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Help coding this please

  1. #1
    Default Help coding this please
    Medical Coding Books
    75680
    75650
    75665
    75685
    75685
    75710

    this is what our provation came up with. I have never billed for one of these so does anyone disagree and do you beleive this is enough doumentation?
    thanks so much


    Procedure:
    .
    Carotid Arteriography
    Indications:
    Carotid stenosis documented on ultrasound.
    Procedure Medications:
    Total IV Fluids Administered
    - IV Fluids: 0.9NaCl IV started @ 50 ml/hr IV Fluids
    Local Anesthetic to right groin 7.5 ml Lidocaine 2% >Initial mL, local infiltration total dose.
    Heparin 2000 units IV
    Complications:
    No immediate complications. Estimated blood loss minimal.
    Patient History:
    Pt Status: Admission Status: Outpatient Referral
    Pt Status: Patient Admission Type >> Outpatient
    Pt Status: Insurance Payor: Commercial
    Hx/Risk Factors: Peripheral Vasc: Percutaneous intervention to extremities
    Hx/Risk Factors: Heart Disease: Hx of CAD
    Hx/Risk Factors: Hx of Smoking: Yes-Former
    Hx/Risk Factors: Pulmonary Disease: COPD
    Hx/Risk Factors: Dyslipidemia
    Hx/Risk Factors: Other Cardiac: Cardiomyopathy/Heart Failure
    Previous Procedures: Cardiac Cath - Positive 04-01-2009
    Previous Procedures: Peripheral Perc Intervention: Atherectomy 06-18-2009
    Hx/Risk Factors: Heart Disease: MI: >7 days ago
    Plt Aggregation Inhibitor-Clopidogrel (Plavix) > Yes
    Aspirin-Aspirin > Yes
    Lipid Lowering - Statins-Statins (any) > Yes
    Beta Blocker-Beta Blocker > Yes
    ALLERGIES: NKDA
    Description of Procedure:
    Fluoroscopy
    - Fluoroscopy time: 6.9 minutes.
    Devices Used
    - Meditech/Namic Fixed Core 3mm J .035" 145 cm
    - Terumo Standard 5 Fr.
    - Boston Scientific 4 Fr. JR 4.0 cm
    - V+Pad
    - Namic 12 cc Control
    Approach:
    - Right femoral artery approach. Access method: Percutaneous puncture.
    - Right femoral artery approach. Access method: Percutaneous puncture.
    Left Heart Catheterization
    - At the conclusion of the procedure, the right femoral artery sheath was removed. Hemostasis was obtained with
    manual compression.
    Findings/Interventions:
    Head and Neck Arteriography Injections
    - The pigtail catheter was advanced into the aortic arch and an injection of contrast was performed. The JR4 catheter was advanced into the brachiocephalic trunk and an injection of contrast was performed to better visualize
    distal vasculature. The JR4 catheter was advanced into the left common carotid artery and an injection of contrast
    was performed to better visualize distal vasculature.
    Aorta and Major Vessels
    - There was a normal aortic arch present.
    Head and Neck Arteriography
    - Aorta
    There were no obstructing lesions in the aortic arch. Blood flow appeared normal.
    - Right
    There was a 10% discrete atherosclerotic stenosis in the brachiocephalic artery. There was a 100% discrete
    atherosclerotic stenosis in the right external carotid. There was a 20 to 30% discrete atherosclerotic stenosis in the
    proximal right internal carotid. There were no obstructing lesions in the distal right vertebral artery. Blood flow
    appeared normal.
    - Left
    There was a 10% discrete atherosclerotic stenosis in the proximal left subclavian artery. There were no
    obstructing lesions in the left internal carotid artery. Blood flow appeared normal. There were no obstructing lesions
    in the left common carotid. Blood flow appeared normal. There were no obstructing lesions in the left common
    carotid artery. Blood flow appeared normal. There were no obstructing lesions in the left common carotid at its
    junction with the internal and external carotid. Blood flow appeared normal. There were no obstructing lesions in
    the left external carotid. Blood flow appeared normal. There were no obstructing lesions in the distal left vertebral
    artery. Blood flow appeared normal.

    Impression:
    .
    There were no obstructing lesions in the left internal carotid.
    Mild left upper extremity atherosclerotic vascular disease.
    There was a normal arch present.
    10% stenosis of the brachiocephalic artery.
    Occluded right external carotid.
    20 to 30% stenosis of the proximal right internal carotid.
    10% stenosis of the proximal left subclavian artery.

  2. #2
    Default
    Quote Originally Posted by lindseyj View Post
    75680
    75650
    75665
    75685
    75685
    75710

    this is what our provation came up with. I have never billed for one of these so does anyone disagree and do you beleive this is enough doumentation?
    thanks so much


