292016Sep

AV Access Procedures

September 29, 2016 Question: I am continually confused by the AV access codes, in particular, the percutaneous codes. I have one specific question. Does code 36147 include all imaging, venous and arterial? Answer: Yes, the entire range of venous access codes are very confusing and complex! Code 36147 is an all-inclusive code and includes all…

152016Sep

Is It Co-surgery or Not?

September 15, 2016 Question: I was asked by a urologist to clear a vena cava thrombus during his patient’s nephrectomy for a malignancy. I was able to dissect the malignancy from the vena cava without any reconstruction. I think I should bill for my work separately from the urologist. My coders disagree. How is this…

12016Sep

New Patients and NPs

September 1, 2016 Question: Our office-based NP usually sees established patients with established problems, and the supervising physician is onsite. What should we do if the NP sees a new patient or a returning patient has a new problem? Answer: The practice has two options. First, the NP could simply bill that visit using the…

162016Aug

Reimbursement: Co-surgery

August 18, 2016 Question: What is the reimbursement for co-surgery? Is it different for the primary and co-surgeon? Answer: For Medicare, co-surgery requires two different specialties performing separate parts of a single CPT code. For both surgeons, a 62 modifier is appended to the appropriate CPT code(s). Medicare multiples the allowable fee by 125% and…

42016Aug

Vena Cava Coding

August 4, 2016 Question: While placing a vena cava filter, the physician documented a venogram and intravascular ultrasound. Can these imaging procedures be reported separately? Answer: No, vena cava filter placement, 37191, is an all inclusive code that includes all imaging including a venogram and intravascular ultrasound (IVUS) codes, 37252 and 37253. Vena cava filter…

202016Jul

New vs. Established Patient

July 21, 2016 Question: If I see a new patient and during that visit I identify the need for surgery the same day, can I append a Modifier 57 to the E/M service and get paid? Answer: You determine during the evaluation that the patient would need surgery the same or next day for a…

62016Jul

Vena Cava Coding

July 7, 2016 Question: While placing a vena cava filter, the physician documented a venogram and intravascular ultrasound. Can these imaging procedures be reported separately? Answer: No, vena cava filter placement, 37191, is an all inclusive code that includes all imaging including a venogram and intravascular ultrasound (IVUS) codes, 37252 and 37253. Vena cava filter…

232016Jun

Source for a Consult

June 23, 2016 Question: What is an appropriate “source” for a consult? I asked at a recent workshop and the instructors did not have an answer. Answer: The guidelines for a consultation (inpatient or outpatient) must be requested by a physician, or qualified non-physician practitioner. Guidelines are not clear regarding individuals who may be considered…

92016Jun

Coding Modifier 57 with E/M Visits

June 9, 2016 Question: If I see a patient and during an E/M visit where I identify the need for surgery the same day, can I append a Modifier 57 to the E/M service and get paid for that E/M service? Answer: Yes, if you determine during the evaluation that the patient requires surgery the…

262016May

Using Modifier 57

May 26, 2016 Question: I saw a patient on a Friday and scheduled surgery for that Monday. Do I need a 57 modifier on the E/M I did on Friday? Answer: No. The 57 modifier is required on an E/M code that is the decision for surgery visit if it occurs the day of or…

122016May

Minor vs. Major Procedure

May 12, 2016 Question: What is the difference between a minor and major procedure? Answer: A minor procedure is defined as one with a zero or 10 day global period.  For example, debridement has a zero day global period, and excision of a benign skin lesion has a 10 day global period.  A major procedure…

262016Apr

Coding Ultrasound – Guided Sclerotherapy

April 28, 2016 Question: I performed an ultrasound guided sclerotherapy. What ultrasound code should be used to reflect the guidance? Answer: Codes 36470 and 36471, Injection of sclerosing solution, may be reported with code 76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation. Remember that ultrasound guidance procedures…

132016Apr

Code 37202 – Deleted!

