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Lower extremity revascularization
When coding lower extremity re-vascularization procedures, can the tibial-peroneal trunk, posterior tibial and anterior tibial arteries all be coded separately?
Question:
When coding lower extremity re-vascularization procedures, can the tibial-peroneal trunk, posterior tibial and anterior tibial arteries all be coded separately?
Answer:
The tibial peroneal trunk (TPT) splits into the peroneal and posterior tibial (PT) arteries. The anterior tibial artery branches off the popliteal artery above the tibial peroneal trunk. Therefore, when coding, the anterior tibial artery is considered separate from the TPT; however, the PT is considered a continuation of the TPT and not a separately coded vessel. So, if the anterior tibial, the posterior tibial, and the peroneal arteries are all treated, for example, with atherectomy, each may be separately reported.
*This response is based on the best information available as of 9/9/24.
Moderate Sedation
Can our vascular surgeon bill for moderate sedation if an RN was present to observe and monitor the patient?
Question:
Can our vascular surgeon bill for moderate sedation if an RN was present to observe and monitor the patient?
Answer:
Yes; an RN has the knowledge and experience to observe and monitor the patients vital signs, including BP, oxygen levels, heart rate and level of consciousness under the direct supervision of the physician.
*This response is based on the best information available as of 7/11/24.
Can we Bill Co-surgeon if Called in to OR by Another Specialty for a Separate Procedure?
Our vascular surgeon was called into the OR by an orthopedic surgeon who was treating a patient for a traumatic injury of the lower left extremity as the result of an MVA. While stabilizing an open tib-fib fracture the ortho surgeon identified a transected posterior tibial artery and called the vascular surgeon for an intra-operative consult. The vascular surgeon quickly repaired the injured artery and then turned the patient back over to the ortho surgeon. Can we bill the vascular surgeon as co-surgeon?
Question:
Our vascular surgeon was called into the OR by an orthopedic surgeon who was treating a patient for a traumatic injury of the lower left extremity as the result of an MVA. While stabilizing an open tib-fib fracture the ortho surgeon identified a transected posterior tibial artery and called the vascular surgeon for an intra-operative consult. The vascular surgeon quickly repaired the injured artery and then turned the patient back over to the ortho surgeon. Can we bill the vascular surgeon as co-surgeon?
Answer:
No; co-surgery involves both surgeons performing integral portions of the same procedure (CPT code). In this case, the vascular surgeon is the only one repairing the injured vessel so the vascular surgeon would document his/her own op note with the details of the vascular procedure and code accordingly (likely CPT code 35226).
*This response is based on the best information available as of 6/20/24.
Stent vs. Embolization or Both
If the surgeon uses a covered stent and performs an embolization on a patient with a pseudoaneurysm, can we bill for both the stent and removal of the embolus?
Question:
If the surgeon uses a covered stent and performs an embolization on a patient with a pseudoaneurysm, can we bill for both the stent and removal of the embolus?
Answer:
If a covered stent is deployed as the sole management of an aneurysm, pseudoaneurysm or vascular extravasation, then the stent deployment should be reported and not the embolization code.
*This response is based on the best information available as of 4/11/24.
Coding +34713
Can code 34713 for placement of a larger than 12 French sheath in endograft placement be reported with an open exposure of the same artery?
Question:
Can code 34713 for placement of a larger than 12 French sheath in endograft placement be reported with an open exposure of the same artery?
Answer:
No, add-on code +34713 is specifically for percutaneous placement. See code description below.
+34713 - Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed unilateral (List separately in addition to code for primary procedure)
*This response is based on the best information available as of 2/29/24.
Denials for Initial Hospital Care and Observation E/M Codes: 2024
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
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 recognize these changes as they apply to billing. You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting.
*This response is based on the best information available as of 2/15/24.