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Selective cath placements

  1. Question Selective cath placements
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    I need help with Medicare denial. Pt had a carotid angiogram, Dr selectively engaged RT carotid, LT carotid and then the LT subclavian. I billed 36216 for the RT carotid, 36215-59 for the LT carotid and 36215-59 for the LT subclavian and Humana Medicare is not wanting to pay for the subclavian cath placement. I have been searching for a Medicare policy for vascular families and can't locate one. The follow up staff is saying Humana says they won't pay for 2 left sided cath placements. (of course I billed the S&I codes but only having problem with the cath placement denial).
    Thanks for any and all help.
    Peggy

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    I am as perplexed as you, all three cath placements are correc they are three separate vascular families. If you hace access to the Z-Health interventional coding book, I would locate the rules for cath placements in theses vessels and submit that with the report supporting proper documentation os these cath placements.

  3. #3
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    Quote Originally Posted by PeggySanders View Post
    I need help with Medicare denial. Pt had a carotid angiogram, Dr selectively engaged RT carotid, LT carotid and then the LT subclavian. I billed 36216 for the RT carotid, 36215-59 for the LT carotid and 36215-59 for the LT subclavian and Humana Medicare is not wanting to pay for the subclavian cath placement. I have been searching for a Medicare policy for vascular families and can't locate one. The follow up staff is saying Humana says they won't pay for 2 left sided cath placements. (of course I billed the S&I codes but only having problem with the cath placement denial).
    Thanks for any and all help.
    Peggy
    Make that three perplexed.

    Clearly they are not understanding that there are three vascular families involved. I think a graft/image of the aortic arch (Zhealth has great products) with a summary of each selection might help. Good luck...
    Danny L. Peoples
    CIRCC,CPC

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