April 14, 2016 Question: What happened to code 37202 for non-thrombolytic infusions? Answer: The code for transcatheter therapy, infusion other than thrombolysis; any type (37202) has been deleted, along with its paired radiological supervision and interpretation code for guidance (75896). Peripheral injection of a non-thrombolytic drug, verapamil for example, is considered inclusive to the primary…

312016Mar

Revising an Upper Extremity Bypass

March 31, 2016 Question: What codes are used for revision of an upper extremity bypass graft? Answer: Use an unlisted code as there are no existing CPT codes for revision of an upper extremity bypass graft. *This response is based on the best information available as of 03/31/16.

172016Mar

Venous Stents – Are they Coded by Vascular Territory?

March 17, 2016 Question: I understand that arterial stenting in the lower extremities is coded based on vascular territory; the iliac, fem-pop and tibial-peroneal territories. Do these same territories apply for venous stenting in the lower extremities? Answer: Good question. These relatively new codes (established in 2014) do not follow the vascular territories as described…

32016Mar

Coding Venous Thrombectomy

March 3, 2016 Question: If a percutaneous thrombectomy is performed in more than one vein, can each one be reported separately? Answer: As described by CPT, percutaneous transluminar mechanical thrombectomy (37187) is reported once per session, regardless of the number of veins treated. The code specifies “vein(s)” which means any number of veins treated is…

22016Feb

New IVUS Codes 2016!!

February 2, 2016 Question: I heard the intravascular ultrasound IVUS codes have been changed for 2016. What specific changes were made? Answer: The IVUS codes, 37250 and the add–on code 37251 were deleted and replaced by codes 37252 and the add-on code 37253. The biggest change is that the radiological guidance codes, previously separately billable,…

142016Jan

Visceral Angiograms

January 14, 2016 Question: Does visceral angiogram code 75726 include any number of visceral vessels studied? Answer: Code 75726, Angiography, visceral, selective or super selective (with or without flush aortogram) is reported per visceral vessel selectively catheterized and studied.  Each artery, (for example, the superior mesenteric) must be selectively catheterized and the interpretation for each…

172015Dec

Finding Medicare Reimbursement Amounts

December 17, 2015 Question: Where can I find Medicare reimbursement amounts for the procedures I do? Answer: The Centers for Medicare and Medicaid Services (CMS) provides a means of computing Medicare reimbursement amounts for individual CPT codes on its website through the Medicare Physician Fee Schedule. To access the Medicare Physician Fee Schedule on the…

32015Dec

Coding AV Access Complications

12/03/15 Question: Is an angioplasty of an AV shunt for stenosis always coded as venous? Answer: The AV shunt is considered to be venous and most interventions are coded as venous. So an angioplasty would be coded as 35476 and 75978 for radiological supervision and interpretation. The exception to this is if the stenosis is…

302015Jul

Merging Practice and Patients

Question: We recently had a surgeon merge his practice with ours. Can I bill his patients as new (99201-99205) when they are seeing the same physician but he has joined/merged with our practice? We will be billing using our tax ID/NPI number. They have seen him previously under his old tax ID/NPI. Answer: Even under…

162015Jul

Embolizing the Internal Iliac During an EVAR

Question: During an EVAR I embolized the internal iliac. Can I code separately for that? Answer: Yes. The internal iliac is outside the target zone of the endograft, so an intervention in that vessel may be reported separately. You would bill 37242-59 for the embolization. If the catheterization of the internal iliac is also documented,…

22015Jul

Revisions of Upper Arm Bypass

Question: How do I report a revision of an upper arm bypass? Answer: Unfortunately, there is no CPT code for an upper arm bypass revision. An unlisted code is used for this procedure. To set your fee, use the lower extremity revision code for comparison purposes.

112015Jun

Medicare Coverage Policies for Vascular Surgeons

Question: My coder mentioned following an “LCD”. What is an LCD and how does it apply to vascular surgery? Answer: LCD is an acronym for Local Coverage Decision (or Determination). An LCD outlines Medicare’s coverage policy for a specific procedure or service. Most Medicare carriers have an LCD for varicose vein surgery, non-invasive imaging, wound…

212015May

Medicare Elimination of Global Periods

Question: I’ve heard that Medicare will be eliminating the global period and soon I can bill for post-op visits. Is this true? Answer: In the calendar year 2015, Medicare Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Services (CMS) proposed an elimination of the zero day global period in 2017 and the…

