Vascular Coding Questions and Answers

Overview

Coding is a complicated aspect of all medical fields. To help vascular surgery professionals better understand the ins and outs of coding, the SVS will be posting frequently asked questions and their answers on this webpage. If you have questions of your own, they can be submitted via the form below.

Frequently Asked Questions

Date/Topic	Question/Answer
April 2023 Lesion Crossing Two Territories	Q: Our vascular surgeon did a single intervention on a lesion that was at the juncture of the femoral/popliteal and tibial/peritoneal territories. Can we charge for two interventions? A: Lesions that extend across the margins of one vessel vascular territory into another, but can be treated with a single therapy are reported with a single intervention code.
April 2023 Venogram and Catheterization	Q: During catheterization, the surgeon performed a venogram. I don’t see that these procedures are bundled, is that correct? A: Venous catheterization codes are separately reported with venograms unless they are performed at the same session with an intervention that includes catheterization.
April 2023 Catheterization and Intervention Billing	Q: Does TEVAR allow for billing of catheterization and intervention? Would a 59 modifier be needed? A: Yes, billing for catheterization in addition to the TEVAR is allowed. And no, a modifier 59 is not needed as these two codes do not bundle.
April 2023 Nonselective or Selective	Q: When does a nonselective catheterization become a selective catheterization? A: If the catheter (not just the wire) is manipulated into another vessel beyond the puncture site or beyond the aorta, then it is coded as a selective catheterization.
April 2023 Modifier 52 VS 53	Q: We are confused about the difference between modifier 52 and 53. What is the difference? A: Modifier 52 Reduced Services is used when the procedure or surgery is partially reduced or eliminated by the physician. This is used when a procedure has an existing CPT code, but not all of the components of the code were performed. Modifier 52 is not used for unlisted procedures (where there is no existing CPT code to describe the procedure that was performed). Modifier 53 Discontinued Procedure is used when a procedure is discontinued due to extenuating clinical circumstances or those that threaten the well-being of the patient. An example is during a fem-pop bypass a patient develops an arrhythmia and the procedure is discontinued.
April 2023 Wound Vac Billing	Q: I’m a vascular surgeon. Some of my team are reporting the negative pressure wound therapy codes 97605 and 97606 when applying wound vacs after closing at the completion of their surgical cases. As a result, I am told by my coders that billing for these wound vacs is not appropriate, since there is a Medicare NCCI edit that bundles this with more comprehensive procedures at the same anatomic area. The physicians and coders disagree about how to handle these edits. Some of the physicians believe the wound vacs are billable because they are applied to the skin which constitutes a different body system. The coders think the wound vacs are dressings which are included in the global surgical fee and would not billable. After multiple discussions with the physicians and coders, we are unable to provide a definitive answer. Could I please ask you for your advice regarding this issue? What is the right answer? A: The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and closed wounds. However, that does not mean that payors will reimburse separately for the service, so use caution and track results.
April 2023 Angiogram billing for All Vessels Viewed	Q: Can we bill for all vessels mentioned if they are documented within the angiogram? A: No. You should only bill for vessels that are targeted and are medically necessary. Documentation alone doesn’t mean that procedures are always separately billable.
April 2023 Co-Surgery Due to Complex Procedure	Q: I have 2 vascular surgeons from the same practice that want to bill co-surgery for a complex open abdominal aneurysm repair. They both performed the same code but say that it should be co-surgery because it was complex and needed both surgeons. Can we bill with modifier -62? A: The surgery described does not support the definition of a co-surgery (each surgeon performs distinct work described within the same code) and should be billed as a primary and assistant surgeon. Co-surgery implies two surgeons with a different skill set, i.e. different specialties, each provider performing distinct portions of the case, and each documenting their portion in separate operative reports. Also, Medicare and other payors may require that surgeons be of different specialties when billing for co-surgery. Note that the federal Office of Inspector General (OIG) has identified co-surgery as an area of potential overpayment/incorrect payment, making this an audit target. For more information go to the link below: https://oig.hhs.gov/oas/reports/region1/12000503.asp

Date/Topic

Question/Answer

April 2023

Lesion Crossing Two Territories

Q: Our vascular surgeon did a single intervention on a lesion that was at the juncture of the femoral/popliteal and tibial/peritoneal territories. Can we charge for two interventions?

