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Thread: 75710-26-59?

  1. #1

    Default 75710-26-59?

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    Is it appropriate to append a -59 modifier to CPT 75710-26 for given procedure?

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Right common femoral angiography.
    -- Coronary Bare Metal Stent Placement.
    -- Intervention on OM1: stent.

    RECOMMENDATIONS:
    The patient should continue with the present medications.

    INDICATIONS: Angina/MI: stable angina.

    PRIOR DIAGNOSTIC TEST RESULTS: Nuclear stress test was positive. There was
    ischemia in the territory of the circumflex.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. Global left ventricular function was normal. EF calculated
    by contrast ventriculography was 60 %.

    VALVES: AORTIC VALVE: The aortic valve was evaluated by left
    ventriculography. The aortic valve appeared to be structurally normal. The
    aortic valve leaflets exhibited normal thickness and normal excursion.
    There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
    by left ventriculography. The mitral valve appeared grossly normal. The
    mitral leaflets exhibited normal thickness and normal excursion. The
    mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. There was
    1-vessel coronary artery disease (circumflex). Left main: Normal. LAD:
    Angiography showed minor luminal irregularities. 1st obtuse marginal:
    There was a discrete 80 % stenosis at the site of a prior stent. RCA:
    Angiography showed minor luminal irregularities.

    RIGHT LOWER EXTREMITY VESSELS: Right leg angiography was limited to the
    common femoral and the proximal portion of the superficial femoral and
    deep femoral arteries. These vessels appeared normal.

    PROCEDURE: The risks and alternatives of the procedures and conscious
    sedation were explained to the patient and informed consent was obtained.
    The patient was brought to the cath lab and placed on the table. The
    planned puncture sites were prepped and draped in the usual sterile
    fashion.

    -- Right femoral artery access. The puncture site was infiltrated with
    local anesthetic. The vessel was accessed using the modified Seldinger
    technique, a wire was threaded into the vessel, and a sheath was advanced
    over the wire into the vessel.

    -- Left heart catheterization. A catheter was advanced to the ascending
    aorta. After recording ascending aortic pressure, the catheter was
    advanced across the aortic valve and left ventricular pressure was
    recorded. Ventriculography was performed using power injection of contrast
    agent. Imaging was performed using an RAO projection.

    -- Left coronary artery angiography. A catheter was advanced to the aorta
    and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right coronary artery angiography. A catheter was advanced to the
    aorta and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right common femoral angiography. A catheter was positioned under
    fluoroscopic guidance.

    LESION INTERVENTION: A stent was performed on the lesion in the 1st obtuse
    marginal.

    -- Vessel setup was performed. A Runway 6F LBU 3.5 guiding catheter was
    used to cannulate the vessel.

    -- Vessel setup was performed. A BMW HT 190cm wire was used to cross the
    lesion.

    -- A INTEGRITY 2.5 X 14 bare-metal stent at a maximum inflation pressure
    of 12 atm.

    CARDIAC INTERVENTIONS
    -- Coronary Bare Metal Stent Placement.

    COMPLICATIONS:
    There were no adverse outcomes.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 09:05. Test concluded at 09:45. RADIATION EXPOSURE:
    Fluoroscopy time: 5.8 min.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 09:01.
    Midazolam, 1 mg, IV, at 09:06.
    Midazolam, 1 mg, IV, at 09:35.
    Fentanyl, 50 mcg, IV, at 09:36.
    Labetalol (Trandate), 5 mg, IV, at 09:00.
    Bivalirudin (Angiomax), 13 ml, IV, last dose at 09:25.
    Bivalirudin (Angiomax), infusion rate of 30 ml/hr, IV, last dose at 09:38.
    Clopidogrel (Plavix), 600 mg, PO, last dose at 09:38.
    Aspirin, 325 mg, PO, last dose at 09:44.
    CONTRAST GIVEN:
    Omnipaque 130 ml.

  2. #2
    Join Date
    Apr 2007
    Location
    Green Bay
    Posts
    402

    Default

    Personally, I don't think the 75710-26 is even separately billable at all. It's not entirely clear to me why the femoral angiography was done for but I don't think it was for diagnostic reasons.

    May have been to see if a closure device could be placed?

    Other opinions on this one?

