Oscar Posted Wed 28th of December, 2016 08:56:35 AM
Please answer the following coding question.
1) Let's say my doctor placed the sheath in Left common femoral artery and went all the way up to Abdominal aorta and placed the catheter at the level of Renals and injected the contrast and took the pictures of abdominal aorta and then he placed the catheter in Left common Iliac and injected the contrast again for Left lower extremity angiogram, then he moved the catheter back and gone contralateral and placed the catheter in Right superficial artery and injected the contrast for Right lower extremity angiogram. In this scenario my coding would be...
36247-RT & 75716, in this case I am not coding Left common iliac placement as it is sheath placed side and also some times doctor performs the angiogram through sheath. Am I correct or should I bill 36245-LT as well? also suggest if it is performed through sheath?
in the same scenario as above..
If doctor selectively placed catheters in multiple arteries eg: Right Internal iliac, superficial femoral artery and Tibio-Peroneal trunk placement and injected the contrast in 3 arteries per medical necessity. In this situation should I code as follows. Codes will continue from above scenario also....
36247-RT, 36248X2, 75716, 75774X2
is the above coding correct or not?
2) If doctor placed catheter in Abdominal aorta at renals and contrast injected, performed abdominal aortogram and at aorta bifurcation or distal aorta injected the contrast again and performed bilateral lower extremity angiogram, in this case we are coding...
36200 & 75630 is it correct?
We are clear about selective cath placement codes inclusions in Interventions if performed. Apart from this, if there are any special guidelines in these angiogram codes reporting please suggest.
Thanks & Regards
SuperCoder Answered Thu 29th of December, 2016 05:11:37 AM
Hi, the following guidelines will help solving the problem :
- Select the appropriate non-selective code when an access is made and the catheter does not reach the aorta or a branch off the access vessel. For example, if the right common femoral artery is entered and a sheath is placed for a right lower extremity angiogram, the catheter placement code is 36140.
- Do not report a separate code for the access site (sheath placement) when the aorta is entered or there was a selective catheter placement.
- Report 36200 when the catheter enters the aorta (which is non-selective). Remember not to code where the tip of the wire is placed, but rather where the sheath, diagnostic catheter, or working catheter tip is placed. For example, during an ostial stent placement in a renal artery, the wire may be placed into a second- or third-order vessel for stability, but the correct code is 36245 because the catheter the stent was deployed from is a first-order selection.
- Call upon the appropriate selective code when a vessel off the aorta or access vessel is entered. The documentation must confirm that a particular vessel was selected, or that the catheter tip was placed into the vessel. Placement of a catheter “near” or “at” the origin of a vessel does not document a selective catheter placement.
- The selective code includes the non-selective code from the same access site. For example, if the right renal is selected, report only 36245, not 36200 and 36140 from a transfemoral approach.
- Code once the highest order/level of catheter selection within a vascular family (e.g., 36xx5, 36xx6, or 36xx7). If, in the same vascular family, additional branch vessels are catheterized, use the appropriate additional second-order, third-order, and beyond code (36218 or 36248) for each additional vessel that is selected. These are add-on codes and do not require modifier 59 Distinct procedural service for multiple service units.
- Repeat the same guidelines above for each separate vascular family that is selected. For example, in a normal aortic arch, if each of the great vessels (e.g., brachiocephalic, left common carotid, and left subclavian) are selected, you will have a minimum of three codes to report (36xx5, 36xx6 or 36xx7). If additional vessels within any of these three vascular families are also selected, additional (36xx8) code(s) are necessary.
- If a second access is performed, the coding starts again following the same guideline above for any and all vessels selected. For example, if the right femoral is entered and a catheter is placed into the bilateral renals and a second access is made into the left femoral with a catheter placed into the aorta, the reported codes would be 36245-50 and 36200-59. Modifier 59 indicates this to be a separate and distinct procedure, while modifier 50 Bilateral procedure describes the bilateral access to the renals.