Stab Phlebectomies

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.

Ablation of Truncal

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 separate access sites and treatments performed on a single leg.

Time Reporting for E/M Levels

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 (MDM) applied during the encounter, or
• Total time spent on the visit.

Providers may choose which component – MDM or time – they would like to use as long as the documentation supports the code chosen.

Reporting time is an option when selecting the level of Evaluation and Management servicewhetheror not counseling or coordination of care dominates the service. Time is calculated as the total time spent personally by the provider and/or QHP on the date of the encounter this includes both face-to-face and non-face-to-face time. Remember, there must be medical necessity to support reporting the E/M service by time. Typically, we do not expect vascular surgeons to code E/M services solely based on time.

Coding for TCAR

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 the area of the blockage.

TCAR is reported with the same code as a carotid stent, 37215,Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection.

Medicare High Risk Criteria in Carotid Stenting

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 of a surgeon. Significant comorbid conditions include but are not limited to:

• congestive heart failure (CHF) class III/IV;
• left ventricular ejection fraction (LVEF) < 30%;
• unstable angina.
• contralateral carotid occlusion;
• recent myocardial infarction (MI);
• previous CEA with recurrent stenosis ;
• prior radiation treatment to the neck; and
• other conditions that were used to determine patients at high risk for CEA in the prior carotid artery stenting trials and studies, such as ARCHER, CABERNET, SAPPHIRE, BEACH, and MAVERIC

Billing FEVAR with a Physician-Modified Endovascular Graft ( PMEG)

Question:

We use a Physician-Modified Endovascular Graft (PMEG) for our FEVAR procedures. Do we have to bill this with an unlisted code?

Answer:

No, use of a PMEG does not require billing as an unlisted code. Use the existing FEVAR codes based on endograft coverage and number of fenestrations.