Leigh Posted Wed 25th of September, 2013 16:32:00 PM
At what percentage of carotid artery stenosis can you code 433.10 according to Nascet criteria? We were told once that it must be over 15% but now we are thinking it should be over 50%. Also can you direct me to an official rule stating this?
SuperCoder Answered Wed 25th of September, 2013 23:28:00 PM
I was unable to find any authoritative source referencing a specific percentage criterion for assigning 433.10. ICD-9 indexes carotid arteriosclerosis, narrowing, embolism, obstruction, occlusion, and thrombosis to 433.1x.
On the other hand, many payers use NASCET in deciding whether the stenosis is at the right level to support medical necessity for CAS. For instance, a payer policy may allow coverage for a patient with 50% to 99% stenosis as well as either symptoms or contraindication for endarterectomy.