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Please help code cath report - Can someone please guide me

  1. Question Please help code cath report - Can someone please guide me
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    Can someone please guide me on how to code cath reports? I am unsure.

    Pt was prepped & draped in sterile fashion followed by lidocaine injection to anesthestize the tissues of the right groin. Access was gained to the right common femoral artery & a 4F Brite Tip Sheath was placed. An aortogram with run off was then performed using a 4F UF catheter which was placed in the distal aorta. The catheter was then advanced to the contralateral SFA and a left lower extremity angiogram was performed. The Brite Tip sheath and UF catheter were exchanged for a 6F 110 cm Cook sheath which was positioned with the tip at the level of the left popliteal artery. A VIPER wire was then advanced through the peroneal occlusion and elliptical atherectomy was then performed using 1.25 PREDATOR device followed by PTA using 2.5 x 120 mm and 3.0 x 100 mm SLEEK balloons serially. A 3.5 x 40 m SLEEK balloon was then used to dilate the popliteal artery. Final angiography reveals in line flow to the ankle vial the peroneal artery.

    Thank you!

  2. Default
    Look at code 37229 for the atherectomy of the peroneal (this includes all catheter placements and imaging) and then you should look at code 37224 for the popliteal artery(which also includes all catheter placements and imaging).

  3. #3
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    Quote Originally Posted by csnow View Post
    Look at code 37229 for the atherectomy of the peroneal (this includes all catheter placements and imaging) and then you should look at code 37224 for the popliteal artery(which also includes all catheter placements and imaging).
    Although we may not have the whole report, the code 75716 may also come into play, if there was a true diagnostic cath performed first.
    HTH,
    Jim Pawloski, CIRCC

  4. Default
    Thank you for responding so promptly. Here is other info I did not incluce.

    Vessel Angiography Findings

    AORTOGRAM WITH RUNOFF:
    Moderate tortuosity bilateral iliac systems....

    RIGHT LOWER EXTREMITY ANGIOGRAM:
    Mild non obstructive diffuse disease right SFA...
    100% occlusion

    LEFT LOWER EXTREMITY ANGIOGRAM:
    Mild non abstructive diffuse disease left SFA
    100% occlusion...

    CONCLUSIONS:
    Successful recanalization left peroneal occlusion
    Successful atherectomy and PTA left popliteal and peroneal arteries

    My Dr. Billed:
    36140 - Denied
    36247 - Denied
    75716(26) - Denied
    36200 - Denied
    75626(26) - Paid
    37225 - Paid
    37229 - Paid
    37232 - Paid

    Can anyone explain whether he billed correctly?
    Can you guide me by highlighting what & why he should bill a particular code? I really want to learn how to code cath-reports?
    CSnow, why did you select 37224?

  5. Default
    Quote Originally Posted by coders_rock! View Post
    Thank you for responding so promptly. Here is other info I did not incluce.

    Vessel Angiography Findings

    AORTOGRAM WITH RUNOFF:
    Moderate tortuosity bilateral iliac systems....

    RIGHT LOWER EXTREMITY ANGIOGRAM:
    Mild non obstructive diffuse disease right SFA...
    100% occlusion

    LEFT LOWER EXTREMITY ANGIOGRAM:
    Mild non abstructive diffuse disease left SFA
    100% occlusion...

    CONCLUSIONS:
    Successful recanalization left peroneal occlusion
    Successful atherectomy and PTA left popliteal and peroneal arteries

    My Dr. Billed:
    36140 - Denied
    36247 - Denied
    75716(26) - Denied
    36200 - Denied
    75626(26) - Paid
    37225 - Paid
    37229 - Paid
    37232 - Paid

    Can anyone explain whether he billed correctly?
    Can you guide me by highlighting what & why he should bill a particular code? I really want to learn how to code cath-reports?
    CSnow, why did you select 37224?
    Code 36140 is the puncture for the extremity and included with the intervention and cannot be billed,
    36247 is the catheter placement code and also cannot be billed in addition to the intervention,
    75716(26) is for the S&I portion of the aortogram and can be only billed in addition to the intervention if it is truly diagnostic and a (59) has to be added to indicate it was diagnostic
    36200 is for the cath placement in the aorta, as soon as an intervention is done, this code is not billable
    37225 is for the atherectomy of the fempop area, and I am not seeing that as documented, so it would be inappropriate to bill
    37229 is for the peroneal atherectomy and is appropriate
    37232 is for the balloon in the vessel that had the atherectomy, and is included in the atherectomy code and cannot bill in addition


    I would also bill the 37224 for the balloon of the popliteal

    hope this helps,

    Heather Shaw, CPC, CIRCC
    Last edited by heatheralayna; 12-09-2011 at 10:35 AM.

  6. Default
    Are you saying that this does not support the use of 37225?

    A VIPER wire was then advanced through the peroneal occlusion and elliptical atherectomy was then performed using...
    Last edited by coders_rock!; 12-09-2011 at 11:54 AM.

  7. Default
    yes it absolutely supports an atherectomy, but he describes an atherectomy of the peroneal vessel, 37225 is an atherectomy of a femoral/popliteal vessel. At least that is how I am understanding his dictation.

    Heather Shaw, CPC, CIRCC

  8. #8
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    As dictated, I agree with Heather on 37229, 37224, and possibly 75716-26-59, and that all the other codes are inappropriate.

    However, in one section he describes only a peroneal atherectomy -"A VIPER wire was then advanced through the peroneal occlusion and elliptical atherectomy was then performed using 1.25 PREDATOR device followed by PTA using 2.5 x 120 mm and 3.0 x 100 mm SLEEK balloons serially."; but in another area he says "Successful atherectomy and PTA left popliteal and peroneal arteries".
    If he did an atherectomy of the popliteal he will need to dictate an addendum describing that procedure. If he did the procedure and documents it, then you would not code 37224, but would instead code 37225.

    To code a diagnostic angiogram S & I with an intervention there must be documentation that either this was the first angiogram and the decision to do the intervention was based on the findings, or that a previous angiogram was performed but was not adequate for visualization or the patient's condition has changed.
    I see way too many that say they did an angiogram and document findings, but never indicate the decision for intervention.

  9. Default Vessel angiogram with intervention
    Sodonnajrichmond... are you saying that you can only bill the study if the intervention is not planned? Does CTA before intervention mean that you shouldn't be billing for the angiography done prior to intervention?

    Do you know of a place I can get references on this to share with the docs I work for?

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