    Jessica CPC, CCC

  3. #3
    Join Date
    Apr 2007
    Location
    Richardson, TX
    Posts
    817

    Default

    Quote Originally Posted by amym View Post
    Is it appropriate to append a -59 modifier to CPT 75710-26 for given procedure?

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Right common femoral angiography.
    -- Coronary Bare Metal Stent Placement.
    -- Intervention on OM1: stent.

    RECOMMENDATIONS:
    The patient should continue with the present medications.

    INDICATIONS: Angina/MI: stable angina.

    PRIOR DIAGNOSTIC TEST RESULTS: Nuclear stress test was positive. There was
    ischemia in the territory of the circumflex.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. Global left ventricular function was normal. EF calculated
    by contrast ventriculography was 60 %.

    VALVES: AORTIC VALVE: The aortic valve was evaluated by left
    ventriculography. The aortic valve appeared to be structurally normal. The
    aortic valve leaflets exhibited normal thickness and normal excursion.
    There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
    by left ventriculography. The mitral valve appeared grossly normal. The
    mitral leaflets exhibited normal thickness and normal excursion. The
    mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. There was
    1-vessel coronary artery disease (circumflex). Left main: Normal. LAD:
    Angiography showed minor luminal irregularities. 1st obtuse marginal:
    There was a discrete 80 % stenosis at the site of a prior stent. RCA:
    Angiography showed minor luminal irregularities.

    RIGHT LOWER EXTREMITY VESSELS: Right leg angiography was limited to the
    common femoral and the proximal portion of the superficial femoral and
    deep femoral arteries. These vessels appeared normal.

    PROCEDURE: The risks and alternatives of the procedures and conscious
    sedation were explained to the patient and informed consent was obtained.
    The patient was brought to the cath lab and placed on the table. The
    planned puncture sites were prepped and draped in the usual sterile
    fashion.

    -- Right femoral artery access. The puncture site was infiltrated with
    local anesthetic. The vessel was accessed using the modified Seldinger
    technique, a wire was threaded into the vessel, and a sheath was advanced
    over the wire into the vessel.

    -- Left heart catheterization. A catheter was advanced to the ascending
    aorta. After recording ascending aortic pressure, the catheter was
    advanced across the aortic valve and left ventricular pressure was
    recorded. Ventriculography was performed using power injection of contrast
    agent. Imaging was performed using an RAO projection.

    -- Left coronary artery angiography. A catheter was advanced to the aorta
    and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right coronary artery angiography. A catheter was advanced to the
    aorta and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right common femoral angiography. A catheter was positioned under
    fluoroscopic guidance.

    LESION INTERVENTION: A stent was performed on the lesion in the 1st obtuse
    marginal.

    -- Vessel setup was performed. A Runway 6F LBU 3.5 guiding catheter was
    used to cannulate the vessel.

    -- Vessel setup was performed. A BMW HT 190cm wire was used to cross the
    lesion.

    -- A INTEGRITY 2.5 X 14 bare-metal stent at a maximum inflation pressure
    of 12 atm.

    CARDIAC INTERVENTIONS
    -- Coronary Bare Metal Stent Placement.

    COMPLICATIONS:
    There were no adverse outcomes.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 09:05. Test concluded at 09:45. RADIATION EXPOSURE:
    Fluoroscopy time: 5.8 min.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 09:01.
    Midazolam, 1 mg, IV, at 09:06.
    Midazolam, 1 mg, IV, at 09:35.
    Fentanyl, 50 mcg, IV, at 09:36.
    Labetalol (Trandate), 5 mg, IV, at 09:00.
    Bivalirudin (Angiomax), 13 ml, IV, last dose at 09:25.
    Bivalirudin (Angiomax), infusion rate of 30 ml/hr, IV, last dose at 09:38.
    Clopidogrel (Plavix), 600 mg, PO, last dose at 09:38.
    Aspirin, 325 mg, PO, last dose at 09:44.
    CONTRAST GIVEN:
    Omnipaque 130 ml.
    I agree with jess1125. I don't see any medical necessity and per his findings "they are normal." Furthermore, you need to be certain that if billing 75710-26-59 you follow the new rules.

    CPT 2011 has also restructured the way we can bill for diagnostic angiography. Diagnostic angiography performed at the time of an interventional procedure is separately reportable if:

    I. No prior catheter-based angiography study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study, OR

    II. Prior study is available, but as documented in the medical record:

    A. The patient’s condition with respect to the clinical indication has changed since the prior study, OR

    B. There is inadequate visualization of the anatomy and/or pathology, OR

    C. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention

    I personally do not believe I'd bill for it. Hope that helps!
    Julie Graham, BA, CPC, CCC

  4. #4

    Default

    Thank you all for your help!