72015May

AV Graft Coding

Question: In order to treat occlusion of an AV graft, I had to angioplasty both the venous portion and the arterial anastomosis. Can I report both 35475 for the arterial angioplasty and 35476 for the venous angioplasty? Answer: CPT rules specify that only one angioplasty may be reported for the AV circuit portion of the…

232015Apr

Coding Kissing Stents

Question: I placed stents in the right and left common iliac arteries. I also did angioplasties of both vessels. Do I bill this as one stent and angioplasty or two?? And do I use the add-on code for the second side? Answer: Kissing stents, stents placed in bilateral common iliacs, are coded as two stents,…

262015Mar

Carotid Stenting and Diagnostic Angiograms

Question: I was told that no diagnostic angiogram can be billed with a carotid stent. Is this true? Answer: Not exactly! Any carotid angiograms on the ipsilateral (same) side are included in a carotid stent procedure. Medically necessary diagnostic carotid stenting on the contralateral side and vertebral angiography on either side are separately reportable.

122015Mar

Carotid Stenting without Embolic Protection

Question: I did a carotid stent but was unable to deploy the embolic protection device. Carotid stent placement was successful with no complications. Since I attempted placement, can I still code 37215? Answer: No, if embolic protection cannot be deployed, 37216 must be reported. Unfortunately, Medicare does not reimburse for a carotid stent without embolic…

262015Feb

Carotid Stenting

Question: Is catheterization separately reported with placement of a carotid stent? Answer: No, all carotid stents codes (the traditional carotid stent codes 37215/37216 and the newer codes, 37217 and 37218) include catheterization of the carotid system on the same side as the stent procedure.

222015Jan

Colectomy Coding

Question: A general surgeon asked me to assist in a colectomy where he had inadvertently nicked a mesenteric artery. I entered the case and did a direct repair of the artery. Should I bill as his assistant or co-surgeon and what modifier should I use? Answer: In this case, you would not bill as an…

82015Jan

Weekend Rounding

Question: I have question regarding weekend rounding. I share weekend call with another practice that I am not affiliated with. Sometimes, when rounding, I check on 5-10 of their post–op patients. Since I am not part of their practice, is this something I can bill for? If so, should I bill a consult or a…

232014Dec

Modifiers and AV Access Revisions – 78 or 79?

Question: We have read conflicting recommendations for which modifier to report with an AV graft revision. Some say use the 79 modifier and some say 78. Which is the correct modifier? Answer: Problems that occur with an AV graft in the 90 day global period, stenosis, clots, etc., are complications of the AV graft creation…

132014Nov

Denials for Assistant Surgeon: What Can We Do?

Question: We have been seeing some denials for the assistant surgeon, and the payor is saying the assistant’s role wasn’t documented. Does that mean the assistant needs to write an operative note? Answer: Thank you for your question! No, the assistant does not need to write his/her own operative note. However, the primary surgeon must…

162014Oct

SMA Stent – What else can I bill?

Question: I placed a stent in the superior mesenteric artery. Someone told me this stent code is now bundled. What does that mean? Answer: The CPT code for an arterial stent placed in the superior mesenteric artery is reported as 37236. This code was newly defined in 2014, replacing the prior stent code 37205. While…

22014Oct

Stenosis of an AV Graft

Question: When treating stenosis of an AV graft with a stent, do I code an arterial or venous stent? Answer: Per CPT, the AV graft is considered to be venous and most interventions are coded with the venous intervention codes – in this case, 37238 for stent. The exception is if the stenosis is at…

182014Sep

Transcatheter Carotid Stent

Question: I know Medicare has criteria for when a transcatheter carotid stent is medically covered (paid). We are having a debate regarding whether the criteria related to the percent of arterial occlusion is 70% or 80%. Can you help? Answer: In regards to extent of vessel occlusion, Medicare’s current criteria require a 70% occlusion, evidenced…

212014Aug

Catheterization Coding

Question: Can catheterization be reported separately with the new embolization codes? Answer: Yes, the new embolization codes (37241-37244) revised in 2014 exclude catheterization codes. These may be separately billed. However, the new codes do bundle the guidance and follow-up radiologic supervision codes (previously 75894/75898), but do not include diagnostic angiography when appropriately performed.

