Any thoughts of dx code for this?
Thanks so much
Diane Peterson CPC
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SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest. SET has been recommended as the initial treatment for patients suffering from IC, the most common symptom experienced by people with PAD.
SET program covers Up to 36 sessions over a 12-week period if all of the following components of a SET program are met:
The SET program must:
Consist of sessions lasting 30-60 minutes, comprising a therapeutic exercise-training program for PAD in patients with claudication.
Be conducted in a hospital outpatient setting, or a physician’s office.
Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD.
Be under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques.
Coding Requirements for SET
CPT:
93668 Peripheral arterial disease (PAD) rehabilitation, per session
ICD 10 Codes:
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.318 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.618 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.718 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, other extremity
Place of Service (POS):
11 Office
19 Off Campus-Outpatient Hospital
22 On Campus-Outpatient Hospital
MACs will deny claims for SET if services are not provided in above POS.
You may also like “Coverage information for Therapy services“
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Tag Archives: Exercise
Using the diagnosis Exercise counseling in WCC
Hello!
I am the Billing Manager of a pediatric office that is apart of The Children’s Care Network. TCCN has codes that we need to include in our list of diagnosis’ for well checks. One of those codes is Z71.82 which is Exercise counseling. UHC has been placing co pays on well checks lately and when I inquired with customer service they said that the Z71.82 is not considered preventative. Has anyone else had this issue? UHC is one of pickiest payers when it has to do with diagnosis coding. (That I have seen anyway!) Thanks in advance for your time and knowledge!
Amanda 
There’s a Time and Place for Supervised Exercise Therapy
Don’t expect Medicare to reimburse SET unless you meet all the requirements. The Centers for Medicare & Medicaid Services (CMS) considers supervised exercise therapy (SET) reasonable and necessary for Medicare beneficiaries with intermittent claudication (IC) for treatment of symptomatic peripheral artery disease (PAD), but there are many requirements for coverage. A National Coverage Determination (NCD) for SET, effective May […]
AAPC Knowledge Center
Coding guidelines for Supervised Exercise Therapy (SET)
SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest. SET has been recommended as the initial treatment for patients suffering from IC, the most common symptom experienced by people with PAD.
SET program covers Up to 36 sessions over a 12-week period if all of the following components of a SET program are met:
The SET program must:
Consist of sessions lasting 30-60 minutes, comprising a therapeutic exercise-training program for PAD in patients with claudication.
Be conducted in a hospital outpatient setting, or a physician’s office.
Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD.
Be under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques.
Coding Requirements for SET
CPT:
93668 Peripheral arterial disease (PAD) rehabilitation, per session
ICD 10 Codes:
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.318 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.618 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.718 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, other extremity
Place of Service (POS):
11 Office
19 Off Campus-Outpatient Hospital
22 On Campus-Outpatient Hospital
MACs will deny claims for SET if services are not provided in above POS.
You may also like “Coverage information for Therapy services“