On Demand: Vascular Coding Series 3: Open Vessel Procedures-Q&A

Q&A
Pdf Summary
This document is a question-and-answer session from MedAxiom, dated October 24, 2024, focusing on vascular coding for open vessel procedures. It addresses various coding queries commonly encountered by practitioners.<br /><br />1. **Vein Harvest Coding:** When bypass veins are harvested from locations other than commonly used areas like the femoropopliteal or upper extremities, an unlisted code might be applicable, although this situation is rare.<br /><br />2. **Modifier Issues:** It discusses discrepancies in claim rejections with modifiers 78 and 59, suggesting a check with the carrier, as some prefer the 58 modifier.<br /><br />3. **Included Procedures:** Debridement is generally considered part of the procedural preparation when reopening a previous incision unless it's performed on a separate area.<br /><br />4. **Endarterectomy Coding:** For coding, separate incisions are required if the procedure involves multiple arteries like the SFA or profunda.<br /><br />5. **Carotid Endarterectomy and EEG Monitoring:** Whether EEG monitoring during a carotid endarterectomy can be coded separately depends on who reads the EEG and meets documentation requirements, usually performed by a neurologist.<br /><br />6. **Aortic Aneurysm Repair with Infected Graft:** Both the repair and removal of an infected graft can be coded when an aortic aneurysm repair is involved, given there's no coding bundling.<br /><br />7. **Timeline for EVAR and Open AAA Repair Coding:** Codes 34830-34832 are used whenever a previous EVAR fails, regardless of the time elapsed before an open repair is conducted.<br /><br />8. **Ligation vs Aneurysm Repair:** Ligation procedures preparing vessels for a primary procedure are typically included, requiring case specifics for definitive guidance.<br /><br />9. **Case-Specific Modifier Use:** It discusses modifiers 80, 82, and AS related to the involvement of assistants and stipulates not using modifier 62 for providers of the same specialty.<br /><br />10. **Catheter Selection in Open Procedures:** Generally, a selective catheter isn't separately coded unless used diagnostically prior to surgery.<br /><br />11. **Anatomical Modifiers:** For procedures involving singular vessels, some payers may require LT/RT modifiers to indicate the side of access. <br /><br />Overall, the document provides comprehensive coding clarification, addressing how procedural nuances and documentation requirements influence correct coding practices.
Keywords
vascular coding
open vessel procedures
vein harvest
modifier issues
endarterectomy coding
carotid endarterectomy
aortic aneurysm repair
EVAR coding
ligature procedures
anatomical modifiers