Leorah Posted Sun 03rd of March, 2019 03:27:03 AM
The doctor performed a diagnostic cerebral angiogram and injected the left subclavian (36225 LT), the thyrocervical trunk (36217) and performed a thrombectomy procedure on the right vertebral artery (61645). I coded a 61645, 36225 59 LT and a 36217 59. The insurance did not pay for the 36217 and said it was bundled . Could you please explain why? Thank you
SuperCoder Answered Tue 05th of March, 2019 07:42:37 AM
As per NCCI guidelines, code 36217 is a column 2 code for 36225, modifier 59 is allowed in order to differentiate between the services provided and code 36225 is a column 2 code for 61645, modifier 59 is allowed in order to differentiate between the services provided. You used the modifiers with codes 36217 and 36225 correctly. CPT 61645 is good to go, but missed to append the modifier RT. However, CPT 36225 is second order branch, whereas thyrocervical trunk is third order branch, as per guidelines catheter placement should be coded for farthest branch for the same vascular family, so third order branch should be coded i.e. thyrocervical trunk. Out of 36127 and 36225 there should one code be billed, that is the reason that payer considered it bundled with the other procedure. It is suggested to check the explanation of benefit, fulfil the reason of denial and re-bill the claim.
Hope this helps!