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Medicaid denied dx 584.6 for cpt 76937 as inappropriate

  1. #1
    Question Medicaid denied dx 584.6 for cpt 76937 as inappropriate
    Medical Coding Books
    The following report below has been billed as cpt 36556, 77001-26, 76937-26; However Mediciad denied cpt 76937 w/ inappropriate dx code?? I was wondering what other code is to be used for this report? I dont think is V45.11? Thank you in advance...

    History: 55-year-old male requiring short-term dialysis needs access.

    Procedure: Consent for Shiley catheter placement was obtained. Patient was placed under fluoroscopic table and supine position. Technique was prepped and draped in sterile fashion. 1% lidocaine was used as prosthetic.

    Under sonographic guidance using 17-gauge needle regular vein was accessed. Over the Amplatz wire of the dilatation 16 cm long 11.5 French nonthrombosis catheter was uneventfully place with the tip in the right atrium. It was secured to skin is a suture. Senescent was applied. The catheter was flushed with saline low dose heparin. There were no complications.

    Impression: Uneventful sonographic and fluoroscopic guided placement of the right jugular vein 11.5 French 16 cm long bone tunnel dialysis catheter.

  2. #2
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    Quote Originally Posted by she803 View Post
    The following report below has been billed as cpt 36556, 77001-26, 76937-26; However Mediciad denied cpt 76937 w/ inappropriate dx code?? I was wondering what other code is to be used for this report? I dont think is V45.11? Thank you in advance...

    History: 55-year-old male requiring short-term dialysis needs access.

    Procedure: Consent for Shiley catheter placement was obtained. Patient was placed under fluoroscopic table and supine position. Technique was prepped and draped in sterile fashion. 1% lidocaine was used as prosthetic.

    Under sonographic guidance using 17-gauge needle regular vein was accessed. Over the Amplatz wire of the dilatation 16 cm long 11.5 French nonthrombosis catheter was uneventfully place with the tip in the right atrium. It was secured to skin is a suture. Senescent was applied. The catheter was flushed with saline low dose heparin. There were no complications.

    Impression: Uneventful sonographic and fluoroscopic guided placement of the right jugular vein 11.5 French 16 cm long bone tunnel dialysis catheter.
    There is no comment of patiency of the vein that was cannulated (which was?), and no comment of a hard copy image placed into the chart or a imaged sent to PACS.
    HTH,
    Jim Pawloski, CIRCC

  3. #3
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    So what should the diagnosis be? That's what I'm asking. Thanks...

  4. #4
    Location
    Columbia, MO
    Posts
    12,844
    Default
    Quote Originally Posted by she803 View Post
    So what should the diagnosis be? That's what I'm asking. Thanks...
    The diagnosis HAS TO BE the one documented by the provider in the medical record. Sorry but it really is no better than that.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Alexandria, LA
    Posts
    518
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    Quote Originally Posted by she803 View Post
    So what should the diagnosis be? That's what I'm asking. Thanks...
    if this was denied for diagnosis then your medicaid apparently has a policy and you will need to check that for their guidelines. What jim was saying is that based on this documentation 76937 shouldn't be billed at all -regardless of DC

  6. #6
    Default
    Ok thank you...now i understand. However, how should I code this report based on this documentation? Thats what I'm pretty much stumped on...

  7. #7
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    Quote Originally Posted by she803 View Post
    Ok thank you...now i understand. However, how should I code this report based on this documentation? Thats what I'm pretty much stumped on...
    36556 and 77001

    HTH,
    Jim Pawloski, CIRCC

  8. #8
    Default
    Thank you but those two codes 36556 and 77001 were already billed. I'm asking for the diagnosis. That was my primary question...what diagnosis should I code for the history of this report:

    History: 55-year-old male requiring short-term dialysis needs access.

  9. #9
    Location
    Alexandria, LA
    Posts
    518
    Default
    Ok, I think we need to step back and start over.

    You originally said that codes 36556, 77001-26, 76937-26 had been coded, but that 76937-26 had been denied because of the diagnosis code and what diagnosis code should you use instead of 584.6.

    Based on the report you gave, 76937-26 should not be coded - so you don't need a diagnosis code for that. I personally would not have coded 77001 either since there is no evidence of radiographic documentation of tip.

    If 36556 was also denied and you need a diagnosis for that, did you check your state Medicaid website for policies regarding dialysis patients and central venous catheters? They may want V58.81 or V56.1, although 584.6 should be appropriate for that (assuming that the dx is correct for the patient's condition!).

  10. #10
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    Where can i find info on NJ medicaid site? I was googling for days and even on different pages of the actual medicaid site and cant seem to find that info...

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