A: Lesions that extend across the margins of one vessel vascular territory into another, but can be treated with a single therapy are reported with a single intervention code.

April 2023

Venogram and Catheterization

Q: During catheterization, the surgeon performed a venogram. I don’t see that these procedures are bundled, is that correct?

A: Venous catheterization codes are separately reported with venograms unless they are performed at the same session with an intervention that includes catheterization.

April 2023

Catheterization and Intervention Billing

Q: Does TEVAR allow for billing of catheterization and intervention? Would a 59 modifier be needed?

A: Yes, billing for catheterization in addition to the TEVAR is allowed. And no, a modifier 59 is not needed as these two codes do not bundle.

April 2023

Nonselective or Selective

Q: When does a nonselective catheterization become a selective catheterization?

A: If the catheter (not just the wire) is manipulated into another vessel beyond the puncture site or beyond the aorta, then it is coded as a selective catheterization.

April 2023

Modifier 52 VS 53

Q: We are confused about the difference between modifier 52 and 53. What is the difference?

A: Modifier 52 Reduced Services is used when the procedure or surgery is partially reduced or eliminated by the physician. This is used when a procedure has an existing CPT code, but not all of the components of the code were performed. Modifier 52 is not used for unlisted procedures (where there is no existing CPT code to describe the procedure that was performed).

Modifier 53 Discontinued Procedure is used when a procedure is discontinued due to extenuating clinical circumstances or those that threaten the well-being of the patient. An example is during a fem-pop bypass a patient develops an arrhythmia and the procedure is discontinued.

April 2023

Wound Vac Billing

Q: I’m a vascular surgeon. Some of my team are reporting the negative pressure wound therapy codes 97605 and 97606 when applying wound vacs after closing at the completion of their surgical cases. As a result, I am told by my coders that billing for these wound vacs is not appropriate, since there is a Medicare NCCI edit that bundles this with more comprehensive procedures at the same anatomic area.

The physicians and coders disagree about how to handle these edits. Some of the physicians believe the wound vacs are billable because they are applied to the skin which constitutes a different body system. The coders think the wound vacs are dressings which are included in the global surgical fee and would not billable. After multiple discussions with the physicians and coders, we are unable to provide a definitive answer. Could I please ask you for your advice regarding this issue? What is the right answer?

A: The AMA published clarification on wound vac billing in the October 2021 CPT Assistant. Negative pressure wound therapy (97605-97606) is considered billable for both open and closed wounds. However, that does not mean that payors will reimburse separately for the service, so use caution and track results.

April 2023

Angiogram billing for All Vessels Viewed

Q: Can we bill for all vessels mentioned if they are documented within the angiogram?

A: No. You should only bill for vessels that are targeted and are medically necessary. Documentation alone doesn’t mean that procedures are always separately billable.

April 2023

Co-Surgery Due to Complex Procedure

Q: I have 2 vascular surgeons from the same practice that want to bill co-surgery for a complex open abdominal aneurysm repair. They both performed the same code but say that it should be co-surgery because it was complex and needed both surgeons. Can we bill with modifier -62?

A: The surgery described does not support the definition of a co-surgery (each surgeon performs distinct work described within the same code) and should be billed as a primary and assistant surgeon. Co-surgery implies two surgeons with a different skill set, i.e. different specialties, each provider performing distinct portions of the case, and each documenting their portion in separate operative reports. Also, Medicare and other payors may require that surgeons be of different specialties when billing for co-surgery. Note that the federal Office of Inspector General (OIG) has identified co-surgery as an area of potential overpayment/incorrect payment, making this an audit target. For more information go to the link below:

https://oig.hhs.gov/oas/reports/region1/12000503.asp

This Non-CME Activity is supported through an educational grant provided by CVRx.

Vascular Coding Questions and Answers

Overview

Frequently Asked Questions

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