Leorah Posted Tue 10th of December, 2019 01:30:25 AM
Our Dr.'s sometimes have complicated procedures in the brain where they perform a thrombectomy (61645) and then need to put a stent in the same artery to keep it open(37215). We are finding that most times the insurance company will pay the stenting (37215) code but we sometimes have problems getting the thrombectomy (61645) code paid. I recently saw that one of the insurance companies have stated that they did not pay both those codes because the ICD 10 codes which we billed for each of them with separate pointers were bouncing against each other. In particular, they stated that code I63.412 which was pointing toward the 61645 procedure code and I65.21 which was pointing toward the 37215 procedure code were not able to be used together on the same claim. Could you please confirm or deny this and if this is correct? Could you please explain which two ICD 10 codes I am able to report simultaneously in order to have both 37215 and 61645 paid? Thanks
SuperCoder Answered Wed 11th of December, 2019 07:48:59 AM
Thank you for your question.
The provided documentation is a little tricky one.
The documentation states that the thrombectomy and stent placement was performed in the same artery to keep it open; however, if we look at the bottom of the documentation, it’s indicating that for stent placement procedure, CPT® code 37215 was pointing towards I65.21 (Occlusion and stenosis of right carotid artery) and for thrombectomy, CPT® code 61645 was pointing towards I63.412 (Cerebral infarction due to embolism of left middle cerebral artery).
The statement is contradicting, as both the arteries are different, i.e. right carotid artery and left middle cerebral artery.
Also, as per CCI edit, CPT® code 61645 is a column 2 code for 37215. That is, if the thrombectomy and transcatheter stent placement was performed in the same artery then, report only CPT® code 37215. Thrombectomy will be considered inclusive in the stent placement procedure when performed on the same vessel/artery
Note: For stenosis in left middle cerebral artery, the appropriate ICD-10 code will be I66.02 (Occlusion and stenosis of left middle cerebral artery)
Hope this helps.
Leorah Posted Thu 12th of December, 2019 04:04:00 AM
Oops, I'm sorry I meant I63.131 was pointing to the 61645 not the I63.412. In addition, you are saying that if a thrombectomy and stenting occurs in the same vessel, we would get paid only for the stenting procedure but I had asked a similar type question in the past on October 2017 and the answer was the oppostite. The subject was "Thrombectomy and Stent In the Same Procedure" The answer was "As per NCCI guidelines, both CPTs 37215 and 61645 can be reported at the same session by adding modifier-59 with CPT-61645 in order to indicate the distinctness of the procedure." I am truly confused now because in the past I was told that if both procedures occurred in the same vessel then I can code both and get paid for both, but now you are telling me that is not the case?
SuperCoder Answered Fri 13th of December, 2019 06:33:15 AM
Thank you for your additional information.
With your reference to the previous Question with subject “Thrombectomy and Stent In the Same Procedure” dated 01st of October 2017, the documentation indicated that mechanical thrombectomy was performed in right common carotid artery and doctor looked up further to the internal carotid artery and decided that a carotid stent was needed; therefore, appending modifier -59 in such scenario where the locations were different, will be appropriate.
However, in the current scenario, the documentation is indicating that the thrombectomy and stent placement was performed in the same artery, i.e. right carotid artery, to keep it open. It will not be appropriate to report CPT® code 61645 along with 37215.
Also, as per CCI edit, CPT® code 61645 is a column 2 code for 37215.
Hope this helps.