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Here is your ZHealth Coding Newsletter for
October 2006
The following is
a recent example submitted by a member of ZHealth
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Coding
Question: The physician's intent was
to perform an Angioplasty of the SFA & Popliteal.
This was unsuccessful, therefore, atherectomies of each
vessel were performed with stent placement in the SFA.
Is it correct to bill for the two atherectomies and not
the angioplasty? And, can we also bill for the stent
placement?
Dr. Z’s
Answer:
AnCMS states in the 12.3 Provider Policy Manual that was
released 10/1/2006 that the more comprehensive
atherectomy procedure bundles the lesser angioplasty
intervention if performed at the same site, which is
what it sounds like occurred here.
They do allow separate stent placement to be
billed, as long as sub-optimal result from the
atherectomy is documented. This is different from what
was developed in 1992 for component coding, which
allowed the separate billing of the angioplasty and
atherectomy if one was suboptimal and documented as
such. SIR still supports the use of
both codes but CMS does not appear to, so, currently I
have to do what the payor says and work to educate and
change the payors' interpretation along with the
SIR. | 