72014Aug

Arch Angiogram Billing

Question: How do I bill for an arch angiogram during a cervical carotid angiogram? Answer: An arch angiogram (36221) performed at the same time as a cervical carotid angiogram (36222) is bundled into the cervical study. This bundling occurred when the radiology codes (the 70000 series of cerebral angiogram codes) were deleted in 2013 and…

242014Jul

Thrombectomy and Follow-Up Angiogram Coding

Question: We billed percutaneous thrombectomy (37184) for extraction of a clot and an associated completion angiogram (75898). Payors keep denying the angiogram. Is there a way to get this paid? Answer: Per CPT, percutaneous thrombectomy, 37184, includes all fluoroscopic guidance, including completion angiograms. Therefore, 75898 should not be separately reported.

262014Jun

New Stent Codes 2014: Are They Bundled?

Question: I heard the stent code 37205 has been deleted in 2014 and that the new codes are bundled. Can you explain the new codes? Answer: You are correct; the non-lower extremity stent codes (37205 and +37206 transcatheter) and 37207 (open) have been deleted in 2014. They have been replaced with 4 new codes: 2…

122014Jun

+36148 – When Can It Be Billed??

Question: For an occluded AV graft, I made one puncture to shoot contrast and evaluate a problem with the graft and billed 36147. When can the add-on code +36148 be used in addition to 36147? Answer: The CPT states the 36148 is used for “additional access for therapeutic intervention.” Therefore, the purpose of that second…

292014May

FEVAR? What Is It?

Question: My doctor is doing a FEVAR procedure. What exactly is a FEVAR? Answer: FEVAR, or fenestrated endovascular aortic aneurysm repair, is an endovascular approach to the repair of an abdominal aneurysm that involves the upper abdominal or visceral aorta. This mid portion of the aorta contains the celiac, superior mesenteric and renal arteries. FEVAR…

12014May

Thrombolytic Infusion Coding: Can I Bill for Each Day?

Question: The thrombolytic infusion code, 37211, has a 0 day global period. Does that mean if I have an infusion that continues into a second day I should report 37211 again on day 2? Answer: The thrombolytic infusion code, 37211, Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological…

62014Mar

Billing Carotid Stent Without Embolic Protection

Question: During angioplasty and stent placement of the carotid artery, I was unable to deploy the embolic protection device even though it was my intent to do so. Can I bill 37215, carotid stent with embolic protection with a 52 modifier? Medicare will not pay for the carotid stent code without embolic protection. Answer: You…

202014Feb

Cerebral Angiograms and Modifier 26

Question: The prior cerebral angiogram codes in the 70000 series of CPT codes required a 26 modifier. Do we append a 26 modifier to the new codes? Answer: The new cervicocerebral angiogram codes are now surgical codes in the 30000 series of CPT codes, not radiology codes. Therefore, they do not require a 26 modifier…

62014Feb

Help! Denial of Stent Codes for Treating AV Graft Stenosis.

Question: We recently had several denials for placing a stent in an AV graft for graft stenosis. We billed 37205 and the radiology code. Both were denied. Can you help? Answer: The stent codes (for stents other than lower extremity, cervical carotid, extracranial vertebral or intrathoracic, intracranial, or coronary) were totally revised effective in January…

232014Jan

Denials for Cervicocerebral Codes!

Question: Several payors are denying certain cervicocerebral codes when appropriately billed together. For example, an internal carotid angiogram (36224) and a vertebral angiogram (36225). I know these are correctly reported together, so what do I do with these denials? Answer: We see denials for this accurate code combination from many payors. Appeal this denial, attach…

122013Dec

Bundling Hits Vascular Coding Again!

