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Thread: catheter bundling issue with 75716-26

  1. #1

    Default catheter bundling issue with 75716-26

    AAPC: Back to School
    Has anyone else been experiencing a bundling denial of the catheter,in my 2 cases 36247, with 75716-26. I had a denial from our Medicaid carrier and after 3 appeals finally removed the 75716-26 ( paid about $60) and was paid for the catheterization 36247( over $1000) however still do not feel this is correct and I am now experiencing the same issue with Aetna. There are no other procedures billed in either case only the catheter 36247 with 75625-26 and 75716-26. Both Medicaid and Aetna have denied the catheter stating it is incidental to 75716-26.

  2. #2
    Join Date
    Apr 2007
    Alexandria, LA


    Sounds like when they put the new revascularization codes in, they set up their edits in a way that bundles catheterization with angiogram whether or not the revascularization was provided. Someone needs to contact them and ask them to explain the edits.

  3. #3


    Thank-you, I agree. We argued until we were blue in the face with our Medicaid contractor to no avail however we will try with Aetna and may have to take this to our provider rep. I will however be checking these edits very closely since losing the catheter payment is very costly.

  4. #4
    Join Date
    Apr 2007
    Melbourne, FL

    Default aetna

    It is Aetna's scrub/payment software-they definitely have the new revascularization codes combined with all of the angios. Requires a 59 now for all angios even without 37220-37233.

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