Ask Dr. Z

I hope we can reach out to you once more for your expertise. We have a newly credited stroke center and one of our interventional radiologists is treating vertebral occlusions with stents. Cases are coded with 00.61 and 00.64. We are getting MCR rejections; our edits state 00.61 (plasty) needs to be billed in conjunction with 00.63 (carotid stent). The only reference I find is NCD 20.7 which seems to indicate only carotid stenting (w/ or w/out EP) is covered and verbebral remains non-covered. Our doc insists this is the only treatment indicated for the patient symptoms/ presenting problems. He also indicates the procedure can be described as a “Mechanical thrombectomy / revascularization of the vertebral artery” In the end, the stent is the therapeutic procedure performed and thus, coded.

Would you know if there is MCR coverage for vertebral stents (perhaps we are not coding them correctly) or if there is any other treatment alternative for these symptomatic patients with confirmed vertebral obstructions?

As always, your comments are greatly appreciated!