  5. #5
    Join Date
    Apr 2007
    Location
    Birmingham, Alabama
    Posts
    887

    Default

    Quote Originally Posted by amym View Post
    Is it appropriate to append a -59 modifier to CPT 75710-26 for given procedure?

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Right common femoral angiography.
    -- Coronary Bare Metal Stent Placement.
    -- Intervention on OM1: stent.

    RECOMMENDATIONS:
    The patient should continue with the present medications.

    INDICATIONS: Angina/MI: stable angina.

    PRIOR DIAGNOSTIC TEST RESULTS: Nuclear stress test was positive. There was
    ischemia in the territory of the circumflex.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. Global left ventricular function was normal. EF calculated
    by contrast ventriculography was 60 %.

    VALVES: AORTIC VALVE: The aortic valve was evaluated by left
    ventriculography. The aortic valve appeared to be structurally normal. The
    aortic valve leaflets exhibited normal thickness and normal excursion.
    There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
    by left ventriculography. The mitral valve appeared grossly normal. The
    mitral leaflets exhibited normal thickness and normal excursion. The
    mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. There was
    1-vessel coronary artery disease (circumflex). Left main: Normal. LAD:
    Angiography showed minor luminal irregularities. 1st obtuse marginal:
    There was a discrete 80 % stenosis at the site of a prior stent. RCA:
    Angiography showed minor luminal irregularities.

    RIGHT LOWER EXTREMITY VESSELS: Right leg angiography was limited to the
    common femoral and the proximal portion of the superficial femoral and
    deep femoral arteries. These vessels appeared normal.

    PROCEDURE: The risks and alternatives of the procedures and conscious
    sedation were explained to the patient and informed consent was obtained.
    The patient was brought to the cath lab and placed on the table. The
    planned puncture sites were prepped and draped in the usual sterile
    fashion.

    -- Right femoral artery access. The puncture site was infiltrated with
    local anesthetic. The vessel was accessed using the modified Seldinger
    technique, a wire was threaded into the vessel, and a sheath was advanced
    over the wire into the vessel.

    -- Left heart catheterization. A catheter was advanced to the ascending
    aorta. After recording ascending aortic pressure, the catheter was
    advanced across the aortic valve and left ventricular pressure was
    recorded. Ventriculography was performed using power injection of contrast
    agent. Imaging was performed using an RAO projection.

    -- Left coronary artery angiography. A catheter was advanced to the aorta
    and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right coronary artery angiography. A catheter was advanced to the
    aorta and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right common femoral angiography. A catheter was positioned under
    fluoroscopic guidance.

    LESION INTERVENTION: A stent was performed on the lesion in the 1st obtuse
    marginal.

    -- Vessel setup was performed. A Runway 6F LBU 3.5 guiding catheter was
    used to cannulate the vessel.

    -- Vessel setup was performed. A BMW HT 190cm wire was used to cross the
    lesion.

    -- A INTEGRITY 2.5 X 14 bare-metal stent at a maximum inflation pressure
    of 12 atm.

    CARDIAC INTERVENTIONS
    -- Coronary Bare Metal Stent Placement.

    COMPLICATIONS:
    There were no adverse outcomes.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 09:05. Test concluded at 09:45. RADIATION EXPOSURE:
    Fluoroscopy time: 5.8 min.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 09:01.
    Midazolam, 1 mg, IV, at 09:06.
    Midazolam, 1 mg, IV, at 09:35.
    Fentanyl, 50 mcg, IV, at 09:36.
    Labetalol (Trandate), 5 mg, IV, at 09:00.
    Bivalirudin (Angiomax), 13 ml, IV, last dose at 09:25.
    Bivalirudin (Angiomax), infusion rate of 30 ml/hr, IV, last dose at 09:38.
    Clopidogrel (Plavix), 600 mg, PO, last dose at 09:38.
    Aspirin, 325 mg, PO, last dose at 09:44.
    CONTRAST GIVEN:
    Omnipaque 130 ml.

    Angiography of the access site is not separately billable w/o documented medical neccesity independent of the reason for the heart cath/angiography/intervention.

    I would not code 75710.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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