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There are the standard reasons medical claims are denied, such as putting the wrong modifier on a code or putting the diagnoses in the wrong sequence. But did you know that some reasons are not the fault of medical coding? 5 Ways Your Claim Can Be Denied Denials can be cause by more than an […]
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Clinical diagnostic laboratories that fulfilled orders for targeted genomic sequence analysis panel CPT code 81455 between March 16, 2018, and March 31, 2018, may need to resubmit these claims to Medicare. Some claims may have been denied due to non-coverage for the given diagnosis. However, since the Centers for Medicare & Medicaid Services (CMS) announced […]
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Coding assigned: 36901 and 36907 ICD-10 T82.858A T82.868A N18.6 and Z99.2
Summary
Access type: Right Brachial A-Basilic V arm non-transposed AVF
Right unilateral upper extremity fistulogram
Subclavian vein: angioplasty
Contrast type: Omnigpague 18cc (LOCM 300-399mg/ml iodine, 1ml)
Closure type-sutured
Technique:
The patient as brought to the endovascular suite, placed in a supine position and draped in routine sterile fashion. All aspects of the time-out verification were satisfactorily completed prior to the beginning of the procedure. The right upper extremity was prepped using Chloraprep. Moderate sedation/analgesic(conscious sedation) administered with critical care nurse to monito the level of consciousness and physiological status for the total of 30 min(s) using 100 mcg Fentanyl and 1 mg versed. The lower basilic vein was accessed in an antegrade fashion using an 18 gauge needle. A guide wire was introduced through the needle. The needle was removed and a 4-FR sheath was advanced. The sheath was flushed and fistulogram was performed. After carefully reviewing the diagnostic fistulogram, it was decided to proceed with intervention. The 4-Fr sheath was removed and upsized for 7-Fr sheath.
Intervention:
A catheter was placed over the wire in the subclavian vein. A 12 mm x40mm balloon angioplasty was performed on the vessel
Hemostasis:
All wires, catheters and sheaths were removed. The puncture site was sutured.
Findings:
Subclavian vein: occluded
Post Intervention Findings:
The residual stenosis is 40% in subclavian vein
Conclusions:
Successful, uncomplicating recanalization and treatment of outflow central venous occlusion at right subclavian vein with high pressure 12 mm balloon angioplasty as described above
This access is ready for use as needed. Given the high likelihood of recurrent stenosis/occlusion, it is recommended that this patient be clinically evaluated for possible repeat intervention in 3 months. From our standpoint, this access is useable. There is a superficial segment near the arterial anastomosis in the antecubital fossa involving the median cubital vein/ lower basilic vein that courses over the medial epicondyle that is easily palpable and of sufficient caliber before plunging far too deep in the upper arm basilic vein component. We recommend that using this portion should be attempted now. To facilitate cannulation the desired cannulation zones were marked on the skin with a magic marker. Depending on how this goes, a decision to revisit superficialization/transportation surgery can be reconsidered. If access continues to give difficulty and is never going to be transposed/superficialized, then access ligation at the arterial anastomosis is recommended to lessen likelihood/severity of recurrent symptomatic right subclavian vein occlusion.
CPT 78492 is a Cardio imaging procedure and for its need more appropriate modifier should be obtained to indicate the clinical determination. suggested to send corrected claim with valid modifier for the CPT 78492.
DOS 02/11/2019.
We have billed only PET service for this DOS and no additional service billed on same day. Also patient does not have any global.
Can you anyone suggest what modifier require for this.
I require someone assistance. I have reported CPT 3014F, 3017F. insurance denied this CPT as non covered, Could you please suggest any other alternate CPT for the same.
3014F – Screening mammography results documented and reviewed (PV)
3017F – Colorectal cancer screening results documented and reviewed (PV)
Thanks
Subha.P.CPC
Thanks!
I have two separate patients who have Carefirst BC/BS and both are having the end of treatment OTV denied as experimental. The plan, 5 fractions and all other charges during treatment have gone through just fine, and the ICD 10 is appropriate for SBRT. There are no other charges on the date of service that would bundle it and for the life of me I can’t figure out why they are denying it. Anyone else have this problem or know why this is happening?
Thanks 
Valid claims submitted by physical therapists (PTs) in private practice are being denied by some Part B Medicare Administrative Contractors (MACs), according to the Centers for Medicare & Medicaid Services (CMS). These claims are for the professional component (PC) or global code for certain diagnostic services involving electromyography (EMG), nerve conduction velocity (NCV), and sensory-evoked […]
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