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Angioplasty of bilateral transverse sinus stenosis& right sigmoid sinus stenosis

Leorah Posted Thu 30th of January, 2020 14:40:26 PM
Our doctors performed an angioplasty of the bilateral transverse sinus stenosis and right sigmoid sinus stenosis. They injected the right internal carotid, right vertebral, the superior sagittal sinus and the left transverse sinus. Then the catheter was brought to the right internal jugular vein and the pressure was measured using an LP manometer connected to the navien in the SSS. A venous angiogram was performed in the right transverse sinus and the right sigmoid sinus while the left transverse sinus was selected and pressures were obtained of the SSS, Right transverse sinus, proximal , mid and distal , the right sigmoid sinus, left transverse sinus, proximal, mid and distal. Then venous angioplasty was performed on bilateral transverse sinus'. Then a follow up angiogram in the right carotid artery was performed. Please help me with the coding. Thanks
SuperCoder Answered Fri 31st of January, 2020 07:53:37 AM

Hi Leorah,

Thank you for your question.

As per the limited information provided above, the appropriate code to bill for venous angioplasty will be 37248 (Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein).

Note:

For measure of venous pressure, use code 93770 (Determination of venous pressure)

Also, for more clarity and reference to further match with your medical report see the below link.

https://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/vascular-services-master-new-cpt-2017-codes-37246-37249-with-this-angioplasty-qa-153165-article

Leorah Posted Sun 02nd of February, 2020 04:02:29 AM
I would not code anything besides the 37248? I know you mentioned 93770 but I thought we would not get reimbursed for that code anyway.
Leorah Posted Sun 02nd of February, 2020 04:15:51 AM
Shouldn't I be coding the 36224 RT and 36226 RT? In addition, shouldn't I be coding the 37248 with a 50 because it was binary?
SuperCoder Answered Tue 04th of February, 2020 02:07:09 AM

Hi Leorah,

It is correct to bill 37248 with a modifier 50, however this code includes Radiological supervision and interpretation. (Includes 37220-37235).

If there is a separate detailed report for angiogram used for diagnostic purpose and separate report for angioplasties, we will bill both the codes 37248-50 and 36224-RT.

Note:

CPT guidelines state, “Only one code in the range 36222-36224 may be reported for each ipsilateral carotid territory. Only one code in the range 36225-36226 may be reported for each ipsilateral vertebral territory.” So the two areas have separate hierarchies. These presentation slides include examples that may help:  Feel free to ask for any further query.

 http://static.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/e0bdf19e-6a7c-4179-9300-8acc467f224e/34bbafd4-19c0-4fca-934d-63c2532ec377.pdf

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