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Medicaid needs additional dx for 76937 in this report?

  1. #1
    Question Medicaid needs additional dx for 76937 in this report?
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    I received denial from Medicaid of cpt 76937-26 for dx 453.42. Reviewing this report I see dx 453.40 instead 453.42 but what about dx for status post hip arthroplasty? Thank you in advance for your assistance

    Clinical Indication: 52-year-old man status post hip arthroplasty with a left lower extremity DVT. Patient is not tolerating Coumadin. An IVC filter placement is requested.

    Procedure: IVC-gram and IVC filter placement, June 1, 2010

    After informed consent was obtained, the patient was brought to the angiography suite and placed supine on the angiography table. Ultrasound of the right neck was performed. The right internal jugular vein is patent.

    The right neck was widely prepped and draped in usual sterile fashion. Physiologic monitoring was used throughout the procedure.

    1% lidocaine was used as local anesthesia. Real-time ultrasound guidance was used to puncture the right internal jugular vein using micropuncture technique. Over a guidewire, which was placed within the inferior vena cava, a 5 French pigtail catheter was placed. A power injection of low osmolar contrast during digital subtraction imaging was performed as an IVC-gram. Over a guidewire the catheter was exchanged for the 7 French Cook Gunther tulip introducer sheath. The Cook Gunther tulip filter was placed in the infrarenal IVC. A hand-injection of contrast demonstrates placement.

    The catheter was removed and hemostasis was achieved with manual compression. The patient tolerated the procedure and left the angiography suite in stable condition.

    Findings:

    The inferior vena cava is of normal caliber without filling or contour defect.

    The IVC filter is noted in place within the IVC just inferior of the inferior-most renal vein.

    Summary:

    Placement of a Cook Gunther tulip IVC filter in infrarenal IVC.

  2. #2
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    Quote Originally Posted by she803 View Post
    I received denial from Medicaid of cpt 76937-26 for dx 453.42. Reviewing this report I see dx 453.40 instead 453.42 but what about dx for status post hip arthroplasty? Thank you in advance for your assistance

    Clinical Indication: 52-year-old man status post hip arthroplasty with a left lower extremity DVT. Patient is not tolerating Coumadin. An IVC filter placement is requested.

    Procedure: IVC-gram and IVC filter placement, June 1, 2010

    After informed consent was obtained, the patient was brought to the angiography suite and placed supine on the angiography table. Ultrasound of the right neck was performed. The right internal jugular vein is patent.

    The right neck was widely prepped and draped in usual sterile fashion. Physiologic monitoring was used throughout the procedure.

    1% lidocaine was used as local anesthesia. Real-time ultrasound guidance was used to puncture the right internal jugular vein using micropuncture technique. Over a guidewire, which was placed within the inferior vena cava, a 5 French pigtail catheter was placed. A power injection of low osmolar contrast during digital subtraction imaging was performed as an IVC-gram. Over a guidewire the catheter was exchanged for the 7 French Cook Gunther tulip introducer sheath. The Cook Gunther tulip filter was placed in the infrarenal IVC. A hand-injection of contrast demonstrates placement.

    The catheter was removed and hemostasis was achieved with manual compression. The patient tolerated the procedure and left the angiography suite in stable condition.

    Findings:

    The inferior vena cava is of normal caliber without filling or contour defect.

    The IVC filter is noted in place within the IVC just inferior of the inferior-most renal vein.

    Summary:

    Placement of a Cook Gunther tulip IVC filter in infrarenal IVC.

    76937 is an add-on code that requires a primary code. Be sure code code a primary code such as 36010.

    I do not know why it would be rejected based on ICD9 453.42 or 453.40 Either of those codes establish medical necessity better than V43.64

    HTH
    Danny L. Peoples
    CIRCC,CPC

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