Stent and Embolization Coil Used in Same Session

Question:

The surgeon used a stent and then inserted an embolization coil for an aneurysm. Are both billable?

Answer:

If the stent is placed to provide a latticework for deployment of the embolism coil, then no. You would just bill for the embolization. If the stent itself is the sole definitive procedure to treat the aneurysm, then only the stent should be billed.

Billing for Lesion Intervention Crossing Territories

Question:

Our vascular surgeon documented a single intervention for a lesion that crosses the margin between the fem/pop and tibial/peritoneal territories. Should we bill one code or one for each territory?

Answer:

You would bill one code since a single intervention was performed, even though it crossed into another territory.

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.