Question: I’ve heard more vascular codes will be bundled in 2014. Is this true and which codes! Answer: Unfortunately, the trend of bundling endovascular codes has continued for 2014. Transcatheter stent placement (except coronary, cervical carotid, lower extremity, intracranial and extracranial vertebral or carotid) will be bundled beginning January 1, 2014. This category of stent…

142013Nov

Cerebral Angiograms and Modifier 26

Question: The prior cerebral angiogram codes in the 70000 series of CPT codes required a 26 modifier. Do we append a 26 modifier to the new codes? Answer: The new cervicocerebral angiogram codes are now surgical codes in the 30000 series of CPT codes, not radiology codes. Therefore they do not require a 26 modifier…

312013Oct

Billing An Arch Angiogram and Cerebral Angiograms

Question: How do I bill for bilateral internal carotid angiograms (from an internal carotid catheter position) and an arch angiogram? Answer: The new cervicocerebral angiogram codes, both the carotid codes (36222-36224) and the vertebral codes (36225-36226), include and arch angiogram ( 36221). The only time an arch angiogram is reported is when it’s performed without…

172013Oct

A 6 Vessel Cerebral Angiogram: How Is It Coded?

Question: My doctor dictates “6 vessel cerebral angiogram” and the documentation describes catheterization of right and left internal carotid, right and left external carotids, and right and left vertebrals and imaging form each catheter position. How is this coded under the new codes? Answer: Based on CPT 2013 cervicocerebral imaging guidelines this would be reported…

32013Oct

Ligation of Perforators. Which Code Should I Use?

Question: I notice there are two CPT codes for ligation of perforators. I have always used 37760 but now I see there is also, 37761 also for perforator ligation. What’s the difference? Answer: 37760, ligation of perforator vein(s) subfascial, radical, is specifically for a Linton procedure, which includes a large linear medial leg incision. 37661,…

222013Aug

Intra-operative Duplex Studies. Are They Billable?

Question: After a fem-pop bypass or a carotid endarterectomy, I always do an intra-operative duplex to evaluate vessel patency. Can I report my supervision and interpretation of that duplex study? Answer: No, assessing success of an open procedure, i.e., evaluating vessel patency, whether the procedure is a bypass, endarterectomy, etc, is part of the procedure…

252013Jul

Called To the OR to Repair an Artery. What Do I Bill?

Question: I was recently called to the OR to repair an artery that was inadvertently knicked during abdominal surgery. I repaired the artery. Do I bill this as a co-surgeon to the general surgeon? Answer: No, you will report the codes for the procedure(s) that you performed, for example repair blood vessel, intra-abdominal, direct (35221),…

272013Jun

Thrombolysis Coding 2013

Question: For the new 2013 thrombolysis codes, on the final day of therapy, can both 37211, arterial infusion for thrombolysis, and 37214, cessation of therapy, be reported? Answer: No, per CPT, codes 37211-37214 are reported once per date of treatment. On the final day of treatment, when the catheter is removed, the catheter removal and…

132013Jun

Thrombolysis Coding 2013

Question: I am confused on the new thrombolysis codes. What is included in 37211? Answer: 37211, which replaced the deleted code 37201, is for the initial day of thrombolytic therapy. Per CPT this code includes the infusion itself, all radiological supervision and interpretation (initial and any follow-up imaging on that same day) and any catheter…

302013May

Central Line Placement Imaging. What’s Reportable?

Question: I inserted a central line and used both ultrasound and fluoroscopic guidance for placement. Can I report this? Answer: Per CPT Assistant, January 2011, if you do both, document each and keep a permanent image of both, you may report both 76937 (ultrasound guidance for vascular access) for the ultrasound imaging and 77001 (fluoroscopic…

22013May

Carotid – Subclavian Bypass Before a TEVAR

Question: I performed a carotid-subclavian bypass with vein in preparation for TEVA that was then performed on a subsequent day. How are these two procedures reported? Answer: The carotid-subclavian bypass is reported with 35606 as the first stage of this two stage procedure. Since this has a 90 day global and the TEVAR is preformed…

92013Apr

Coding For A DRIL Procedure

Question: My surgeon documented that he did a DRIL procedure. I have never heard of that. What is it and how is it coded? Answer: A DRIL procedure is a distal revascularization and internal ligation (DRIL) of the upper extremity and is performed to correct “steal syndrome.” Steal syndrome is a complication of an AV…

72013Mar

Diagnostic Angiograms and EVAR

Question: I billed a diagnostic aortogram with an EVAR, but the diagnostic study was denied. Should I appeal? It was well documented. Answer: Per CPT, any diagnostic imaging of the aorta and its branches prior to the deployment of the endovascular device is included in 75952, the guidance imaging code for EVAR. Therefore a diagnostic…

212013Feb

Catheterization and EVAR

Question: How do you report two catheters placed in the aorta from bilateral femoral open exposures in an EVAR? Answer: If catheters are advanced into the aorta through bilateral femoral exposures, 36200-50 would be reported.

