foreign body removal only done due to intervention

Margaret Morgan

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I don’t know if anyone can help me or not. I am a coder for a vascular surgeon that does IR too and I am having a debate with my physician on a coding issue. I would like opinion on this issue as we are not agreeing. This has to do with percutaneous interventions of the lower extremities and the foreign body removal CPT code 37197. There are times when my physician will use a capture/foreign body removal catheter to get the wire across a lesion (dental flossing/thru and thru access) so better felicitate the angioplasty catheter crossing the stenosis for angioplasty/stenting. An example would be via dorsalis pedis access a wire crossed the lesion via the capture catheter via the RT CFA. Angioplasty was done and captured wire removed via the RT CFA access. My physician says that is a foreign body removal was the wire was removed from a different access site so therefore billable. I says it is a wire placed and removed to facilitate crossing the lesion for the angioplasty and included in the angioplasty and is not foreign body removal as no wire broke off or foreign body removed during the case and is not billable.

I was a cardiology coder before agreeing to code for vascular surgeons and did my interventional radiology training with Dr. David Zielske and Zhealth publishing CIRCC coding workshop. Their opinion is it is global to the angioplasty as it is not foreign body removal . My doctor is not interested in Dr. Ziekske Opinion.

I would like to know your opinion and any black and white (preferably MCR) documentation to the establish which is correct. He wants me to bill the foreign body removal and I am not comfortable doing so.

Any help you can give me will be greatly appreciated.
Margaret Morgan, CPC, CIRCC
 

Jim Pawloski

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To quote 37197 from the CPT book, "Transcatheter retrieval, percutaneous, of intravascular foreign body (eg. fractured venous or arterial catheter), includes radiological S&I, and imaging guidance (ultrasound or fluoroscopy) when performed." So did his catheter or wire break inside the body? Answer in this case is no, so he can't bill 37197. If he keeps doing this, he might get a fraud caught in his throat.

HTH,
Jim Pawloski, CIRCC, R.T. (CV)
 
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