Wiki Please help code cath report - Can someone please guide me

[coders_rock!]

Can someone please guide me on how to code cath reports? I am unsure.

Pt was prepped & draped in sterile fashion followed by lidocaine injection to anesthestize the tissues of the right groin. Access was gained to the right common femoral artery & a 4F Brite Tip Sheath was placed. An aortogram with run off was then performed using a 4F UF catheter which was placed in the distal aorta. The catheter was then advanced to the contralateral SFA and a left lower extremity angiogram was performed. The Brite Tip sheath and UF catheter were exchanged for a 6F 110 cm Cook sheath which was positioned with the tip at the level of the left popliteal artery. A VIPER wire was then advanced through the peroneal occlusion and elliptical atherectomy was then performed using 1.25 PREDATOR device followed by PTA using 2.5 x 120 mm and 3.0 x 100 mm SLEEK balloons serially. A 3.5 x 40 m SLEEK balloon was then used to dilate the popliteal artery. Final angiography reveals in line flow to the ankle vial the peroneal artery.

Thank you!

 

[csnow]

Look at code 37229 for the atherectomy of the peroneal (this includes all catheter placements and imaging) and then you should look at code 37224 for the popliteal artery(which also includes all catheter placements and imaging).

 

[Jim Pawloski]

Look at code 37229 for the atherectomy of the peroneal (this includes all catheter placements and imaging) and then you should look at code 37224 for the popliteal artery(which also includes all catheter placements and imaging).

Although we may not have the whole report, the code 75716 may also come into play, if there was a true diagnostic cath performed first.
HTH,
Jim Pawloski, CIRCC

 

[coders_rock!]

Thank you for responding so promptly. Here is other info I did not incluce.

Vessel Angiography Findings

AORTOGRAM WITH RUNOFF:
Moderate tortuosity bilateral iliac systems....

RIGHT LOWER EXTREMITY ANGIOGRAM:
Mild non obstructive diffuse disease right SFA...
100% occlusion

LEFT LOWER EXTREMITY ANGIOGRAM:
Mild non abstructive diffuse disease left SFA
100% occlusion...

CONCLUSIONS:
Successful recanalization left peroneal occlusion
Successful atherectomy and PTA left popliteal and peroneal arteries

My Dr. Billed:
36140 - Denied
36247 - Denied
75716(26) - Denied
36200 - Denied
75626(26) - Paid
37225 - Paid
37229 - Paid
37232 - Paid

Can anyone explain whether he billed correctly?
Can you guide me by highlighting what & why he should bill a particular code? I really want to learn how to code cath-reports?
CSnow, why did you select 37224?

 

[heatheralayna]

Thank you for responding so promptly. Here is other info I did not incluce.

Vessel Angiography Findings

AORTOGRAM WITH RUNOFF:
Moderate tortuosity bilateral iliac systems....

RIGHT LOWER EXTREMITY ANGIOGRAM:
Mild non obstructive diffuse disease right SFA...
100% occlusion

LEFT LOWER EXTREMITY ANGIOGRAM:
Mild non abstructive diffuse disease left SFA
100% occlusion...

CONCLUSIONS:
Successful recanalization left peroneal occlusion
Successful atherectomy and PTA left popliteal and peroneal arteries

My Dr. Billed:
36140 - Denied
36247 - Denied
75716(26) - Denied
36200 - Denied
75626(26) - Paid
37225 - Paid
37229 - Paid
37232 - Paid

Can anyone explain whether he billed correctly?
Can you guide me by highlighting what & why he should bill a particular code? I really want to learn how to code cath-reports?
CSnow, why did you select 37224?

Code 36140 is the puncture for the extremity and included with the intervention and cannot be billed,
36247 is the catheter placement code and also cannot be billed in addition to the intervention,
75716(26) is for the S&I portion of the aortogram and can be only billed in addition to the intervention if it is truly diagnostic and a (59) has to be added to indicate it was diagnostic
36200 is for the cath placement in the aorta, as soon as an intervention is done, this code is not billable
37225 is for the atherectomy of the fempop area, and I am not seeing that as documented, so it would be inappropriate to bill
37229 is for the peroneal atherectomy and is appropriate
37232 is for the balloon in the vessel that had the atherectomy, and is included in the atherectomy code and cannot bill in addition


I would also bill the 37224 for the balloon of the popliteal

hope this helps,

Heather Shaw, CPC, CIRCC

 

[coders_rock!]

Are you saying that this does not support the use of 37225?

A VIPER wire was then advanced through the peroneal occlusion and elliptical atherectomy was then performed using...

 

[heatheralayna]

yes it absolutely supports an atherectomy, but he describes an atherectomy of the peroneal vessel, 37225 is an atherectomy of a femoral/popliteal vessel. At least that is how I am understanding his dictation.

Heather Shaw, CPC, CIRCC

 

[donnajrichmond]

As dictated, I agree with Heather on 37229, 37224, and possibly 75716-26-59, and that all the other codes are inappropriate.

However, in one section he describes only a peroneal atherectomy -"A VIPER wire was then advanced through the peroneal occlusion and elliptical atherectomy was then performed using 1.25 PREDATOR device followed by PTA using 2.5 x 120 mm and 3.0 x 100 mm SLEEK balloons serially."; but in another area he says "Successful atherectomy and PTA left popliteal and peroneal arteries".
If he did an atherectomy of the popliteal he will need to dictate an addendum describing that procedure. If he did the procedure and documents it, then you would not code 37224, but would instead code 37225.

To code a diagnostic angiogram S & I with an intervention there must be documentation that either this was the first angiogram and the decision to do the intervention was based on the findings, or that a previous angiogram was performed but was not adequate for visualization or the patient's condition has changed.
I see way too many that say they did an angiogram and document findings, but never indicate the decision for intervention.

 

[pmyland]

Vessel angiogram with intervention

Sodonnajrichmond... are you saying that you can only bill the study if the intervention is not planned? Does CTA before intervention mean that you shouldn't be billing for the angiography done prior to intervention?

Do you know of a place I can get references on this to share with the docs I work for?