Ask Dr. Z

We received a claim denial for excessive procedures based on the following codes: 35355-50, 37221-50, 37236. The patient had bilateral LE AS with life-limiting claudication and severe proximal aortic stenosis. Our physician performed the following procedures: bilateral iliofemoral endarterectomy with patch angioplasty, aortogram and bilateral iliac angiograms; placement of an 8 x 39 VBX stent within the proximal abdominal aorta; SWL of the left common and EIA; placement of a 6mm x 10cm Viabahn stent in the left EIA; placement of a 7 x 40 bare metal self-expanding stent in distal common and proximal EIA; placement of a 7mm x 15cm Viabahn stent within the right common and EIA.

Are the endarterectomy and stenting procedures bundled, as in two treatments in one vessel? If so, which should be coded? Did we miss coding any of the procedures? Please advise on the correct coding for this case, and why. Thank you.