mlovorn1
New
Is anyone else having issues with insurances denying CPT 36902 when billed with CPT 37246? Our provider is billing the 37246 angioplasty separately because it is being performed on an artery outside of the dialysis circuit. (At least 2cm away from the perianastomotic area) There seems to be some confusion of what is actually included in the dialysis circuit and we are having issues getting the insurance companies to understand our explanations in our appeals. Has anyone else had this issue or found a way to resolve the confusion?
Example: Billed CPT 37246, 36902, 36215, 99152, Q9967
Procedure Note: The right arm was prepped and draped in the usual sterile fashion. The left upper arm brachio-cephalic fistula was cannulated with a 18G needle directed in a retrograde direction. A 0.035 inch guidewire was inserted and exchange made for a 7Fr sheath. Contrast (Q9967) injection via the side port of the sheath was performed. Angiogram of the outflow showed patient cephalic vein and cephalic arch. Most of her cepahlic vein and arch are previously stented. The central veins were patent. The angiogram of the fistula showed a 70% juxta-anastomotic cephalic vein stenosis along with a 70% proximal radial artery stenosis (5cm proximal to the arterial anastomosis and not in the peri-anastomotic area.) In order to better visulaize the arterial inflow of the fistula and diagnose any other arterial inflow problems, an arteriogram was necessary and justified .A glide wire was inserted through the 6Fr sheath and with the aid of a guiding catheter, the wire was manipulated across the arterial anastomosis with some difficulty to selectively catheterize the first order axillary artery (36215.) An arteriogram (75710) of the upper extremity was then performed via a 5Fr diagnostic catheter positioned in the axillary artery, The axillary, radial and ulnar arteries were normal in caliber but there was a distinct 60% stenosis in the proximal brachial artery (5cm proximal to the arterial anastomosis and not in the peri-anastomotic area) along with the previously seen 70% juxta-cephalic vein stenosis. The wire was replaced, and the catheter removed and a 5 x 40 mm angioplasty balloon was advanced across the arterial anastomosis and positioned across the proximal brachial artery lesion. Arterial angioplasty (37246) was carried out th 12 ATM at the proximal brachial artery lesion (5cm proximal to the arterial anastomosis and not in the peri-anastomotic area.) Next a 6 x 40 mm angioplasty balloon positioned over the wire in the juxta cephalic vein lesion. Venous angioplasty (36902) was then performed to 20 ATM. Given the risk of vascular rupture with a retrograde angiogram, an arterial angiogram was perfromed with the tip of the diagnostic catheter in the subclavian artery. A post-angioplasty catheter directed arteriogram showed less than 10% residual stenosis at both the proximal radial artery lesion and the juxta-cephalic lesion. The fistula vein had a stronger thrill. Augmentation was improved.
Example: Billed CPT 37246, 36902, 36215, 99152, Q9967
Procedure Note: The right arm was prepped and draped in the usual sterile fashion. The left upper arm brachio-cephalic fistula was cannulated with a 18G needle directed in a retrograde direction. A 0.035 inch guidewire was inserted and exchange made for a 7Fr sheath. Contrast (Q9967) injection via the side port of the sheath was performed. Angiogram of the outflow showed patient cephalic vein and cephalic arch. Most of her cepahlic vein and arch are previously stented. The central veins were patent. The angiogram of the fistula showed a 70% juxta-anastomotic cephalic vein stenosis along with a 70% proximal radial artery stenosis (5cm proximal to the arterial anastomosis and not in the peri-anastomotic area.) In order to better visulaize the arterial inflow of the fistula and diagnose any other arterial inflow problems, an arteriogram was necessary and justified .A glide wire was inserted through the 6Fr sheath and with the aid of a guiding catheter, the wire was manipulated across the arterial anastomosis with some difficulty to selectively catheterize the first order axillary artery (36215.) An arteriogram (75710) of the upper extremity was then performed via a 5Fr diagnostic catheter positioned in the axillary artery, The axillary, radial and ulnar arteries were normal in caliber but there was a distinct 60% stenosis in the proximal brachial artery (5cm proximal to the arterial anastomosis and not in the peri-anastomotic area) along with the previously seen 70% juxta-cephalic vein stenosis. The wire was replaced, and the catheter removed and a 5 x 40 mm angioplasty balloon was advanced across the arterial anastomosis and positioned across the proximal brachial artery lesion. Arterial angioplasty (37246) was carried out th 12 ATM at the proximal brachial artery lesion (5cm proximal to the arterial anastomosis and not in the peri-anastomotic area.) Next a 6 x 40 mm angioplasty balloon positioned over the wire in the juxta cephalic vein lesion. Venous angioplasty (36902) was then performed to 20 ATM. Given the risk of vascular rupture with a retrograde angiogram, an arterial angiogram was perfromed with the tip of the diagnostic catheter in the subclavian artery. A post-angioplasty catheter directed arteriogram showed less than 10% residual stenosis at both the proximal radial artery lesion and the juxta-cephalic lesion. The fistula vein had a stronger thrill. Augmentation was improved.