242013Jan

New vs Established Patient

Question: One of my vascular surgeon partners does only endovascular procedures. If I see a patient for a possible by fem-pop bypass, 2 years after he did a carotid stent, is this a new patient visit? Answer: No, this is an established visit. Since you are both vascular surgeons, any patient seen by the same…

102013Jan

Coding Consultations in the ER

Question: Since Medicare doesn’t recognize consultations any longer, what do I report when I am called to the ER to evaluate a trauma patient? The patient was admitted by another service and did not need any vascular intervention. Answer: According of Medicare rules, this scenario would be reported with an ER visit code, 99281-99285. For…

272012Dec

Carotid Stenting and Diagnostic Angiograms

Question: If a diagnostic angiogram is performed of the cervical carotids during the same session as carotid stenting, can the angiogram be reported? No prior angiogram was available. Answer: The carotid stenting codes (37215 and 37216) include all ipsilateral cervical and cerebral carotid angiography, so these may not be separately reported.

292012Nov

Embolectomy With A Bypass

Question: I did a popliteal embolectomy and a fem-pop bypass with vein. Can I report both the bypass and the embolectomy? Answer: CPT states “Primary vascular procedures include establishing inflow and outflow by whatever procedures necessary”. Since the popliteal vessel is the outflow vessel, any procedure performed in that vessel; endarterectomy or embolectomy are included…

152012Nov

Reporting Extensions with TEVAR: Part 2

Question: When placing an endovascular thoracic endograft for a thoracic aneurysm, a proximal extension was placed. This extension covered the left subclavian artery. Do I report the TEVAR code 33880, for an endograft covering the left subclavian and the extension? Or do I report the TEVAR code 38811 for an endograft not covering the left…

12012Nov

Reporting Extensions with TEVAR: Part 1

Question: When placing an endovascular thoracic endograft for a thoracic aneurysm, a proximal extension was placed. Is this separately billable and if so how is it coded? Answer: TEVAR, endovascular repair of a descending thoracic aorta, is reported with either 33880, for an endograft covering the left subclavian artery or 33881 for endograft covering the…

182012Oct

Billing Renal Angiograms with Aortogram

Question: I performed a renal angiogram and an aortogram. Can I bill both? Answer: The new renal angiogram codes (36251-36245), revised in 2012, as with the prior renal angiogram codes, include a flush aortogram. Therefore, only the renal angiogram may be billed if both are performed.

42012Oct

Assistant Surgeon Billing

Question: I’ve recently been advised by another consultant to bill for both the primary surgeon and surgical assistant on the same claim form. That didn’t seem right to me. What do you think? Answer: We do not advise you to bill for two different providers on the same claim form. The services performed by two…

62012Sep

Lower Extremity Revascularization Codes

Question: The guidelines for the new lower extremity revascularization codes (angioplasty, stent, atherectomy) state that they include all radiological supervision and interpretation directly related to the intervention. Does that include diagnostic studies? Answer: No, diagnostic studies are separately reportable as long as all coding rules for reporting diagnostic studies have been followed. (See last month’s…

232012Aug

Diagnostic Angiograms

Question: I heard at a seminar that diagnostic angiograms performed at the same operative session as a stent or angioplasty can never be billed. Is that true? Answer: No that is not exactly true. According to CPT, diagnostic angiograms performed at the time of an interventional procedure may be separately reported if: No prior catheter-based…

92012Aug

Iliac Atherectomy

Question: If a common iliac atherectomy is performed and a stent is placed in the same vessel can both be billed? What about the catheterization and radiological supervision and interpretation? Answer: As of 2011, supra-inguinal arthrectomies (which include all iliac vessels) are reported with Category III codes. These codes specifically state that other interventions in…

262012Jul

Medicare Auditors – Is My Practice at Risk?

