Leorah Posted Mon 16th of March, 2020 10:39:35 AM
Looking at the Crosswalks Tool for CPT Code 76377, I did not see any ICD-10 codes appropriate for coding 76377 concurrently with a diagnostic angiogram or aneurysm embolization procedure. When CPT codes 36221 through 36228 was first introduced in 2013 according to CPT changes issued by the AMA 76377 was an approved reportable code when used during catheterization CPT codes 36221-36228, and it was a necessary and essential component of the endovascular management and of diagnosis complex lesions and management and diagnosis of cerebral aneurysms. We recently noticed that Medicare is no longer paying for 76377 when we code the usual ICD-10 codes which we had in the past year for justification of these procedures. We also noticed in Supercoder that when searching the crosswalks in Supercoder there are no longer ICD 10 codes matched for 76377 that begin with an "I". Is the Supercoder crosswalk tool just a sampling of ICD codes and as such an incomplete list of the possible diagnosis that may be reported to prove medical necessity? Looking at the NCD and LCD restriction for 76377, I used to be able to code I63.9, if not what are the ICD 10 codes that can be used to conjunctively report 76377 when performed out of medical necessity during diagnostic angiograms of the cervicocerebral arteries and during cerebral embolizations?
SuperCoder Answered Tue 17th of March, 2020 08:26:00 AM
Your observation is right. We have checked the Medicare list of ICD-10-CM codes mapped with CPT 76377. There is no mapping of ICD-10-CM I63.9 with CPT 76377 in any of the Medicare LCD policy/Article. However, there are many codes with alphabet “I”. What we show on the crosswalk tool are the commonly used and/or reimbursed diagnosis codes on the global basis, but not on the basis of state specific or LCD/Articles. So, you can use the diagnosis codes with the procedure code which are not in the crosswalk list when there is medical necessity. We will be adding the appropriate diagnosis codes begin with an "I" to the CPT 76377. Meanwhile you can use the diagnostic angiograms of the cervico-cerebral arteries and during cerebral embolization wen there is medical necessity.
Hope this helps!
Leorah Posted Tue 17th of March, 2020 17:26:17 PM
In that case which "I" codes am I allowed to use for coding CPT code 76377? Thx
SuperCoder Answered Wed 18th of March, 2020 05:18:47 AM
Hope you are keeping well.
There are numerous “I” codes are in support group by the Medicare. The below list of code series is the one for which Medicare provide the support group diagnosis in respect to the CPT 76377 for different states:
I05.0-I05.9, I08.0-I08.9, I23.1-I23.5, I33.0, I34.0-I34.9, I36.1-I36.9, I39, I48.0, I48.11-I48.21, I48.3-I48.4, I48.91-I48.92, I51.0-I51.2, I97.110-I97.19.
However, you can bill other codes also, but you will need to prove the medical necessity.
This list of codes will be available on the SuperCoder Crosswalk Tool soon.
Hope this helps!
Leorah Posted Sun 22nd of March, 2020 02:57:59 AM
None of the codes you mentioned apply to the procedures that our dr.'s perform. I used to be able to use I63.9 code but now Medicare is no longer accepting this code. What should our practice do now? Our dr.'s perform the 3D rendering many times and as I mentioned before it was acceptable when the code was first introduced in 2013 according to the AMA and was an approved reportable code when used during catheterization CPT codes 36221-36228. How do you suggest I prove medical necessity besides submitting an appeal and the medical procedure report because we have tried that and are still getting denied the payment that is due to us according to the AMA and CMS ruling? How can we increase the 'I" codes on the crosswalk listing?
SuperCoder Answered Mon 23rd of March, 2020 05:44:52 AM
Hope you are working well.
ICD-10-CM I63.9 Unspecified Cerebral Infarction, is not mentioned in the support category of the CPT code 76377. The above mentioned "I" codes are the only codes mapped with the CPT 76377 by CMS on LCD/LCA. If your payment is based on the LCD/LCA, then you have to follow the state specific guidelines of CMS. There are timewise changes from the CMS, no other options except following the present mapped codes and guidelines. Also, you can change the diagnosis if persist to the patient with add-on of doctor's addendum to the medical documentation and re-bill the claim. Or you can select the other series ICD-10-CM code from the list of LCD CPT to ICD-10-CM crosswalk.
It is also suggested to check the explanation of benefit (EOB) provided by payer to check the actual cause of denial (if now only the ICD-10-CM), assess it, fix it and re-bill.
We wish the best reimbursement for the claim.
Hope this helps!