    Procedure:
    .
    Carotid Arteriography
    Indications:
    Carotid stenosis documented on ultrasound.
    Procedure Medications:
    Total IV Fluids Administered
    - IV Fluids: 0.9NaCl IV started @ 50 ml/hr IV Fluids
    Local Anesthetic to right groin 7.5 ml Lidocaine 2% >Initial mL, local infiltration total dose.
    Heparin 2000 units IV
    Complications:
    No immediate complications. Estimated blood loss minimal.
    Patient History:
    Pt Status: Admission Status: Outpatient Referral
    Pt Status: Patient Admission Type >> Outpatient
    Pt Status: Insurance Payor: Commercial
    Hx/Risk Factors: Peripheral Vasc: Percutaneous intervention to extremities
    Hx/Risk Factors: Heart Disease: Hx of CAD
    Hx/Risk Factors: Hx of Smoking: Yes-Former
    Hx/Risk Factors: Pulmonary Disease: COPD
    Hx/Risk Factors: Dyslipidemia
    Hx/Risk Factors: Other Cardiac: Cardiomyopathy/Heart Failure
    Previous Procedures: Cardiac Cath - Positive 04-01-2009
    Previous Procedures: Peripheral Perc Intervention: Atherectomy 06-18-2009
    Hx/Risk Factors: Heart Disease: MI: >7 days ago
    Plt Aggregation Inhibitor-Clopidogrel (Plavix) > Yes
    Aspirin-Aspirin > Yes
    Lipid Lowering - Statins-Statins (any) > Yes
    Beta Blocker-Beta Blocker > Yes
    ALLERGIES: NKDA
    Description of Procedure:
    Fluoroscopy
    - Fluoroscopy time: 6.9 minutes.
    Devices Used
    - Meditech/Namic Fixed Core 3mm J .035" 145 cm
    - Terumo Standard 5 Fr.
    - Boston Scientific 4 Fr. JR 4.0 cm
    - V+Pad
    - Namic 12 cc Control
    Approach:
    - Right femoral artery approach. Access method: Percutaneous puncture.
    - Right femoral artery approach. Access method: Percutaneous puncture.
    Left Heart Catheterization
    - At the conclusion of the procedure, the right femoral artery sheath was removed. Hemostasis was obtained with
    manual compression.
    Findings/Interventions:
    Head and Neck Arteriography Injections
    - The pigtail catheter was advanced into the aortic arch and an injection of contrast was performed. The JR4 catheter was advanced into the brachiocephalic trunk and an injection of contrast was performed to better visualize
    distal vasculature. The JR4 catheter was advanced into the left common carotid artery and an injection of contrast
    was performed to better visualize distal vasculature.
    Aorta and Major Vessels
    - There was a normal aortic arch present.
    Head and Neck Arteriography
    - Aorta
    There were no obstructing lesions in the aortic arch. Blood flow appeared normal.
    - Right
    There was a 10% discrete atherosclerotic stenosis in the brachiocephalic artery. There was a 100% discrete
    atherosclerotic stenosis in the right external carotid. There was a 20 to 30% discrete atherosclerotic stenosis in the
    proximal right internal carotid. There were no obstructing lesions in the distal right vertebral artery. Blood flow
    appeared normal.
    - Left
    There was a 10% discrete atherosclerotic stenosis in the proximal left subclavian artery. There were no
    obstructing lesions in the left internal carotid artery. Blood flow appeared normal. There were no obstructing lesions
    in the left common carotid. Blood flow appeared normal. There were no obstructing lesions in the left common
    carotid artery. Blood flow appeared normal. There were no obstructing lesions in the left common carotid at its
    junction with the internal and external carotid. Blood flow appeared normal. There were no obstructing lesions in
    the left external carotid. Blood flow appeared normal. There were no obstructing lesions in the distal left vertebral
    artery. Blood flow appeared normal.

    Impression:
    .
    There were no obstructing lesions in the left internal carotid.
    Mild left upper extremity atherosclerotic vascular disease.
    There was a normal arch present.
    10% stenosis of the brachiocephalic artery.
    Occluded right external carotid.
    20 to 30% stenosis of the proximal right internal carotid.
    10% stenosis of the proximal left subclavian artery.
    First code the catheter placement
    36215- 1st order Brachiocephalic
    36215-59 - 1st order Lt Common Carotid
    No code for the Catheter Placement Aorta since a selective run was performed.

    Now for the S&I
    75650 - Arch Arteriogram
    75680-59 - Bilateral cervical carotid angio.
    75671-59 - Bilateral Cerebral angio.
    75685 - ? bilateral Vertebral angio/ Described from arch injection

    Extremity angio bill has to be the complete extremity, I don't feel that it can be billed.

    Hopes this helps!
    Last edited by Jim Pawloski; 08-28-2009 at 07:21 AM. Reason: forgot modifiers

  3. #3
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by Jim Pawloski View Post
    First code the catheter placement
    36215- 1st order Brachiocephalic
    36215-59 - 1st order Lt Common Carotid
    No code for the Catheter Placement Aorta since a selective run was performed.

    Now for the S&I
    75650 - Arch Arteriogram
    75680-59 - Bilateral cervical carotid angio.
    75671-59 - Bilateral Cerebral angio.
    75685 - ? bilateral Vertebral angio/ Described from arch injection

    Extremity angio bill has to be the complete extremity, I don't feel that it can be billed.

    Hopes this helps!

    I agree, but don't see the need for the 59 modifier. Am I missing something?

    HTH
    Danny L. Peoples
    CIRCC,CPC

  4. #4
    Default
    Quote Originally Posted by dpeoples View Post
    I agree, but don't see the need for the 59 modifier. Am I missing something?

    HTH
    I may have overdone modifier -59, but is the modifier needed to distinguish the separate vessles? Rt and Lt could be used instead depending on insurance company.

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