Leorah Posted Thu 14th of September, 2017 14:42:48 PM
Our doctors performed a complicated spinal arteriogram. We submitted the following codes 36215x19, 36245(50)x5, 36246(50), 36218(50),75705x24, 75736,and 75716 along with the diagnosis code of I60.9, a non traumatic subarachnoid hemorrhage. The claim denied many of the codes. Including the 36215 and 36245 for frequency,36218 because the qualifying procedure has not been received- do you understand that?,75705 not covered unless a prerequisite procedure provided, 75736 # of units exceeds- but I submitted only 1 unit. Could you please advise on why these codes were denied and how to submit this correctly?
SuperCoder Answered Fri 15th of September, 2017 08:45:42 AM
As per the provided documentation, below could be the reason for denial.
Hope that helps!
- 36215 and 36245 : MUE is 6 units, so maximum 6 units can be billed. Also, there is a bundling issue between 36245 and 36245 so modifier 59 will be required.
- 36218-Qualifying procedure has not been received means that payment not paid seperately. Submit with correct modifier or take adjustment. this is an add on code. USe 36218 in addition to 36216 or or 36217.
- 75705 and 75736 -According to CPT guidelines for aorta and artery procedures, you should report diagnostic angiography performed with an interventional procedure only if you meet one of the following two requirements:
- No prior angiography is available, the provider performs a full diagnostic study and decides to intervene based on the diagnostic study; or
2. A prior study is available, but documentation shows one of the following three requirements:
a. the patient's condition has changed
b. the prior study offers inadequate visualization
c. a clinical change during the procedure requires new evaluation outside the intervention area.
Before you report 75736 you need to look further into the documentation, Check the history and findings to determine whether 75736 is appropriate.