Appeal type: Practitioner Services
Decision: Partially Favorable

 
We decided that the Plan has to pay for 75736. We decided that the Plan does not have to pay for 75710 and 
36246.  
 
You asked the Plan to pay for angiography and selective catheter placement provided to the enrollee on June 
29, 2022.. You say that this should be paid for. The Plan says that the documentation does not support the 
services billed. 
 
We decided that the Plan has to pay for 75736.  
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to determine if the Plan was correct in denying the request for CPT 75736. The definition of this code is 
"Angiography, pelvic, selective or supraselective, radiological supervision and interpretation." Our reviewer 
says that there is satisfactory documentation of a pelvic angiogram demonstrating active hemorrhage from a 
left internal iliac anterior division branch. This is separately reportable from the embolization code. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have been met. Therefore, we decided that the Plan has to pay for 
75736.  
 
We also decided that the Plan does not have to pay for 75710 and 36246. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code.  
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request to pay for 75710 and 36246. The definition of these 
codes is: 
 
CPT 36245: 
 
Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery 
branch, within a vascular family 
 
CPT 75710: 
 
Angiography, extremity, unilateral, radiological supervision and interpretation 
 
Our reviewer says that CPT 75710 codes for supervision and interpretation of unilateral extremity 
angiography. There is no documentation that extremity angiography was performed. In terms of CPT 36245, 
this codes for a first order selective catheterization. A higher-level catheterization code, specifically 36246, 
coding for a second order catheterization, was already billed and covered. This supersedes the first order 
catheterization. Both are not billable unless there is clear documentation of the individual vessels catheterized 
and that the second order vessel was not a branch of the first order vessel. There is no documentation that this 
additional work was performed.  
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of 75710 and 36246 have not been met. Therefore, we decided that the Plan does 
not have to pay for 75710 and 36246. 
 
If the Plan does not agree with our decision, they can ask us to open a case again. We only open a case again 
if we believe there was a mistake or if there is new information to review. The Plan has to show us the mistake 
and/or send us the new information. This does not happen often. If we decide to open the case again, we will 
send you a letter.