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Multiple interventions-peripheral

  1. #1
    Default Multiple interventions-peripheral
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    Scenario 1:
    Dr. reported one atherectomy & I'm trying to decide if 2 are supported. Separate areas of stenosis are documented in each vessel (50% in common fem & 95%+ in SFA) and the report says:

    "Decision was made to proceed with atherectomy of an extremely severe ostial right SFA and distal common femoral stenosis..." and;

    "TurboHawk LSC device was now advanced and a series of cuts were made in the distal common femoral & the proximal aspect of the right SFA. The Silverhawk was removed after a series of 12 cuts..."

    Would you code the atherectomy for both the common fem and superficial fem?


    2nd Scenario
    Again, stenosis/occlusions documented in each vessel and docum. states:

    "Preparations were made for cryoballoon angioplasty of the right SFA and this was performed in 2 locations involving the proximal SFA and the distal aspect of the right common femoral artery with a 6x40 PolarCath device."

    Does this support separate angioplasties in both vessels?


    Thanks for any input you might have!

    Keri

  2. #2
    Default
    Quote Originally Posted by KKCODER View Post
    Scenario 1:
    Dr. reported one atherectomy & I'm trying to decide if 2 are supported. Separate areas of stenosis are documented in each vessel (50% in common fem & 95%+ in SFA) and the report says:

    "Decision was made to proceed with atherectomy of an extremely severe ostial right SFA and distal common femoral stenosis..." and;

    "TurboHawk LSC device was now advanced and a series of cuts were made in the distal common femoral & the proximal aspect of the right SFA. The Silverhawk was removed after a series of 12 cuts..."

    Would you code the atherectomy for both the common fem and superficial fem?



    2nd Scenario
    Again, stenosis/occlusions documented in each vessel and docum. states:

    "Preparations were made for cryoballoon angioplasty of the right SFA and this was performed in 2 locations involving the proximal SFA and the distal aspect of the right common femoral artery with a 6x40 PolarCath device."

    Does this support separate angioplasties in both vessels?


    Thanks for any input you might have!

    Keri
    To me, it looks like one lesion in each of the reports. I would only bill for one.
    HTH,
    Jim Pawloski, CIRCC

  3. Default
    Code each ather done on different vascular sites or separate lesions within the same vascular site.

    Guideline states "assign one procedure code regardless of the number of studies per operative field or site. However, multiple pathologies (lesions) in the lower extremities (in multiple operative fields) for example, qualify as multiple sites

    1) Would you code the atherectomy for both the common fem (36246) and superficial fem (36247)?

    So I would code as: common 35493 + 75992-26 with the SFA 35493-59 + 75993-26 and cath placement 36247

    2) 2 locations involving (angioplasty of) the proximal SFA (36247) and the distal aspect of the right common femoral (36246)

    So I would code the Plasty as: proximal SFA 35474 + 75962-26 and cath placement 36247 with rt common femoral 35474-59 + 75964-26

    If he did an ather on the Common Fem, another on the SFA and another on the Popliteal, I would code 36247 for the cath placement and
    35493 + 75992 for the CF
    35493-59 + 75993 for the SFA
    35495 + 75993-59 for the Pop

    It's late at night so correct me if I am wrong
    Last edited by sbicknell; 06-03-2010 at 10:36 PM.

  4. #4
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    Default
    Quote Originally Posted by KKCODER View Post
    Scenario 1:
    Dr. reported one atherectomy & I'm trying to decide if 2 are supported. Separate areas of stenosis are documented in each vessel (50% in common fem & 95%+ in SFA) and the report says:

    "Decision was made to proceed with atherectomy of an extremely severe ostial right SFA and distal common femoral stenosis..." and;

    "TurboHawk LSC device was now advanced and a series of cuts were made in the distal common femoral & the proximal aspect of the right SFA. The Silverhawk was removed after a series of 12 cuts..."

    Would you code the atherectomy for both the common fem and superficial fem?


    2nd Scenario
    Again, stenosis/occlusions documented in each vessel and docum. states:

    "Preparations were made for cryoballoon angioplasty of the right SFA and this was performed in 2 locations involving the proximal SFA and the distal aspect of the right common femoral artery with a 6x40 PolarCath device."

    Does this support separate angioplasties in both vessels?


    Thanks for any input you might have!

    Keri
    This looks like a "bridging lesion" to me between the distal CFA and proximal SFA. One lesion (stenotic area), one intervention is the rule I use.
    35493/75992 or 35474/75962 and of course 36247 for the catheter placement.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  5. Default
    correct, if scenario 2 ( proximal SFA and the distal aspect of the right common femoral) is one contineous lesion, then it is coded as one intervention

    Hopefully your report documentation iprovides more specifics. If not, then verify with the physician if 1 lesion or 2 separate lesions. He will need to amend his report to support the appropriate coding

  6. #6
    Default
    The CFA and SFA are 1 vessel, I would only code the atherectomy, and cath placement 36247 as it is more intense than the angioplasty.

  7. Default
    CFA and SFA are not 1 vessel for coding purposes. Under the premise you give, the CFA, SFA, popliteal and peroneal would all be considered one vessel. This would not be correct

    The CFA is a 36246 and the SFA is a 36247

    If one lesion extending from distal CFA into the SFA (bridging as dpeoples stated), then it is coded as one lesion

    If there are 2 separate lesions (is there a space between them, no matter how small?) then code for 2

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