Angiogram Billing for All Vessels Viewed

Question:

Can we bill for all vessels mentioned if they are documented within the angiogram?

Answer:

No. You should only bill for vessels that are targeted and are medically necessary. Documentation alone doesn’t mean that procedures are always separately billable.

Billing for Vascular Access

Question:

I’m new to vascular coding, can we bill for vascular access for a catheterization? The provider documents this, so I’m thinking I am missing a code.

Answer:

No, vascular access itself is not separately billable with a catheterization. However, the provider must document the vessel accessed , what side of the body, RT or LT y, and the end point of the catheter, so the proper catheterization codes can be billed. Remember, some interventions ( cervico-cerebral angiograms, carotid stenting on the same side as the stenting, and more) include catheterization and it would not be separately billable.

Co-Surgery Due to Complex Procedure

Question:

I have 2 vascular surgeons from the same practice that want to bill co-surgery for a complex open abdominal aneurysm repair. They both performed the same code but say that it should be co-surgery because it was complex and needed both surgeons. Can we bill with modifier -62?

Answer:

The surgery described does not support the definition of a co-surgery (each surgeon performs distinct work described within the same code) and should be billed as a primary and assistant surgeon. Co-surgery implies two surgeons with a different skill set, each provider performing distinct portions of the case, and each documenting their portion in separate op reports. Also, Medicare and other payors may require that surgeons be of different specialties when billing for co-surgery.

Payment and Coding Changes You Need to Know With Open Exposure in EVAR

Question:

Does it matter that the open exposure codes are now add-on codes? Does that change payment or coding in any way?

Answer:

Yes, this change has both coding and payment implications. In terms of coding, the open exposure codes can now only be reported with a primary code; the main body EVAR code. If a different provider performs the open exposure, he/she would also have to report as assistant on the EVAR main body code in order to report the add-on exposure code.

From a reimbursement perspective, add-on codes should be paid as 100% of the allowable and are not subject to the multiple procedure payment reduction of 50%. For example, when femoral exposure, 34812, was a primary code, it received a 50 % reduction when performed with an EVAR and when performed bilaterally. As an add-on code, it is paid in full. To avoid a payment reduction, CPT advises that all exposure codes for EVAR be reported with units instead of a 50 modifier when performed bilaterally.

Billing Code 34713, Using a 12 French or Larger Catheter with EVAR

Question:

I almost always use a 12 French or larger catheter for placing the main body for EVAR. Do I always bill the new code 34713, when what I use is a 12 French or larger?

Answer:

Yes, if your approach/exposure is percutaneous. CPT code +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,is only appropriate when the access is percutaneous. If you do an open exposure and use a 12 French or larger catheter, code 34713 would not be reported.

For more detailed information on coding the new EVAR code set, please contact us for a consultation.

Approved Telehealth Platforms

Question:

Now that we aren’t limited to HIPAA compliant software, can we use any app or platform to conduct a telemedicine visit?

Answer:

During the public health emergency (PHE), you may use any app or platform that is not “public facing” according to HHS. Platforms such as Facebook Live, Twitch, and TikTok are considered public facing. Skype, FaceTime, Facebook Messenger Chat, and Google Hangouts video are all approved platforms.