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2 caths same day

  1. #1
    Location
    Melbourne, Florida
    Posts
    124
    Question 2 caths same day
    Medical Coding Books
    ANY INPUT WOULD BE APPRECIATIVE
    WE BILLED 2 CATHS IN ONE DAY AND BLUE CROSS DIDN'T PAY ON THE SECOND CATH. PLEASE REVIEW ..THANK YOU SO MUCH.
    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>

    PROCEDURE DIAGNOSIS:
    Angina.

    POSTPROCEDURE DIAGNOSIS:
    Severe obstructive coronary artery disease.

    OPERATION PROCEDURE:
    1. Left ventriculogram.
    2. Coronary angiogram.
    3. Left subclavian angiogram.
    4. Left heart catheterization.
    5. PTCI of the SVG to the PDA.
    6. PTCI x2 of the SVG to the OM 1.
    7. PTCA x2 to the proximal and mid circumflex.


    FINDINGS:
    1. Occluded SVG to the ramus.
    2. Patent LIMA to the LAD.
    3. Occluded LAD and RCA disease.

    4. A 75% mid body lesion in the SVG to the PDA that was
    successfully stented with a drug-eluting stent.
    5. SVG to the OM with 2 lesions, 90% at mid body and 80% in the
    distal anastomosis, both stented with drug-eluting stents.
    6. A 90% proximal circumflex and 75% mid circumflex. Both
    lesions successfully ballooned.
    7. Normal left ventricular function with an EF of 60%.

    COMPLICATIONS:
    Please see next dictation regarding dissection and thrombus formation
    in the vein graft.

    WE BILLED THIS FIRST PROCEDURE AS SUCH AND RECEIVED PAYMENT ON ALL OF THE BELOW CODES

    93510
    36215-59
    93543
    75685-2659
    93545
    92980-RC
    93555-2659
    92981-LC
    93556-2659



    *******THEN THE SECOND PROCEDURE WAS DONE ON THE SAME DAY***


    Acute stent thrombosis.

    POSTPROCEDURE DIAGNOSES:
    1. Dissection and thrombosis of the proximal SVG to the OM 1.
    2. Distal edge dissection of the mid SVG to the PDA stent.

    OPERATIVE PROCEDURES:
    1. IVUS of the SVG to the OM 1.
    2. Coronary angiogram.
    3. PTCI x2 to the SVG to the OM 1.
    4. Thrombectomy of the SVG to the OM 1.
    5. IVUS of the SVG to the PDA.
    6. PTCI of the SVG to the PDA.
    ANESTHESIA:
    IV Versed and fentanyl with local lidocaine.



    FINDINGS:
    1. Dissection with subtotal occlusion of the ostial and
    proximal body of the SVG to the OM with thrombus, requiring
    thrombectomy and 2 drug-eluting stents.
    2. A 75% distal edge dissection of the SVG to the PDA mid body
    distal to the prior stent requiring a second stent Promus 3.0 x18.
    3. Patent circumflex.

    ****WE CODED THIS AS******

    92980-LC26
    92981-RC76
    93508-26
    93545
    93556-2676
    92978-2659
    92979-2659

    **BUT BLUE CROSS PAID SOME AND DENIED THESE FOLLOWING CODES**

    92980 LC 76 DENIED
    92981-RC76 PAID
    93508-26 DENIED
    93545 DENIED
    93556-2659 DENIED
    92978-2659 PAID
    92979-2659 PAID

    ***THANK YOU FOR TAKING THE TIME TO READ ! ****
    Last edited by Pillow1; 01-12-2010 at 01:31 PM. Reason: TYPO
    Denise Gilrane-Pillow, CPB

  2. Default
    Once you have have coded for the initial Aniogram, unless there has been a change in status, the Angiogram cannot be charged again. Only the intervention can be charged.

