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Thread: Cpt 36245 denial--please help!!! Last attempt from payor

  1. #1
    Join Date
    Apr 2007
    Posts
    93

    Question Cpt 36245 denial--please help!!! Last attempt from payor

    I received denial from billing dept that CPT 36245 was denied due to wrong modifier & Medicaid's requesting appropriate Modifier for CPT 36245--this claim was submitted as 36245--Mod 50 for 3 units. I seriously need help on this report. This is my first time coding for Interventional Radiology. This is the 3rd and last attempt as insurance will consider paying this claim being that it was submitted twice already. Someone please advise. Thank you again for your time and consideration. Greatly appreciate it! The report is as followed:

    Administrative/medical emergency consent was obtained/signed by trauma team. The patient was brought to the Angio suite from emergency room by trauma team and placed on angio table in supine position. Right groin was prepped and draped in the usual sterile fashion. 1% lidocaine was used as local anesthetic. Access was gained to right common femoral artery using single wall 18 gauge needle. 5 French vascular sheath was placed . Pigtail catheter abdominal aortogram failed to reveal contrast extravasation.
    Bilateral lumbar arteries where studied.
    5 French catheter was used to access left L2 artery. Diagnostic angiogram of theleft L2 showed acute hemorrhage .Distal branch of the left second lumbar artery was selected using 3 French micro- catheter.Embolization was performed using 4 3x30 mm 0.018 coils with an excellent angiographic result.
    5 French catheter was used to access right L2 artery. Diagnostic angiogram of the the right second lumbar showed acute hemorrhage .Distal branch of the right second lumbar was selected using 3 French micro- catheter.Embolization was performed using 4 3x30mm 0.018 coils with an excellent angiographic result.

    5 French catheter was used to access left third lumbar artery. Diagnostic angiogram of the left third lumbar showed acute hemorrhage .Distal branch of the left third lumbar was selected using 3 French micro- catheter.Embolization was performed using 3 3x30mm 0.018 coils with an excellent angiographic result.

    5 French catheter was used to access left fourth lumbar artery. Diagnostic angiogram of the left fourth lumbar showed acute hemorrhage .Distal branch of the left fourth lumbar was selected using 3 French micro- catheter.Embolization was performed using 3 3x30mm coils with an excellent angiographic result Post-embolization angiogram of fourth left lumbar shows no acute extravasation.

    Additional selective angiogram of left common iliac, right common iliac, thoracic aorta and left intercostal arteries shows no evidence of extravasation.

    Case was discussed with trauma team. R right groin arterial sheath was connected to a pressure bag an the patient was sent to SICU in satisfactory condition

    Impression :

    1/ Successful embolization off theleft L2, L3 L4 and R L2 arteries as described above.

    2 / No gross evidence of acute arterial extravasation from thoracic aorta or intercostal arteries.

  2. #2
    Join Date
    Apr 2007
    Posts
    16

    Default Second order catheterization - code 36246

    I'd code 36246-50 for Lt and Rt L2 branches selection; 36246-59 for Lt L3 branch and 36246-59 for Lt L4 branch.

  3. #3
    Join Date
    Apr 2007
    Location
    Birmingham, Alabama
    Posts
    886

    Default

    Quote Originally Posted by she803 View Post
    I received denial from billing dept that CPT 36245 was denied due to wrong modifier & Medicaid's requesting appropriate Modifier for CPT 36245--this claim was submitted as 36245--Mod 50 for 3 units. I seriously need help on this report. This is my first time coding for Interventional Radiology. This is the 3rd and last attempt as insurance will consider paying this claim being that it was submitted twice already. Someone please advise. Thank you again for your time and consideration. Greatly appreciate it! The report is as followed:

    Administrative/medical emergency consent was obtained/signed by trauma team. The patient was brought to the Angio suite from emergency room by trauma team and placed on angio table in supine position. Right groin was prepped and draped in the usual sterile fashion. 1% lidocaine was used as local anesthetic. Access was gained to right common femoral artery using single wall 18 gauge needle. 5 French vascular sheath was placed . Pigtail catheter abdominal aortogram failed to reveal contrast extravasation.
    Bilateral lumbar arteries where studied.
    5 French catheter was used to access left L2 artery. Diagnostic angiogram of theleft L2 showed acute hemorrhage .Distal branch of the left second lumbar artery was selected using 3 French micro- catheter.Embolization was performed using 4 3x30 mm 0.018 coils with an excellent angiographic result.
    5 French catheter was used to access right L2 artery. Diagnostic angiogram of the the right second lumbar showed acute hemorrhage .Distal branch of the right second lumbar was selected using 3 French micro- catheter.Embolization was performed using 4 3x30mm 0.018 coils with an excellent angiographic result.

    5 French catheter was used to access left third lumbar artery. Diagnostic angiogram of the left third lumbar showed acute hemorrhage .Distal branch of the left third lumbar was selected using 3 French micro- catheter.Embolization was performed using 3 3x30mm 0.018 coils with an excellent angiographic result.

    5 French catheter was used to access left fourth lumbar artery. Diagnostic angiogram of the left fourth lumbar showed acute hemorrhage .Distal branch of the left fourth lumbar was selected using 3 French micro- catheter.Embolization was performed using 3 3x30mm coils with an excellent angiographic result Post-embolization angiogram of fourth left lumbar shows no acute extravasation.

    Additional selective angiogram of left common iliac, right common iliac, thoracic aorta and left intercostal arteries shows no evidence of extravasation.

    Case was discussed with trauma team. R right groin arterial sheath was connected to a pressure bag an the patient was sent to SICU in satisfactory condition

    Impression :

    1/ Successful embolization off theleft L2, L3 L4 and R L2 arteries as described above.

    2 / No gross evidence of acute arterial extravasation from thoracic aorta or intercostal arteries.
    Your payer seems not to like modifier 50, you may ask if they prefer RT/LT, 59 or 76? Also, I see four selective catheter placements, all 2nd order (distal branches/36246), with angiographies, and the Embolization (37204/75894) for which I certainly hope you billed. My scenario would be:
    37204/75894-26, 75898-26
    36246 RT /75705-26
    36246 LT /75705-26,76
    36246 LT,76 /75705-26,76
    36246 LT,76 /75706-26,76

    HTH
    Danny L. Peoples
    CIRCC,CPC

  4. #4
    Join Date
    Apr 2007
    Posts
    93

    Default

    Thank you soooo very much! I truly appreciate your help! I thought the L2 was for 2nd order 36246 not the 36245 that they orginially billed--i just wasnt sure how to bill the remainig services--this procedure was done in 2010-- i just started this yr in radiology dept so i have to correct errors the previous coder made and interventional radiology is very challenging so i wasnt sure how to code this report...enjoy your holidays and thanks again!

  5. #5
    Join Date
    Apr 2007
    Location
    Dallas, GA
    Posts
    207

    Default

    When we bill Medicaid they do not accept any modifiers other than a 26.

    This is how I would submit the claim:

    37204
    75894-26
    75898-26
    36246 x 4 units
    75705 -26 – x 3 units
    75706-26

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