Medicaid denied dx 584.6 for cpt 76937 as inappropriate

she803

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The following report below has been billed as cpt 36556, 77001-26, 76937-26; However Mediciad denied cpt 76937 w/ inappropriate dx code?? I was wondering what other code is to be used for this report? I dont think is V45.11? Thank you in advance...

History: 55-year-old male requiring short-term dialysis needs access.

Procedure: Consent for Shiley catheter placement was obtained. Patient was placed under fluoroscopic table and supine position. Technique was prepped and draped in sterile fashion. 1% lidocaine was used as prosthetic.

Under sonographic guidance using 17-gauge needle regular vein was accessed. Over the Amplatz wire of the dilatation 16 cm long 11.5 French nonthrombosis catheter was uneventfully place with the tip in the right atrium. It was secured to skin is a suture. Senescent was applied. The catheter was flushed with saline low dose heparin. There were no complications.

Impression: Uneventful sonographic and fluoroscopic guided placement of the right jugular vein 11.5 French 16 cm long bone tunnel dialysis catheter.
 

Jim Pawloski

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The following report below has been billed as cpt 36556, 77001-26, 76937-26; However Mediciad denied cpt 76937 w/ inappropriate dx code?? I was wondering what other code is to be used for this report? I dont think is V45.11? Thank you in advance...

History: 55-year-old male requiring short-term dialysis needs access.

Procedure: Consent for Shiley catheter placement was obtained. Patient was placed under fluoroscopic table and supine position. Technique was prepped and draped in sterile fashion. 1% lidocaine was used as prosthetic.

Under sonographic guidance using 17-gauge needle regular vein was accessed. Over the Amplatz wire of the dilatation 16 cm long 11.5 French nonthrombosis catheter was uneventfully place with the tip in the right atrium. It was secured to skin is a suture. Senescent was applied. The catheter was flushed with saline low dose heparin. There were no complications.

Impression: Uneventful sonographic and fluoroscopic guided placement of the right jugular vein 11.5 French 16 cm long bone tunnel dialysis catheter.
There is no comment of patiency of the vein that was cannulated (which was?), and no comment of a hard copy image placed into the chart or a imaged sent to PACS.
HTH,
Jim Pawloski, CIRCC
 

donnajrichmond

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So what should the diagnosis be? That's what I'm asking. Thanks...
if this was denied for diagnosis then your medicaid apparently has a policy and you will need to check that for their guidelines. What jim was saying is that based on this documentation 76937 shouldn't be billed at all -regardless of DC
 

she803

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Ok thank you...now i understand. However, how should I code this report based on this documentation? Thats what I'm pretty much stumped on...
 

she803

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Thank you but those two codes 36556 and 77001 were already billed. I'm asking for the diagnosis. That was my primary question...what diagnosis should I code for the history of this report:

History: 55-year-old male requiring short-term dialysis needs access.
 

donnajrichmond

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Ok, I think we need to step back and start over.

You originally said that codes 36556, 77001-26, 76937-26 had been coded, but that 76937-26 had been denied because of the diagnosis code and what diagnosis code should you use instead of 584.6.

Based on the report you gave, 76937-26 should not be coded - so you don't need a diagnosis code for that. I personally would not have coded 77001 either since there is no evidence of radiographic documentation of tip.

If 36556 was also denied and you need a diagnosis for that, did you check your state Medicaid website for policies regarding dialysis patients and central venous catheters? They may want V58.81 or V56.1, although 584.6 should be appropriate for that (assuming that the dx is correct for the patient's condition!).
 

she803

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Where can i find info on NJ medicaid site? I was googling for days and even on different pages of the actual medicaid site and cant seem to find that info...
 

cblack712

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There are a few problems here that I would get corrected before you do anything else. Nothing is documented and what is documented needs verification. A Shiley Cath is typically a non-tunneled placement (36556) However your physician indicates in his impression that it was a "long bone tunnel dialysis catheter" - That being said - it does appear to be a transcription error somewhere - you may want the clairification before you use the 36556. Next neither the 76937 or 77001 are documented according to AMA standards and coding for such can lead to problems if this reports happens to get audited and will open the practice up to additional audits. Everyone hates getting a physician to change his / her "ways" - but the doc needs to understand that CMS is coming down on things like this extremely hard.

As far as the dx goes - there is nothing in the report that comes close to supporting the use of 584.6 - where did that come from? The report supports the use of V56.1 - since the encounter is not for renal failure but the dialysis cath placement. If you have documentation to support 584.6 that should be used as a secondary dx.
In my experience V56.1 is a payable code by medicaid standards and should be used as primary in placements of dialysis caths.
As far as the NJ Medicaid website it is www.njmmis.com
Hope that helps some!
Carrie
 

she803

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Thanks for the info. Truly appreciate it. I informed billing dept to delete the code. I dont do the initial coding--I receive denials from billing dept to correct and/or appeal denials based on the reports and some of these reports are so confusing and inaccurate that it's ridiculous sometimes! That's why i was wondering as to how to code this report in particular. Interventional Radiology is challenging enough as it is but when they submit codes based on reports that are incomplete and inaccurate they make it that much more difficult for us...

Btw can you refer me any Interventional radiology coding guidelines in books or websites?
 

ajs

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Thanks for the info. Truly appreciate it. I informed billing dept to delete the code. I dont do the initial coding--I receive denials from billing dept to correct and/or appeal denials based on the reports and some of these reports are so confusing and inaccurate that it's ridiculous sometimes! That's why i was wondering as to how to code this report in particular. Interventional Radiology is challenging enough as it is but when they submit codes based on reports that are incomplete and inaccurate they make it that much more difficult for us...

Btw can you refer me any Interventional radiology coding guidelines in books or websites?
www.zhealthpublishing.com. Dr. David Zielske is one of the premier authorities on Interventional Radiology and he has written several books on the subject. He is a former member of the AAPC National Advisory Board.
 

cblack712

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Thanks for the info. Truly appreciate it. I informed billing dept to delete the code. I dont do the initial coding--I receive denials from billing dept to correct and/or appeal denials based on the reports and some of these reports are so confusing and inaccurate that it's ridiculous sometimes! That's why i was wondering as to how to code this report in particular. Interventional Radiology is challenging enough as it is but when they submit codes based on reports that are incomplete and inaccurate they make it that much more difficult for us...

Btw can you refer me any Interventional radiology coding guidelines in books or websites?
Z health is a bible for IR coders. Another good resource is http://www.sirweb.org/ and the ACR publishes the Interventional Radiology Coding User's Guide which is another great tool!
 
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