Leorah Posted Thu 02nd of November, 2017 01:59:42 AM
Our doctors performed a diagnostic cerebral angiogram after a follow up for an embolization. They needed to visualize the tiny vessel details to make sure blood flow was not blocked. They performed a 3D rendering once in 3 different vessels in the brain. It was documented for each artery as such "A 3-D rotational angiogram intracranial circulation was performed. All sources images from the 3-D rotational angiogram was sent to a dedicated workstation for reconstruction and review. The reconstruction was created by the physician at the time of the procedure" This was repeated in the report 3x next to the 3 vessels that were selected. Medicare just paid one of the 76377 codes. Their response when we appealed was"The submitted documentation is missing the reports to support the tests were performed. For more facts please go to www.ssa.gov to XVIII of the Social Security(SSA) Act 1833" I tried that site but did not see any relevant information. They also wrote "Service was not furnished directly to the patient and or not documented." Could it be that it is because I submitted this as a 76377 with a 26, 59 modifiers as 3 units when I should have been put on 3 different line items with perhaps an XS and 76 modifier as well? Do we need to submit the actual scan to Medicare to prove that the 3-D rendering were performed?
SuperCoder Answered Fri 03rd of November, 2017 08:06:17 AM
Cpt code 76377 is multi-slice imaging and enhanced techniques allow for the generation of three-dimensional images. It is billable for multiple vessel once when performed one time. If performed twice for reconfirmation of results then two unit is billable. Modifier 76 is used when a provider may repeat a procedure because the patient did not respond well to the first procedure or because the first procedure was not successful. A provider may also repeat a radiology procedure to render a definitive diagnosis.
If the provider did not perform the same procedure twice, you should use modifier 59, Distinct Procedural Service, instead of modifier 76. Modifier 59 identifies procedures or services not normally performed together, but are appropriate under specific circumstances.
Do we need to submit the actual scan to Medicare to prove that the 3-D rendering were performed: Original documents are always required to code the report.
Hope this helps!
Leorah Posted Sun 05th of November, 2017 07:25:00 AM
You mentioned "It is billable for multiple vessel once when performed one time" I am not sure what you mean by this. Many times we need to perform a 76377 once for different arteries in one procedure. So there are times during an angiogram that we need a 3D rendering for the vertebral and the carotid arteries. Two different arteries during one procedure. Can we bill for two 76377's? We have billed more than one 76377 with a modifier 59 and the code was denied payment because we have exceeded billable amounts.
When you write "Original documents are always required to code the report" I have never sent in the actual scan to an insurance company. Is that what you mean? We have the original medical records but it is necessary to send in more than that?
Have you looked into "Social Security(SSA) Act 1833"? Do you see what it is referring to?
SuperCoder Answered Mon 06th of November, 2017 07:23:18 AM
CPT code 76377 is used for multiple vessel imaging at one time:-It means if this procedure was performed on multiple arteries/vessels then only one unit is billable.
If provider perform this test for reconfirmation of results or the test performed earlier didn't show good results then two units are billable with specific modifier. As you have exceeded billable units then insurance has asked for original scans. Social Security(SSA) Act 1833" this act is beneficial for payment related denials not for 76377.
Hope this helps!
Leorah Posted Mon 06th of November, 2017 16:28:10 PM
Multiple vessel imaging at one time, could imply that all the vessels needed to be imaged are seen in one reconstruction. In the case of our procedure, a diagnostic cerebral angiogram, we only look at one vessel at a time and the 3D rendering will only show one vessel at a time, however during a Diagnostic cerebral angiogram, we can do separate renderings and reconstructions on several vessels, each rendering and reconstruction showing a separate vessel is done within a few minutes of each other depending on how long it takes the provider to get out of one vessel and catheterize another completely separate vessel. Is this considered "at one time"?
SuperCoder Answered Tue 07th of November, 2017 05:03:15 AM
For catheterization of vessels use separate code along with 3D rendering angiogram CPT 76377. CPT code 76377 is used to 3 D reconstruction view of these catheterized artery/vessels. There are separate codes for arterial catheterization. Please use specific code from 36221-36228 as per your documentation.
76377 would be used once per encounter for 3D imaging of single/multiple vessel.