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reviewing 36245-59

  1. Default reviewing 36245-59
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    We are getting reviewed all of a sudden from a local ins. This is what is coded:
    93459-26
    36245-59
    36215-59
    75710-26-59
    75650-26-59
    the claims are being reviewed for the 36245-59. Does anyone else have this problem and am I coding correctly? Thank uou for your help w/this Nancy

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by n.anselmo@yahoo.com View Post
    We are getting reviewed all of a sudden from a local ins. This is what is coded:
    93459-26
    36245-59
    36215-59
    75710-26-59
    75650-26-59
    the claims are being reviewed for the 36245-59. Does anyone else have this problem and am I coding correctly? Thank uou for your help w/this Nancy

    This is an unusual coding scenario with a heart cath. In this particular case, what vessel does 36245 represent? and is there separate medical necessity for that selection and injection?
    Danny L. Peoples
    CIRCC,CPC

  3. Red face
    The 36245 is billed w/the iliac angiography 75710 and w/every cath done w/75710 I send in the cath report. When we switched to the new codes for caths that is how we were told to bill. Is this correct?

  4. #4
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by n.anselmo@yahoo.com View Post
    The 36245 is billed w/the iliac angiography 75710 and w/every cath done w/75710 I send in the cath report. When we switched to the new codes for caths that is how we were told to bill. Is this correct?
    If the iliac (lower extremity) angiography is of the access site, not only is 36245 incorrect, 75710 is not separately billable. Can you provide a report?

    Danny L. Peoples
    CIRCC,CPC

  5. Default
    Procedure: LHC, SCA, left ventriculography, iliac angiography

    History of present illness: history of hypertension, reported atrial arrhythmias & lonstanding mitral valve prolapse that had symptoms consistent w/SOB on exertion. Pt states he does not have the energy he used to. Pt had recent ecocardiogram that demonstrated bileaflet mitral valve prolapse w/severe regurgitation & left atrial enlargement. In the context of these symptoms, heis referred for diagnostic angiography as a prelude to mitral valve repair. He also had mild-to-moderate tricuspid regurgitation w/evidence of moderate pulmonary hypertension w/estimated pulmonary artery systolic pressure of 50mmHg.

    Right common femoral artery was accessed using modified Seldinger technique in which a 6 French 11cm sheath was placed without complication. A JL4 & JR4 diagnostic catheter was used to perform selective coronary angiography and a pigtail catheter for left ventriculography to assess left ventricular end diastolic pressure and transaortic gradient. at the conclusion of the procedure, iliac angiography was performed. There was no evidence of significant disease in the external iliac, femoral, SFA or deep profunda w/appropriate placement of the arteriotomy site sutible for percutaneous closure. An Angio-Seal device was deployed without complication.

  6. #6
    Default
    Quote Originally Posted by n.anselmo@yahoo.com View Post
    Procedure: LHC, SCA, left ventriculography, iliac angiography

    History of present illness: history of hypertension, reported atrial arrhythmias & lonstanding mitral valve prolapse that had symptoms consistent w/SOB on exertion. Pt states he does not have the energy he used to. Pt had recent ecocardiogram that demonstrated bileaflet mitral valve prolapse w/severe regurgitation & left atrial enlargement. In the context of these symptoms, heis referred for diagnostic angiography as a prelude to mitral valve repair. He also had mild-to-moderate tricuspid regurgitation w/evidence of moderate pulmonary hypertension w/estimated pulmonary artery systolic pressure of 50mmHg.

    Right common femoral artery was accessed using modified Seldinger technique in which a 6 French 11cm sheath was placed without complication. A JL4 & JR4 diagnostic catheter was used to perform selective coronary angiography and a pigtail catheter for left ventriculography to assess left ventricular end diastolic pressure and transaortic gradient. at the conclusion of the procedure, iliac angiography was performed. There was no evidence of significant disease in the external iliac, femoral, SFA or deep profunda w/appropriate placement of the arteriotomy site sutible for percutaneous closure. An Angio-Seal device was deployed without complication.
    Your 36245 and 75710 aren't separately billable here. Angiogram is just being done to see if the Angio-Seal device can be placed.

    From the NCCI manual:
    18. Placement of an occlusive device such as an angio seal or vascular plug into an arterial or venous access site after cardiac catheterization or other diagnostic or interventional procedure should be reported with HCPCS code G0269. A physician should not separately report an associated imaging code such as CPT code 75710 or HCPCS code G0278.

    Jessica CPC, CCC

  7. #7
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by n.anselmo@yahoo.com View Post
    Procedure: LHC, SCA, left ventriculography, iliac angiography

    History of present illness: history of hypertension, reported atrial arrhythmias & lonstanding mitral valve prolapse that had symptoms consistent w/SOB on exertion. Pt states he does not have the energy he used to. Pt had recent ecocardiogram that demonstrated bileaflet mitral valve prolapse w/severe regurgitation & left atrial enlargement. In the context of these symptoms, heis referred for diagnostic angiography as a prelude to mitral valve repair. He also had mild-to-moderate tricuspid regurgitation w/evidence of moderate pulmonary hypertension w/estimated pulmonary artery systolic pressure of 50mmHg.

    Right common femoral artery was accessed using modified Seldinger technique in which a 6 French 11cm sheath was placed without complication. A JL4 & JR4 diagnostic catheter was used to perform selective coronary angiography and a pigtail catheter for left ventriculography to assess left ventricular end diastolic pressure and transaortic gradient. at the conclusion of the procedure, iliac angiography was performed. There was no evidence of significant disease in the external iliac, femoral, SFA or deep profunda w/appropriate placement of the arteriotomy site sutible for percutaneous closure. An Angio-Seal device was deployed without complication.
    I don't mean to alarm you or be overly critical, but the only code I would have used for this case is 93458, I do not see any indication that grafts were injected or imaged to justify 93459. I also do not see an interpretation of the arch to justify 75650, and the ipsilateral lower extremity angiography is for the closure device placement and should not be billed separately. I also do not understand coding 36215?

    HTH
    Danny L. Peoples
    CIRCC,CPC

  8. Default
    Quote Originally Posted by dpeoples View Post
    I don't mean to alarm you or be overly critical, but the only code I would have used for this case is 93458, I do not see any indication that grafts were injected or imaged to justify 93459. I also do not see an interpretation of the arch to justify 75650, and the ipsilateral lower extremity angiography is for the closure device placement and should not be billed separately. I also do not understand coding 36215?

    HTH

    Danny is absolutely correct.
    Theresa CCS-P CPMA CCC ICDCT-CM

  9. Default
    I apologize, after I got to read your response last night, I realized that I put in the wrong pt's cath report for the senerio I was trying to get answers for. I hope to get time today today. Thank you all Nancy

  10. Default
    Quote Originally Posted by n.anselmo@yahoo.com View Post
    I apologize, after I got to read your response last night, I realized that I put in the wrong pt's cath report for the senerio I was trying to get answers for. I hope to get time today today. Thank you all Nancy


    Nancy,
    thank goodness. look forward to seeing the "real" report
    Theresa CCS-P CPMA CCC ICDCT-CM

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