  3. #3
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by Pillow1 View Post
    ANY INPUT WOULD BE APPRECIATIVE
    WE BILLED 2 CATHS IN ONE DAY AND BLUE CROSS DIDN'T PAY ON THE SECOND CATH. PLEASE REVIEW ..THANK YOU SO MUCH.
    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>

    PROCEDURE DIAGNOSIS:
    Angina.

    POSTPROCEDURE DIAGNOSIS:
    Severe obstructive coronary artery disease.

    OPERATION PROCEDURE:
    1. Left ventriculogram.
    2. Coronary angiogram.
    3. Left subclavian angiogram.
    4. Left heart catheterization.
    5. PTCI of the SVG to the PDA.
    6. PTCI x2 of the SVG to the OM 1.
    7. PTCA x2 to the proximal and mid circumflex.


    FINDINGS:
    1. Occluded SVG to the ramus.
    2. Patent LIMA to the LAD.
    3. Occluded LAD and RCA disease.

    4. A 75% mid body lesion in the SVG to the PDA that was
    successfully stented with a drug-eluting stent.
    5. SVG to the OM with 2 lesions, 90% at mid body and 80% in the
    distal anastomosis, both stented with drug-eluting stents.
    6. A 90% proximal circumflex and 75% mid circumflex. Both
    lesions successfully ballooned.
    7. Normal left ventricular function with an EF of 60%.

    COMPLICATIONS:
    Please see next dictation regarding dissection and thrombus formation
    in the vein graft.

    WE BILLED THIS FIRST PROCEDURE AS SUCH AND RECEIVED PAYMENT ON ALL OF THE BELOW CODES

    93510
    36215-59
    93543
    75685-2659
    93545
    92980-RC
    93555-2659
    92981-LC
    93556-2659



    *******THEN THE SECOND PROCEDURE WAS DONE ON THE SAME DAY***


    Acute stent thrombosis.

    POSTPROCEDURE DIAGNOSES:
    1. Dissection and thrombosis of the proximal SVG to the OM 1.
    2. Distal edge dissection of the mid SVG to the PDA stent.

    OPERATIVE PROCEDURES:
    1. IVUS of the SVG to the OM 1.
    2. Coronary angiogram.
    3. PTCI x2 to the SVG to the OM 1.
    4. Thrombectomy of the SVG to the OM 1.
    5. IVUS of the SVG to the PDA.
    6. PTCI of the SVG to the PDA.
    ANESTHESIA:
    IV Versed and fentanyl with local lidocaine.



    FINDINGS:
    1. Dissection with subtotal occlusion of the ostial and
    proximal body of the SVG to the OM with thrombus, requiring
    thrombectomy and 2 drug-eluting stents.
    2. A 75% distal edge dissection of the SVG to the PDA mid body
    distal to the prior stent requiring a second stent Promus 3.0 x18.
    3. Patent circumflex.

    ****WE CODED THIS AS******

    92980-LC26
    92981-RC76
    93508-26
    93545
    93556-2676
    92978-2659
    92979-2659

    **BUT BLUE CROSS PAID SOME AND DENIED THESE FOLLOWING CODES**

    92980 LC 76 DENIED
    92981-RC76 PAID
    93508-26 DENIED
    93545 DENIED
    93556-2659 DENIED
    92978-2659 PAID
    92979-2659 PAID

    ***THANK YOU FOR TAKING THE TIME TO READ ! ****
    Well, I have a couple of thoughts on this case:
    First procedure, I do not see support for 36215/75685. Evaluation of the LIMA should have been coded 93539 (no extra for catheter placement) and evaluation of the SVG should have been 93540. Evaluation of the subclavian (for which there are no findings) is usually done to see the LIMA and should not be separately reported. I know you have received payment but I just wanted to be thorough.

    For the second procedure, perhaps adding modifier 78 will help as this was clearly a complication of the first procedure, or you may just have to appeal and send all appropriate reports.

    Also, on the second procedure, I think you could have also coded the thrombectomy (92973).

    HTH
    Danny L. Peoples
    CIRCC,CPC

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