placed into the branch of the right anterior cerebral artery. So 36217-RT can be billed along with 61624, 75894, 75898 x 3, and 76377.
Thanks,
Jim Pawloski, CIRCC
 
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