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Billing LE Angiogram

  1. #1
    Question Billing LE Angiogram
    Medical Coding Books
    What can I code in addition to 36200? Thanks.

    PROTOCOL: The patient was brought to the cath lab after written consent
    was obtained. Both groins were prepped and draped in the usual fashion.
    The left common femoral artery was cannulated without difficult. A 5-
    French sheath was placed. A 5-French OmniFlush catheter was then
    advanced. Imaging was obtained with the catheter placement at level of
    L1 and then subsequently pulled back above the bifurcation. Bolus chase
    method was used for angiography. No complications occurred. After
    completion of the procedure the sheath was removed with manual
    compression.

    FINDINGS:
    1. The aorta demonstrates normal caliber with no significant disease.
    2. The left renal artery is patent. The right renal artery demonstrated
    40 to 50% plaque in the proximal segment. The remaining portion of the
    descending aorta is normal.
    3. The right extremity reveals the following: Common iliac artery is
    patent. The right internal iliac artery is occluded. Right external
    iliac artery is patent with good flow with mild atherosclerosis. The
    common femoral artery and right superficial femoral artery area showing
    moderate disease of up to 40 to 50% plaque and focal areas within the
    mid superficial femoral artery. The popliteal artery is widely patent
    and the trifurcation is preserved with mild disease. The right anterior
    tibial artery shows proximal 75 to 80% focal narrowing, which is leading
    up to a three-vessel runoff in the lower extremity with mild disease in
    the other vessels.
    6. The left extremity reveals that left internal iliac artery shows 90%
    stenosis. The left external iliac is patent and common femoral artery
    is without any significant disease. Left superficial femoral artery
    shows mild to moderate plaque with 30 to 40% plaque in the mid to mid-
    distal segment and popliteal artery is unremarkable. The trifurcation
    reveals left anterior tibial artery with 50 to 70% focal narrowing in
    the mid segment. There is three-vessel runoff with minimal disease
    affecting the posterior tibial and peroneal arteries and the arch is
    intact with good flow to the foot.

  2. #2
    Location
    Richardson, TX
    Posts
    823
    Default
    He/she has results for the Bilateral extremity angiography's but his dictation does not seem to specifically mention his cath placement, unless I'm missing it. So you could possibly bill 75716 - 26, 59 as well.
    Julie Graham, BA, CPC, CCC

  3. #3
    Default
    Quote Originally Posted by jewlz0879 View Post
    He/she has results for the Bilateral extremity angiography's but his dictation does not seem to specifically mention his cath placement, unless I'm missing it. So you could possibly bill 75716 - 26, 59 as well.
    The catheter placements was mentioned when he stated about the imaging.

    Jim Pawloski, CIRCC

  4. #4
    Default
    Quote Originally Posted by amym View Post
    What can I code in addition to 36200? Thanks.

    PROTOCOL: The patient was brought to the cath lab after written consent
    was obtained. Both groins were prepped and draped in the usual fashion.
    The left common femoral artery was cannulated without difficult. A 5-
    French sheath was placed. A 5-French OmniFlush catheter was then
    advanced. Imaging was obtained with the catheter placement at level of
    L1 and then subsequently pulled back above the bifurcation. Bolus chase
    method was used for angiography. No complications occurred. After
    completion of the procedure the sheath was removed with manual
    compression.

    FINDINGS:
    1. The aorta demonstrates normal caliber with no significant disease.
    2. The left renal artery is patent. The right renal artery demonstrated
    40 to 50% plaque in the proximal segment. The remaining portion of the
    descending aorta is normal.
    3. The right extremity reveals the following: Common iliac artery is
    patent. The right internal iliac artery is occluded. Right external
    iliac artery is patent with good flow with mild atherosclerosis. The
    common femoral artery and right superficial femoral artery area showing
    moderate disease of up to 40 to 50% plaque and focal areas within the
    mid superficial femoral artery. The popliteal artery is widely patent
    and the trifurcation is preserved with mild disease. The right anterior
    tibial artery shows proximal 75 to 80% focal narrowing, which is leading
    up to a three-vessel runoff in the lower extremity with mild disease in
    the other vessels.
    6. The left extremity reveals that left internal iliac artery shows 90%
    stenosis. The left external iliac is patent and common femoral artery
    is without any significant disease. Left superficial femoral artery
    shows mild to moderate plaque with 30 to 40% plaque in the mid to mid-
    distal segment and popliteal artery is unremarkable. The trifurcation
    reveals left anterior tibial artery with 50 to 70% focal narrowing in
    the mid segment. There is three-vessel runoff with minimal disease
    affecting the posterior tibial and peroneal arteries and the arch is
    intact with good flow to the foot.
    I would bill 36200, 75625, and 75716. Catheter was moved into two positions, so you get an Abdominal Aortogram and Bilateral Extremity Arteriogram
    HTH,
    Jim Pawloski, CIRCC

  5. #5
    Location
    Tallahassee, FL
    Posts
    13
    Default
    Should there be a modifier appended to 75716? -59?

  6. #6
    Location
    Birmingham, Alabama
    Posts
    890
    Default
    I agree with Jim. I also think modifier 59 is not applicable.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  7. #7
    Location
    Richardson, TX
    Posts
    823
    Default
    So do you only have to append 59 when billing 75710/75716 with the Lower Extremity Revascularizations 37220 - 37235?

    I thought with the new rules 75625/75630 & 75710/75716 were bundled so you have to use 59? Would love to have a better understanding. Thanks!
    Julie Graham, BA, CPC, CCC

  8. #8
    Default
    Quote Originally Posted by jewlz0879 View Post
    So do you only have to append 59 when billing 75710/75716 with the Lower Extremity Revascularizations 37220 - 37235?

    I thought with the new rules 75625/75630 & 75710/75716 were bundled so you have to use 59? Would love to have a better understanding. Thanks!
    What is bundled with the revascularization codes is the catheterization codes. As long as there is a diagnostic arteriogram before the intervention. So yes, you use modifier-59 for the diagnostic portion when the lower extremity intervention is performed.
    HTH,
    Jim Pawloski, CIRCC

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