Ask Dr. Z

"LCC/LIC angiography showing 85% occlusion. Thrombectomy x 3 with no improvement. Decision to place stent. IMPRESSION: Successful left supraclinoid intracranial internal carotid artery stent placement after three passes with aspiration catheter and stent retriever demonstrated no improvement in the near occlusive supraclinoid left internal carotid artery filling defect. Findings suggest acutely ruptured supraclinoid carotid artery plaque causing the patient's stroke syndrome." 

Inpatient status. Billed to Medicare with 61635 but denied for modifier. No modifier used and none found that seem to be applicable. Medicare also not being helpful in helping us determine exactly what it is they want. Should this be billed as thrombectomy instead of stent placement? The dx codes are I63.432 and I67.2.