Appeal type: Testing
Decision: Unfavorable

We decided that the Plan does not have to pay for  an ultrasound evaluation of blood vessel with review by a 
radiologist, with each additional vessel (37253) and a radiological supervision and interpretation for bilateral 
angiography of extremities (75716) provided on August 27, 2022. 
 
You asked the Plan to pay for  an ultrasound and a x-ray. You say that the claim should be paid as billed. The 
Plan denied your request. The Plan says some of the billed services were approved on the appeal; however, 
procedure code 37253 remains not supported. Also, current procedural terminology (CPT) code 75716 would 
not be reported separately, as per NCCI Policy. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
In this case, the CPT Code Manual definition of codes 37253 and 75716 is intravascular ultrasound 
(noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological 
supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for 
primary procedure) and angiography, extremity, bilateral, radiological supervision and interpretation. 
 
We asked our coder 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 a ultrasound and a x-ray. Our reviewer says that 
documentation does not support procedure code 37253, and procedure code 75716 cannot be reported 
separately.  Our reviewer found that the procedure report does not provide clear documentation to support the 
ultrasound evaluation of blood vessel with review by radiologist, each additional vessel billed was provided. 
Also, according to the National Correct Coding Initiative (NCCI) edits, an edit exists between column I code 
37227 and column II code 75716. Physicians should report the HCPCS/CPT code that describes the procedure 
performed to the greatest specificity possible. A HCPCS/CPT code should be reported only if all services 
described by the code are performed'. In this case, the requested CPT code was not documented in the narrative 
of the operative report, for the number of units billed. Regarding the submitted (CPT) code of 75716-59, the 
arteries of bilateral extremities such as both arms and legs, that are not normally seen in an x-ray are examined 
radiologically by injecting contrast material. A local anesthetic is applied over the area of access which could 
be femoral, brachial, subclavian, or axillary artery. The artery is percutaneously punctured with a needle and a 
guidewire is fed through the artery to the point of study. A catheter is threaded over the guidewire until it, too, 
reaches the point of study and the guidewire is removed. Contrast medium is injected through the catheter and a 
series of x-rays or fluoroscopic images taken to visualize the vessels and evaluate any abnormalities. The 
catheter is removed, and pressure applied to the site. This code reports the radiological supervision and 
interpretation. Use a separately reportable code for the catheterization. 
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of an ultrasound and an x-ray have not been met. Therefore, we decided that the 
Plan does not have to pay for  an ultrasound evaluation of blood vessel with review by a radiologist, with each 
additional vessel (37253) and a radiological supervision and interpretation for bilateral angiography of 
extremities (75716) provided on August 27, 2022.