We have won at least one ALJ case ( about 8 patients) on pre-op CABG that I can recall. We would be happy to share it with you. As you are probably aware, each Carrier has their own Medical Director for Medicare, therefore each has their own individual interpretation of ICD-9's acceptable per CPT code. What is acceptable for one Carrier is not necessarily acceptable to another. The best advice you can get is from you peers within your own jurisdiction for your Medicare Carrier.

ALJ decisions are also not precedent setting. However, we have submitted them with Appeals and Fair Hearings and received favorable rulings.

Bob Kane


  ----- Original Message ----- 
  From: [log in to unmask]<mailto:[log in to unmask]> 
  To: [log in to unmask]<mailto:[log in to unmask]> 
  Sent: Wednesday, September 28, 2005 10:54 AM
  Subject: billing codes


  I was hoping to obtain some help with correct diagnosis (ICD-9) billing codes for the following procedures in the state of Florida...any information would be helpful even corrections of the CPT codes we are using...
  Vein mapping Lower (or Upper) extremity CPT 93971
  for vascular surgery ICD 9 459.81 / V72.83 / and code that idicates vascular disease the surgery is being done for such as 440.22 -PVD with rest pain
  Patient we do upper and lower vein mapping on the same day we bill a CPT 93971 x 2 with a 59 modifier (distinct and separate procedure) 
  The other scenerio would be lower extremity vein mapping for CABG...? ICD 9 codes
  Carotid study CPT 93880 for pre-op CABG with no other symptoms ? ICD-9 codes
  AVF evaluations CPT code G0365 ??ICD 9 codes

  Thanks in advance for any help
  Deanna Shelpman RVT
  Shands at the University of Florida
  Gainesville, Fl 32610

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