Ask Dr. Z

Regarding bilateral renal angioplasty 35471-50. Following renal angiography: “An intervention was initially performed on the superior left renal artery, which represented in-stent restenosis. A LIMA guide utilized. A Whisper wire advanced distal and balloon inflation with a 5 x 15 balloon at 12 atmospheres. Final angiogram: No residual stenosis. Attention was then turned to the right renal artery. Guide engagement 0.014 Whisper wire advanced distal and balloon inflations with a 4.0 balloon. There was significant recoil and it became obvious that stenting would be required. A 6.0 x 18 balloon-expandable stent was deployed at 10 atmospheres. Final angiogram: No residual stenosis.  Would you charge 35471-50 or 35471 times two (that is, two separate line items)? Of course, also charge for stenting of right renal artery. My belief is that we need to have a separate charge in the CDM for 35471-50 and that it is not correct to charge either 35471 (unilateral) and append a -50 OR to charge 35471 times two. In the first situation, I don't think we'd be reimbursed properly for the physician's extra risk, work, skill, and time and in the second situation, I think it could be construed as overcharging. I REALLY APPRECIATE YOUR HELP.