Jami Posted Fri 22nd of December, 2017 13:22:24 PM
I need clarification coding this stent placement. I think I should only code for 2 stents and not 4, 37238 and 37239 because they over lapped. Do you agree?
After careful analysis of the intravascular ultrasound results it is deemed that the appropriate diameter size for the common iliac veins is 18 mm, and the appropriate size for the external iliac veins is 14 mm. With this in mind to 18 mm x 90 mm wall stents are introduced and deployed in a kissing fashion into the common iliac veins starting from the inferior vena cava bifurcation. Both stents deployed successfully with good apposition. The left external iliac stent was deployed after overlapping the common iliac vein stents by 2 cm. The right external iliac stent was deployed after overlapping the common iliac vein stent by approximately 3 cm. Good apposition is noted in both external iliac stents.
Intravascular ultrasound was introduced through the left and placed into the inferior vena cava then pulled/recorded. The findings demonstrate good apposition of both the common iliac vein and external iliac vein stents. The compression has resolved. The pre-total surface area of the left common iliac vein was 55.2 mm2 and the post is 205.5 mm2. This indicates excellent results post left iliac venous stenting. The right common iliac vein is visualized next by introducing the intravascular ultrasound into the inferior vena cava, then pulling/recording. The findings demonstrate good apposition of the stents with a pre-total surface area of 68.6 mm² and a post total surface area of 152.5 mm². These results demonstrate successful resolution of the venous compression. Both external iliac vein stents are well opposed with 3 total surface area in the right external iliac vein of 3.8 mm² and post of 16.5 mm². The right external iliac vein total surface area before the stent was 5.2 mm² and the post was 15.3 mm². These are significant improvements and external iliac vein compression.
SuperCoder Answered Tue 26th of December, 2017 02:39:33 AM
Greetings from SuperCoder!
Codes 37238 and 37239 describe transluminal intravascular stent insertion in a vein. Multiple stents placed in a single vessel may only be reported with a single code. So, this scenario should be billed with codes 37238 and 37239 for 2 stents instead of 4.
Please feel free to write if you have any questions.
Jami Posted Thu 28th of December, 2017 13:09:32 PM
Can you explain why you came to this conclusion? Is it because the Doctor states overlapping into another vein? If the stents did not overlap then we could bill for 4 stents? Would that be correct?
SuperCoder Answered Fri 29th of December, 2017 01:39:12 AM
Overlapping is not the criteria to decide how many stents may be billed. The actual criteria is "multiple stents placed in a single vessel may only be reported with a single code". In this case, common iliac veins and external iliac veins are the same vessel. So , these should be coded only once and if done on both sides, then code it twice.