I am very bad at this and need help!
I had received a Medicare denial and before it goes to the second level appeal I would like to know if the coding is correct:
The claim was billed with CPT 75827, 75827-59, 36558, 36009-59, 76937, J2250, J3010, C1769, C1894, C1750 and Q9967. I believe the 75827-59 should be deleted:
Ultrasound and fluoroscopic guided permacath placement. Bilateral neck venograms and removal tunneled dialysis catheter.
History: Reported suboptimal functioning left Perma-Cath.
The patient is well known to me. He insists we remove the left-side Perma-Cath as he feels 8 low position is precluding adequate flow rates for home dialysis. He is requesting placement of a Perma-Cath on the right side despite the possible use of the right arm for a fistula or graft.
Procedure: Caps, masks and sterile gloves and gowns were donned. The area was prepped with Chlorhexidine 2% solution and draped in the usual sterile manner.
With the aid of real-time ultrasound guidance, a micropuncture needle was introduced into the largest venous structure in the right supraclavicular region. A wire was advanced over which the inner dilator of a 4 French micropuncture set was advanced.
Fluoroscopically the course was in the region of the internal jugular vein cephalad. Venography was performed 2 times demonstrating occlusion of the internal jugular vein with multiple collaterals at the base of the neck including crossing the midline. This site was therefore abandoned.
I once again talked to the patient about his choice of having the left Perma-Cath removed, however, he was quite adamant we proceed with a new cystic on the left side. I also discussed the patient's request with Dr. ******.
Procedure: Maximum sterile barrier technique was used including; hand hygiene, caps, masks as well as sterile gowns, gloves and a large sterile sheet. The skin site was prepped with 2% chlorhexidine solution.
With the aid of real time ultrasound guidance, a micropuncture needle was introduced into the internal jugular vein. Ultrasound images were stored to PACS.
Using over-the-wire technique, a dilator was advanced through which a 0.035" guidewire was introduced and placed at the level of the inferior vena cava. A larger dilator was then advanced and capped.
A 14.5 Fr, 31 cm long, tip-cuff dialysis catheter was chosen. Tunneling was then performed in usual fashion.
Under flouroscopic guidance, the tract at the IJ puncture site was serially dilated and the catheter was advanced into position through a peel-away sheath.
Satisfactory course and position of the catheter were demonstrated fluoroscopically. The tip of the catheter is located at the right atrium. Both ports aspirated and flushed normally. The puncture site at the neck was closed with subcutaneous and Dermabond. The hub was also secured with suture. Sterile dressings were applied to both sites.
At this point, the existing Perma-Cath on the left was removed with gentle traction. Hemostasis was readily achieved.
The patient tolerated the procedure well with no immediate complications.
I had received a Medicare denial and before it goes to the second level appeal I would like to know if the coding is correct:
The claim was billed with CPT 75827, 75827-59, 36558, 36009-59, 76937, J2250, J3010, C1769, C1894, C1750 and Q9967. I believe the 75827-59 should be deleted:
Ultrasound and fluoroscopic guided permacath placement. Bilateral neck venograms and removal tunneled dialysis catheter.
History: Reported suboptimal functioning left Perma-Cath.
The patient is well known to me. He insists we remove the left-side Perma-Cath as he feels 8 low position is precluding adequate flow rates for home dialysis. He is requesting placement of a Perma-Cath on the right side despite the possible use of the right arm for a fistula or graft.
Procedure: Caps, masks and sterile gloves and gowns were donned. The area was prepped with Chlorhexidine 2% solution and draped in the usual sterile manner.
With the aid of real-time ultrasound guidance, a micropuncture needle was introduced into the largest venous structure in the right supraclavicular region. A wire was advanced over which the inner dilator of a 4 French micropuncture set was advanced.
Fluoroscopically the course was in the region of the internal jugular vein cephalad. Venography was performed 2 times demonstrating occlusion of the internal jugular vein with multiple collaterals at the base of the neck including crossing the midline. This site was therefore abandoned.
I once again talked to the patient about his choice of having the left Perma-Cath removed, however, he was quite adamant we proceed with a new cystic on the left side. I also discussed the patient's request with Dr. ******.
Procedure: Maximum sterile barrier technique was used including; hand hygiene, caps, masks as well as sterile gowns, gloves and a large sterile sheet. The skin site was prepped with 2% chlorhexidine solution.
With the aid of real time ultrasound guidance, a micropuncture needle was introduced into the internal jugular vein. Ultrasound images were stored to PACS.
Using over-the-wire technique, a dilator was advanced through which a 0.035" guidewire was introduced and placed at the level of the inferior vena cava. A larger dilator was then advanced and capped.
A 14.5 Fr, 31 cm long, tip-cuff dialysis catheter was chosen. Tunneling was then performed in usual fashion.
Under flouroscopic guidance, the tract at the IJ puncture site was serially dilated and the catheter was advanced into position through a peel-away sheath.
Satisfactory course and position of the catheter were demonstrated fluoroscopically. The tip of the catheter is located at the right atrium. Both ports aspirated and flushed normally. The puncture site at the neck was closed with subcutaneous and Dermabond. The hub was also secured with suture. Sterile dressings were applied to both sites.
At this point, the existing Perma-Cath on the left was removed with gentle traction. Hemostasis was readily achieved.
The patient tolerated the procedure well with no immediate complications.