Ask Dr. Z

Regarding the previous Q&As about billing open thrombectomy with open angioplasty or open stent placement, the advice was to bill 36833 for revision. We have been using 36833 instead of 36831 for open thrombectomy with open stent or angioplasty in the dialysis circuit. We have received several denials from Humana and Healthsprings after they have requested and reviewed the procedure notes. They are stating that all angioplasty and or stent placement in the dialysis circuit is bundled and we are billing 36833 in error. The only guideline we can find in CPT states open dialysis circuit creation, revision, and or thrombectomy (36818-36833) bundles peripheral segment angioplasty and or stent placement (36901 36902 36903) However dialysis circuit central segment angioplasty or stent placement may be reported separately (36907 36908). Is there any CPT guidelines or any other references that we can use for the appeals to show that we are correct in using 36833 for open thrombectomy with open stent or open angioplasty in the dialysis circuit?