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Is there a limit for angiograms (75898) for Medicaid managed care?

Leorah Posted Sun 04th of November, 2018 06:17:34 AM
In a previous question to Supercoder we asked "When performing an embolization of an aneurysm up to how many angiography 75898 codes can I use if the procedure was complicated and many coils needed to be inserted?" The answer that Supercoder gave was despite the fact that CPT Assistant says you can code it once, this does not include the central nervous system or intercranial completion. If more than one angiogram was performed then it may be coded and submitted. Knowing all this, we recently submitted a claim to a Medicaid managed care payer and they only paid 4 out of the 5 angiograms. We then appealed for the last angiogram and their denial response stated that they only agreed to pay four of the 5 angiograms because that is Medicaid's limit for angiographies. Is this really the case?
SuperCoder Answered Mon 05th of November, 2018 07:41:41 AM

Hi,

Thanks for your query.

Can you please provide the reference and date of the question you previously asked to Supercoder. Also, please provide the article reference of CPT assistant which was provided to you previously.

Thanks.

Leorah Posted Tue 06th of November, 2018 05:13:00 AM
Here is the date the question was posted "Leorah Posted Tue 26th of September, 2017 03:46:38 AM" Here is the direct quote from the answer which discussed CPT assistant "You typically may report 75898 only once per operative field per session, according to CPT Assistant. The AMA doesn't include central nervous system or intracranial completion angiography in this "once per operative field" rule. When you do report more than one completion angiography on a claim, CPT Assistant recommends using modifier 59 (Distinct procedural service) on the second and subsequent code to indicate their distinct nature."
SuperCoder Answered Thu 08th of November, 2018 11:32:29 AM

Thanks.

SuperCoder Answered Thu 08th of November, 2018 11:33:26 AM

Thank you for your question. Our team is working on this and will get back to you soon.

Thanks.

SuperCoder Answered Fri 09th of November, 2018 09:18:26 AM

 

Hi,

Thanks for your patience.

The MUE (units) that can be billed for 75898 as per Medicaid is 2. So, it means on a single DOS, not more than two units can be billed. Sometimes, if the sum exceeds the MUE value, the payer will deny same-DOS lines with that code on the current claim. Payer may pay excess units upon appeal or may bypass the MUE based on documentation of medical necessity. Please check that the angiographies performed are on different dates.

In this scenario, Medicaid already allowed 4 angiographies.

Hope this answers the questions.

Thanks.

 

 

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