Category: CC-Vascular

Denials for Initial Hospital Care and Observation E/M Codes: 2024
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Denials for Initial Hospital Care and Observation E/M Codes: 2024

February 15, 2024 Question: We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital).  Are we doing something wrong? Answer: You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes. Unfortunately, some payor claims processing systems may not yet...

Modifiers with Unlisted Codes
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Modifiers with Unlisted Codes

February 1, 2024 Question: Can I use modifiers on an unlisted code? Answer: In some circumstances, a modifier may be appropriately appended to an unlisted code. For example, CPT says, while uncommon, if multiple separately reportable unlisted codes are performed on the same patient on the same date by the same physician, multiple unlisted codes...

Venogram with Catheterization
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Venogram with Catheterization

December 28, 2023 Question: During catheterization, If the surgeon performed a venogram during a catheterization are these bundled? Answer: Venous catheterization codes are separately reported with venograms. Unless they are performed at the same session with an intervention that includes catheterization. *This response is based on the best information available as of 12/28/23.    

E/M Coding for Emergency Surgery
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E/M Coding for Emergency Surgery

December 14, 2023 Question: Under the revised 2023 EM guidelines what E/M code would be supported for seeing a patient in the the ED for a ruptured abdominal aorta aneurysm (AAA) and taking them emergently to surgery for repair? Answer: This scenario would support , 99223, the highest level of Initial hospital care. Based on:...

Stab Phlebectomies
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Stab Phlebectomies

November 30, 2023 Question: When a provider preforms less than 10 stab phlebectomies what is the comparison code? Answer: I would recommend using CPT 37999 for the stab phlebectomies. Make sure you are looking at the providers documentation as it depends on the number of incisions the providers make. *This response is based on the...

Ablation of Truncal
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Ablation of Truncal

November 2, 2023 Question: How often can you use the add on codes for mechanochemical ablation of varicose veins? Answer: Use add-on code(s) 36474,36476, 36479 or 36483 for additional veins ablated through separate access sites of other truncal veins in the same leg. Only report add on code ONCE regardless of the number of additional...

Time Reporting for E/M Levels
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Time Reporting for E/M Levels

November 2, 2023 Question: Is it best practice to bill 99202-99215 based on time only? Answer: CPT codes 99202 to 99215 no longer require that the History and Examination be key factors in determining the level of Evaluation and Management (E/M) code. Instead, the E/M code is dependent on: • Level of Medical Decision Making...

Coding for TCAR
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Coding for TCAR

October 19, 2023 Question: How is the TCAR procedure reported? Answer: Transcarotid Artery Revascularization (TCAR) is a minimally invasive procedure that can clear blockages and open a narrowed cervical carotid artery. The surgeon makes an incision over the common carotid artery to perform the repair. During the TCAR procedure, the surgical team reverses blood flow in...

Medicare High Risk Criteria in Carotid Stenting
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Medicare High Risk Criteria in Carotid Stenting

October 5, 2023 Question: What does Medicare consider high risk to support a stent instead of a carotid endarterectomy (CEA)? Answer: Patients at high risk for CEA are defined as having significant comorbidities and/or anatomic risk factors (i.e., recurrent stenosis and/or previous radical neck dissection) and would be poor candidates for CEA in the opinion...

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