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July 1996

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"Ms. Gail Sandager, 8-5221, N4E04, Vascular" <[log in to unmask]>
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From:
"Ms. Gail Sandager, 8-5221, N4E04, Vascular" <[log in to unmask]>
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Fri, 19 Jul 1996 08:35:04 EDT
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Date:          18 Jul 96 14:58:36 EDT
Reply-to:      [log in to unmask]
From:          "Franklin W. West" <[log in to unmask]>
To:            UVM Flownet <[log in to unmask]>
Subject:       Re:  "coding"

Gail,
re:
>>I need help regarding coding for hemodialysis grafts - whenever
>>we  use the ICD code 996.7 for stenosis, thrombosis, etc of a
>>access  graft using the duplex of the access graft code we are
>>denied  payment.  Of course this is only a medicare problem,
>>but every renal  failure pt. is medicare.  Medicare tell us it
>>has to be a problem  because  from manufacturing of the
>>device!!!  Any suggestions or  other possible codes.  

Sounds like they have not given you the entire story, managing to leave out a
couple of key details & tossing in a bit of misinformation just for fun.

First, 996.7 is not an appropriate ICD code only because it doesn't pass the
required specificity test.  That is, the appropriate code is 996.73.

"996.7  Other complications of internal (biological) (synthetic) prosthetic
device, implant, and graft  [Complication NOS, occlusion NOS, fibrosis,
hemorrhage, pain, stenosis, or thrombosis due to (presence of) any graft
classifiable to 996.0 - 996.5]"*

*996.1 refers to "... vascular device, implant, and graft" and its examples
specifically include surgically created arteriovenous fistula or shunt.

"996.73  Due to renal dialysis device, implant, and graft"

The 1996 ICD-9-CM codebook contains no reference to problems secondary to
defects due to manufacturing relative to these codes.  Numerous other codes
exist that could work but 996.73 would be the most appropriate.

*********************************************************

Franklin W. West
writing at 11:57 AM, 
on Thursday, July 18, 1996

Pacific Vascular, Inc.
18702 North Creek Parkway, Suite 212
Bothell, WA   98011

Office:  (206) 483-4058
Fax:     (206) 486-8976
E-mail:  [log in to unmask]
**************************************************************

Frank

Thnaks for the input, however we had initially used the 996.73 code 
for related anastomotic stenoses and were told that it had to be a 
manufacturing problem with the graft itself and were denied every 
time.  If you feel that is the most appropriate code we will appeal 
these cases.  I did not want to spend the time appealling if it really 
wasn't the code of choice. Thanks for the input I will now forge 
ahead!!

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