Wiki Help with Angioplasty coding please

[candicane1010]

I am in the process of learning to code for a Vascular Surgeon and I am getting mixed up on when I can and cannot bill for an angiogram when an angioplasty is performed.

I was given an op note to code for teaching purposes and I cannot understand why the 75710 was billable along with 37228. I thought RS&I was bundled with 37228:

We cannulated the left CFA with the wire entering the saphenous vein graft. Angiograms were performed through that. (Stenosis was found in the entire native posterior tibial artery) With these findings, the decision was made to proceed with any angioplasty. Angioplasty was performed of the entire posterior tibial artery through the proximal anastomosis with a 2mm angioplasty balloon.

I hope that I left enough information in the condensed op note for someone to explain why the 75710 is billable.

Any help is appreciated!!!! Thank you

 

[ciphermed]

As per NCCI edits CPT codes 37228 and 75710 will generate a "bundling" edit. The guidelines for when the codes can and cannot be reported together are found in the CPT manual page 373, just prior to CPT code 75600.

The guideline lists when diagnostic angiography should NOT be used with interventional procedures....(i.e. roadmapping, vessel measurement, post angioplasty/stent/atherectomy angiography)

as well as,

When diagnostic angiography performed at time of an interventional procedure IS separately reportable..
(i.e. No prior cathether based angiography available or prior study however patient's condition as it related to the clinical indication has changed or inadequate visualization of anatomy/pathology, or a clinical change during the procedure that requires a new evaluation outside of the target area of intervention....)

Hope this helps,

 

[candicane1010]

Thank you Anthony, I think I have a grasp on the concept. Wish me luck!!!

 

[Lisa Bledsoe]

As per NCCI edits CPT codes 37228 and 75710 will generate a "bundling" edit. The guidelines for when the codes can and cannot be reported together are found in the CPT manual page 373, just prior to CPT code 75600.

The guideline lists when diagnostic angiography should NOT be used with interventional procedures....(i.e. roadmapping, vessel measurement, post angioplasty/stent/atherectomy angiography)

as well as,

When diagnostic angiography performed at time of an interventional procedure IS separately reportable..
(i.e. No prior cathether based angiography available or prior study however patient's condition as it related to the clinical indication has changed or inadequate visualization of anatomy/pathology, or a clinical change during the procedure that requires a new evaluation outside of the target area of intervention....)

Hope this helps,

Would it be correct then, that if the physician does not state anything about the qualifying criteria, that 75710 should not be reported based on documentation guidelines?