Question: We’re hearing a lot about ZPICs and their focus on vascular practices. What is a ZPIC? Answer: ZPIC stands for Zone Program Integrity Contractors. ZPICs are private companies under contract to Medicare to identify areas of program fraud and abuse and to facilitate payment recoupment of misspent funds to Medicare. The focus of ZPIC…

282012Jun

Medical Necessity Audit

Question: Our Medicare carrier has asked for several patient records from our vein center. They say they are conducting a medical necessity audit. What does that mean? Answer: Most Medicare carriers have a written coverage policy, referred to as a local carrier determination or LCD, that delineates the signs, symptoms, ultrasound findings and more, that…

142012Jun

Debrided Ulcers

Question: I have a patient on whom I debrided ulcers on both his heels. The right ulcer was 4 sq cm and the left one was 5 sq cm. I debrided down to the level of bone on both heels. Do I code 11044 twice with a 50 modifier or a 59 modifier? Answer: The…

312012May

Endoscopic Vein Surgery

Question: How is endoscopic ligation of perforator veins, subfascial, reported? Answer: This is reported as 37500, vascular endoscopy, surgical, with ligation of perforator veins, subfascial. Remember, surgical endoscopy always includes diagnostic endoscopy.

172012May

Bilateral Stent Placement: How is it Coded?

Question: Under the new lower extremity revascularization guidelines, if I place stents in the left and right external iliac arteries is this reported as a primary and add-on code? Answer: Under the new lower extremity revascularization guidelines, bilateral stents in the left and right external iliac arteries would be reported as two primary codes, 37221…

32012May

Reporting Selective with Non-Selective Catheterization

Question: If I catheterize the aorta from a left common femoral access, perform an aortogram and then move the catheter to the right superficial femoral artery, can I bill 36200 and 36247? Answer: Non-selective catheterizations are always bundled once the catheter (from the same access) moves to a more selective vessel. In your scenario, only…

292012Mar

Femoral Artery Stenting

Question: I understand that the new lower extremity codes are by vascular territory and the femoral and popliteal arteries are now considered a single territory. But what if I do an angioplasty in the popliteal artery and a stent in the common femoral. Can I report both the angioplasty and the stent? Answer: The lower…

152012Mar

Carotid Angioplasty Without Stenting

Question: I know that carotid stenting with embolic protection is coded as 37215. But how would you code for a carotid angioplasty without stenting? Answer: A percutaneous carotid angioplasty is reported as 35475, transluminal angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel. The associated radiological supervision and interpretation code, 75964 should also be reported in…

12012Mar

Bundled IVC Filter Codes: 2012

Question: I noticed that the code of placement of an inferior vena cava (IVC), 37620, has been deleted in the CPT 2012 manual. How do we code for this in 2012? Answer: CPT 2012 has developed three new percutaneous codes for the placement, repositioning and removal of IVC filters. 37620, the code used previously for…

162012Feb

Coding Renal Angiography: 2012 Changes

Question: The renal angiography codes are no longer in the 2012 CPT book. What happened? Answer: Per CPT 2012, the renal angiography codes have been bundled with the associated renal catheterization codes. Prior to 2012, renal angiography was reported as 75722 for unilateral and 75724 for bilateral. Catheterization codes were separately reported. The 2012 bundled…

262012Jan

Thrombectomy and Follow-up Angiogram Coding

Question: We billed percutaneous thrombectomy (37184) for an intracranial clot and an associated completion angiogram (75898) but payers keep denying the angiogram. Is there a way to get this paid? Answer: Per CPT rules, percutaneous thrombectomy, 37184, includes all fluoroscopic guidance, including completion angiograms. Therefore, 75898 should not be separately reported. CPT Changes: An Insider’s…

262012Jan

Reporting Non-Thrombolytic Infusions

Question: Is it appropriate to bill 37202 and 75896 for injecting verapamil to treat vasospasm during an aneurysm coiling? Answer: 37202 and its paired radiological supervision and interpretation code, 75896, are reported for a continuous infusion of non-thrombolytic drug such as verapamil. The code is specifically for a continuous infusion. A bolus injection or “push”…