Vascular Diagnostic

brittany1356

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Hi! I am trying to figure out a way to bill for a vascular diagnostic procedure. The doctor selectively engaged the left common carotid and the left subclavian, both first order 36215 but separately identifiable vessels. Does anyone know how I can claim both of these? I already need a modifier 59 because a stent was also placed in the left internal carotid. I would really appreciate any ideas!

Thank you,
Brittany CPC-A
:)
 

dimmitta

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If you selectively engaged the left common carotid and then placed a stent further up into the left internal carotid you cannot bill for the cath placement into the left common, it is included in the 37215/37216 along with any diagnostic pictures.

So you would bill for the carotid stent 37215 or 37216 and then bill 36215-59 for the left subclavian plus any diagnostic pictures taken during that selective cath. The diagnostic pictures for the left subclavian will also require a 59 modifier.
 

brittany1356

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Is this true even if the procedure began all as diagnostic? I was told that if it was diagnostic then you can bill for each.
 

dimmitta

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Carotid Stent

Is this true even if the procedure began all as diagnostic? I was told that if it was diagnostic then you can bill for each.
Both of the carotid stent code descriptions (37215/37216) state they include the selective cath placement and all diagnostic imaging. So once you make the decision to place a carotid stent you lose the cath placement and imaging codes. However, if you do a diagnostic of left and right carotid arteries and then decide to place the stent the next day you would be able to bill for selective cath's and imaging for each artery the first day and then bill only the stent code when it is placed the next day.
 

donnajrichmond

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Both of the carotid stent code descriptions (37215/37216) state they include the selective cath placement and all diagnostic imaging. So once you make the decision to place a carotid stent you lose the cath placement and imaging codes. However, if you do a diagnostic of left and right carotid arteries and then decide to place the stent the next day you would be able to bill for selective cath's and imaging for each artery the first day and then bill only the stent code when it is placed the next day.
In most cases if you do a diagnostic angiogram and then do a procedure then you are allowed to code for the diagnostic S & I code - such as the lower extremity revascularization codes, and embolization procedures. However, there are some intervention codes that include diagnostic angiography. The carotid stent codes all do (0075T, 37215, 37216, 61635), and the notes with those codes in the CPT book tell you that if you do a diagnostic angiogram and then proceed to stent, code only the stent. If you do a diagnostic angiogram and decide not to do a stent, code the diagnostic angiogram.
 
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