Diagnosis Coding for Renal Angiography

Question:

What would be the appropriate ICD-10-CM code if the patient comes for renal artery bleeding and the physician studies renal angiogram and found no active extravasation? Diagnosis R58 is not payable diagnosis as per LCD policy for CPT 36253.  Can  you provide some guidance?

Answer:

When renal angiography is performed for suspected renal artery bleeding and no active extravasation is identified, the diagnosis must accurately reflect the clinical indication and intent of the study. Because nonspecific symptom codes such as diagnosis code R58 do not define an anatomical site or etiology, they often do not support the medical necessity of the procedure.

The order and final impression should clearly document the suspected or underlying cause prompting the angiogram (for example, postprocedural hemorrhage or renal injury). If documentation is unclear or a specific diagnosis cannot be identified, it is appropriate to query the provider to determine the most accurate diagnosis supporting medical necessity. When no suitable ICD-10 code can be established after clarification, append the appropriate G modifier based on ABN status to indicate that medical necessity may not be supported for the service.

*This response is based on the best information available as of 02/05/26.

Office Visits, Unna Boot Application, and Wound Debridement

Question:

Could you provide guidance regarding office visits, the use of an Unna boot or Profore (application or removal), and wound debridement at the time of the visit? I am unclear if the codes for Unna boots, office visits, and debridements on the same day are mutually exclusive, need special modifiers, or flat out cannot be billed simultaneously. Thank you.

Answer:

When the purpose of the visit is to remove an existing Unna boot or Profore, perform wound debridement, and apply a new Unna boot or Profore, an E/M service should not be reported, as the evaluation and management work is inherent to the wound care procedures. An E/M service may only be reported, with modifier 25, when a separate, significant, and identifiable condition is evaluated and managed beyond the wound itself.

Medicare states that all supply items related to an Unna boot are included in CPT code 29580. When debridement and Unna boot application are performed on the same anatomic area during the same encounter, only the debridement is reimbursable; if no debridement is performed, only the Unna boot application may be reported. The NCCI Policy Manual for Medicare Services, Chapter 4, Section G, prohibits reporting debridement codes 11042–11047 or 97597 with codes 29580 or 29581 for the same anatomic area.

*This response is based on the best information available as of 01/22/26.

Documenting Occlusions for 2026 Lower Extremity Endovascular Revascularization Coding

Question:

The CPT guidelines for the lower extremity endovascular revascularization codes state that a straightforward lesion is a stenosis and a complex lesion is an occlusion. When documenting treatment of an occlusion, must the operative report specify the degree of blockage (for example, 100% or total), or does documentation of the lesion as an occlusion alone support reporting a complex lesion?

Answer:

Documentation of the lesion as an occlusion alone is sufficient to support reporting treatment of a complex lesion. CPT defines lesion complexity by lesion type, not by a percentage of narrowing, and an occlusion by definition represents complete blockage. CPT does not require documentation of “100%” or “total” for code selection. That said, because these codes are newly implemented, providers and coders should continue to monitor local MAC and commercial payer policies for any additional documentation requirements as payers begin to adjudicate claims.

*This response is based on the best information available as of 01/08/26.

Modifier Use and Same-Day Vascular Ultrasound Services

Question:

I have a question regarding the appropriate use of modifiers when billing for E/M services performed on the same day as ultrasound procedures (e.g., 93880, 93922, 93978, etc.). Our billing team has been consistently appending modifier 25 to all E/M visits that coincide with same-day ultrasounds, and applying modifier 59 to each ultrasound code. We are a private practice and own the ultrasound equipment, so we do not use modifiers 26 or TC. Could you please confirm whether this approach is correct? Specifically, is it appropriate to routinely apply both modifier 25 to the E/M service and modifier 59 to the ultrasound codes for all in-office visits involving same-day ultrasounds? Thank you in advance for your guidance!

Answer:

Based on NCCI data, there are no procedure-to-procedure edits between office visits and vascular ultrasound codes such as 93880, 93922, or 93978, meaning these services are not inherently bundled and may be reported together when medically necessary and supported by documentation.

Because there are no NCCI conflicts, the use of modifiers 25, 59, or XU is not required for these code combinations. However, some payers may still require one or more of these modifiers for claims processing or system recognition when an E/M service and diagnostic ultrasound are performed on the same day.

It is important to review individual payer policies to determine when modifiers 25, 59, or XU may be necessary to ensure accurate claim submission and avoid denials.

*This response is based on the best information available as of 12/18/25.

Reporting 36015

Question:

We have seen some illustrations suggesting the maximum number for reporting 36015 in one session is 5 (3-right(U,M,L), 2 Left(U,L). This method only counts the lobar arteries and excludes counting the segmental arteries. Is it your opinion that each segmental artery can be individually reported? For example, if the provider performed selective catheterization on the right side of the medial basal segment, the posterior basal segment and the lateral basal segment would this count as three (3) total under the lower lobe or count as one (1) since all are in the lower lobe?

Answer:

You can bill 36015 for each distinct selective catheterization, but only when those vessels are legitimately separate branches per the CPT Appendix L vascular-family hierarchy.

Segmental or subsegmental arteries within the same lobar distribution are not separately reportable; they are included in a single unit of 36015 for that lobe. Therefore, selective catheterization of the medial basal, posterior basal, and lateral basal segmental branches would count as one (1) selective catheterization under the right lower-lobe pulmonary artery, not three.

*This response is based on the best information available as of 12/04/25.

E/M During Global Period for Diabetic Foot Ulcer Following Total Metatarsal Amputation

Question:

If a patient has a total metatarsal amputation for diabetic foot ulcer and he gets readmitted for another condition, but then vascular surgery is consulted for his original underlying condition of DFA and now is treating the ulcer at the amputation site, 80 days post-op is the E/M billable? The TMA surgical wound is healing. The right plantar DFU stage 3 Wagner needs debridement and dressing changes.

Answer:

The evaluation and management service is not separately billable because it appears to represent continued management of the same surgical and disease process that prompted the original total metatarsal amputation. Any care directed toward the amputation wound or related diabetic ulceration in the same region during the 90-day global is included in the global period.

*This response is based on the best information available as of 11/20/25.