Darshna Posted Mon 18th of May, 2020 11:51:30 AM
pt has pelvic congestion syndrome so my doctor perform CPT code 37241, 36012 & 75831. I used N94.89 as primary Dx code but my claim got denied as Dx not supported. So Please advise which Dx should I use to support this procedure.
SuperCoder Answered Tue 19th of May, 2020 11:05:02 AM
Thanks for your question.
As per the limited documentation we have, the CPT codes might be not be appropriate with the procedure. Code N94.89 appears correct with diagnosis pelvic congestion syndrome. So, can you please let us know about the preoperative and postoperative diagnosos as well as the procedure descriptor.
Darshna Posted Tue 19th of May, 2020 15:01:47 PM
So yes pt has same Dx pelvic congestion syndrome for pre & post operative. Can I bill with Dx code I86.2 as primary diagnosis. N94.89 was not supported my CPT code. If I use I86.2 primary dx , will it support CPT code 37241, 36012 & 75831 Please advise
SuperCoder Answered Wed 20th of May, 2020 12:51:37 PM
Pelvic Congestion Syndrome (PCS) is a syndrome involving chronic pelvic pain usually associated with the Varices or Varicosities in the pelvic area.
CPT code 37241 suggests that the physician partially or completely blocks venous blood flow in the target area. This code is for services unrelated to hemorrhage. This code is appropriate for services related to venous malformations, hemangiomas, varicoceles, and varices.
So, as per the description of code 37241, pelvic varices can be used as diagnosis with this code. Code I86.2 pelivc varices crosswalk suggests that the CPT code 37241 can be allowed together. But, kindly check with your procedure documentation for the involvement of the pelvic varices. The medical necessity and payer policy should also be checked.
Hope this helps.