Someone has his or her wires crossed. CMS is not about to suggest that
ultrasound guidance is never covered for, e.g., pericardiocentesis,
endomyocardial biopsy, intrauterine fetal transfusion or cordocentesis,
chorionic villus sampling, amniocentesis, aspiration of ova, biopsy, needle
placement, etc. - even the bureaucrats at CMS understand this one. I
promise that the source of this problem is not CMS ... so find out where the
"N" came from & look at whatever 'official' descriptor of the abbreviations
exist (none of our EOMBs ever have a single letter descriptor - rather they
are a combination of alphanumeric values (e.g., MA25, CO42, etc.) with a
text descriptor ... e.g., "CO50" = "These are non-covered services because
this is not deemed a "medical necessity" by the payer." (Interpretation =
"in our esteemed medical opinion, we don't think the patient needed what you
did - no matter how it altered the clinical course of the patient ... & if
you disagree, then you can go through the appeals process" - with apologies
for the cynicism but I am, at the moment, tired of having to fight to get
paid for procedures that determined precisely what type of intervention was
performed). Time for some R&R ...
Eighty-odd wonderful folks that attended the SVU Current Issues meeting last
week (the 'odd' modifying eighty, not folks) have all the CMS statutes,
rules, regulations, manuals, transmittals and memoranda ... & one of you
gets to weigh in here ... Dwight is deserving of some help ...
********************
Franklin W. West
PVI
425.398.7774 (voice)
425.486.8976 (fax)
[log in to unmask]
********************
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]On
Behalf Of Michael, Dwight
Sent: Tuesday, November 12, 2002 1:19 PM
To: [log in to unmask]
Subject: Re: Ultrasound Guided Pseudoaneurysm Repair
Thanks! According to the nurse auditor 96936 had an "N" code meaning that
it was no longer covered. She stated that all US Needle guidance codes were
no longer covered. (?)
-----Original Message-----
From: Franklin W. West [mailto:[log in to unmask]]
Sent: Tuesday, November 12, 2002 3:07 PM
To: [log in to unmask]
Subject: Re: Ultrasound Guided Pseudoaneurysm Repair
Not that I'm an expert but I am literate and do read ... (anyone that
attended the SVU Current Issues meeting this past week can review the CMS
coverage issues on the CMS CD ROM you received ... just a test, look up PPG
under 50-6 and carotid B-mode under 50-7 ;-)) ... then do a search on this
issue & see what you do not find ...
Dwight,
I hate to disagree with your "Nurse Auditor", but 76936 is covered under
Medicare (as cited in several PM, etc.). You might receive denials for a
variety of other reasons, but it is not because of any CMS program coverage
issue decision (if it were not a covered service, CMS would not have found
it necessary to require personal supervision for the code).
& No, you would not use 76936 for ultrasound guidance for needle placement
for thrombin injection (76936 is for use with "compression repair" as
opposed to "thrombin injection" repair). Ultrasound guidance for needle
placement is included under 76942. The code for the thrombin injection
(solely a physician service) is 36002 (& I sincerely doubt that anyone would
want to push thrombin into the arterial system by compressing a
pseudoaneurysm immediately after injection of thrombin - probably a very bad
idea). Also, the vignette used by the AMA CPT/PEAC and RUC for 36002
specifically did not include any diagnostic studies that might be medically
necessary to identify the existence of a pseudoaneurysm prior to injection.
So, you could conceivably wind up with, e.g., three CPT codes when seeing a
patient ... something like 93926 (limited lower extremity duplex) to
identify the existence of a pseudoaneurysm and thrombosis after the
injection, 36002 for the thrombin injection (claimed by the physician), and
76942 for the ultrasound guidance for needle placement ...
You might want to ask your "Nurse Auditor" for the reason for a denial (as
in from a patient's EOMB) ... I suspect a medical necessity denial, or even
a CCI rejection, as opposed to a coverage issue ... in which case you need
to appeal any denial (assuming everything else is in order) ...
********************
Franklin W. West
PVI
425.398.7774 (voice)
425.486.8976 (fax)
[log in to unmask]
********************
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]On
Behalf Of Dwight Michael
Sent: Tuesday, November 12, 2002 12:25 PM
To: [log in to unmask]
Subject: Ultrasound Guided Pseudoaneurysm Repair
Our "Nurse Auditor" in the business office called last week to notify me
that CPT 76936 (Ultrasound guided compression repare of arterial
pseudoaneurysm...) was not a Medicare covered CPT code. Since I don't
know "everything" I thought I would open this up for your input. For those
of you who really know for sure, are you getting paid for this code by
Medicare. Also do you use this code for thrombin injection. If not what
code do you use for thrombin. Input from Frank West as well as any
other "experts" out there would sure be appreciated.
Dwight Michael, RDCS, RVT
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