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Procedure Left heart cath, selective coronary angio with abd aortogram and runof

Tommy Posted Wed 16th of October, 2013 17:47:18 PM

I am having trouble with denials on abdominal aortography with selective right and left iliac angiography with run off distally. I am confused on the codes for the abdominal aortography and then the selective injection of the right and left iliac in combination with the left heart cath and coronary angiography "93458-26" I charged "36200" and "75625" for aortogram and "75716" for the bilateral extremity angiogram. But the insurance denied stating we need to use a G-code. Any help would be appreciated as we dont do alot of these types of caths.

SuperCoder Answered Wed 16th of October, 2013 22:35:35 PM

We are working on this.

SuperCoder Answered Wed 16th of October, 2013 22:35:35 PM
With Deb
SuperCoder Answered Thu 17th of October, 2013 10:16:04 AM

Most likely, the G-code reference is to NON-SELECTIVE code G0278 (Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)).

But because you mention selective, you may need to coordinate with the payer to make clear that G0278 wouldn’t apply for the bilateral selective service. There’s no selective cath placement code on the claim (e.g., 36245-36247) to indicate the selective service so that’s another area to double-check.

Note that the 75625/75716 combo is often used to represent examination of the abdominal aorta, including the bilateral lower extremity arteries, by positioning the cath high in the abdominal aorta and then low in the abdominal aorta, so this may be the payer’s assumption.

Also note that you can never report 36200 on the same claim as the LHC, according to CCI edits. Selective cath placement code 36245, as well as 75625 and 75716 are also bundled into 93458 by CCI. But if they were performed for a distinct reason supported by medical necessity (not just roadmapping or imaging for the LHC), then you may override the edit with a modifier for any payer that bundles the codes. As always, the final coding depends on the documentation.

Tommy Posted Thu 17th of October, 2013 13:38:20 PM

Okay if I understand correctly. For a left heart catheterization, coronary angiography via right femoral artery with then selective right and left illiac injections the codes would be as follows? The peripheral angiography was seperate reason, not a road map.
'93458'
'36245-50'- but its bilateral. do i charge this twice or how exactly to i bill it to let Medicare know that its both the right and left iliac injected selectively.
and '75716'

SuperCoder Answered Thu 17th of October, 2013 22:47:06 PM

I have asked the opinion of my CE regarding this. Please be patient.

Thanks

SuperCoder Answered Thu 17th of October, 2013 22:47:06 PM
With Cardiology CE
SuperCoder Answered Fri 18th of October, 2013 18:05:03 PM

I suggest:
Likely coding (depending on documentation) would be 93458-26, 36245-59, 75716-59-26.

Payers may pay 36245 only once because the cath had to go into the right iliac for 93458 anyway. We're checking with additional members of the cardio team and will post again if new information comes up!

Tommy Posted Mon 21st of October, 2013 13:39:03 PM

Thank you for checking. If there was not an associated 93458 with this particular procedure How do you bill 36245-50 bilaterally? Does the 50 modifer tell them it was done twice on both sides? Do you bill it with two units or bill it twice. I am still confused how to demonstrated that each side was selectively injected. Thanks

SuperCoder Answered Mon 21st of October, 2013 19:14:40 PM

Bilateral reporting can be specific to the payer. Some will have policies stating to use a single line item with modifier 50 appended. This indicates the procedure was performed once on the left and once on the right. Other payers may ask you to report two line items with LT appended on one line and RT appended on the other.

But generally speaking, reporting 36245-50 with 1 unit represents performing the service once on the left and once on the right.

Note that 36245 has a bilateral indicator of 1 on the Medicare physician fee schedule. That means whether you use 50, RT/LT, or 2 units, a payment adjustment is made:
1 = 150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules.

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