Appeal type: Surgery
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 36200, 36246, 36248, and 75710 billed for 
date of service June 23, 2021. 
 
You asked the Plan to pay for procedure codes 36200, 36246, 36248, and 75710. You say that these services 
should be paid. The Plan denied your request. The Plan says the record does not support the services billed. 
 
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 code 36200 is Introduction of catheter, aorta.  The CPT Code 
Manual definition of code 36246 is Selective catheter placement, arterial system; initial second order 
abdominal, pelvic, or lower extremity artery branch, within a vascular family.  The CPT Code Manual 
definition of code 36248 is  is Selective catheter placement, arterial system; additional second order, third 
order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in 
addition to code for initial second or third order vessel as appropriate).  The CPT Code Manual definition of 
code 75710 is Angiography, extremity, unilateral, 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 procedure codes 36200, 36246, 36248, and 75710. Our 
reviewer says that codes 36200, 36246, and 36248 are not supported by the medical record.  
 
Our reviewer found for code 36200, Medicare states that "Cardiac catheterization, percutaneous coronary artery 
interventional procedures (angioplasty, atherectomy, or stenting), and internal cardioversion include insertion 
of a needle and/or catheter, infusion, fluoroscopy and ECG rhythm strips. All these services are components of 
a cardiac catheterization, percutaneous coronary artery interventional procedure, or internal cardioversion and 
are not separately reportable. Additionally, ultrasound guidance is not separately reportable with these 
procedures. Providers/suppliers shall not report CPT codes 76937, 76942, 76998, 93318, or other ultrasound 
procedural codes if the ultrasound procedure is performed for guidance during one of these procedures.   
 
For code 36246, the operative report does not describe per NCCI Policy Manual, initial second order selective 
catheter placement, "needle is inserted into underlying artery, and threads a guidewire through the needle and 
into the artery, the needle is removed, and the wire is threaded into the specific vessel.  A catheter follows the 
wire into the artery branch. The wire is removed.  Contrast material for arteriography is injected into the 
catheter".  Operative report documents:  "Concurrently stiff Glide wire was replaced into the abdominal aorta 
and the tract was dilated with a 6 French sheath after the micro puncture sheath was removed. On the right 
NGS_9653712 a 7 French by 25cm sheath was then placed into the aorta and on the left an 8 French by 25 cm 
sheath was placed into the external iliac artery. A left iliac angiogram was performed, and the left hypogastric 
artery was selected. An 8mm x 24cm, 8mm x 12cm and 6mm x 17cm Azur coils were then used to pack of left 
hypogastric artery above the bifurcation into the anterior and posterior division. The 8 French sheath was then 
advanced over the dilator into the aorta. A completion angiogram was then performed. The bilateral sheaths 
were removed and the Perclose device cinched down over the wire. There was no significant bleeding from 
either puncture site and the wires were removed."   
 
For code 36248, the operative report does not describe per NCCI Policy Manual "Needle inserted into 
underlying artery.  A guidewire is threaded through the needle into the artery and needle is removed.  The 
guidewire is manipulated into the specific artery.  A catheter follows the wire into the third order, Contrast 
material for arteriography is injected into catheter that been guided to the site under investigation". The 
operative report documents "Concurrently stiff Glide wire was replaced into the abdominal aorta and the tract 
was dilated with a 6 French sheath after the micro puncture sheath was removed. On the right NGS_9653712 a 
7 French by 25cm sheath was then placed into the aorta and on the left an 8 French by 25 cm sheath was placed 
into the external iliac artery. A left iliac angiogram was performed, and the left hypogastric artery was selected. 
An 8mm x 24cm, 8mm x 12cm and 6mm x 17cm Azur coils were then used to pack of left hypogastric artery 
above the bifurcation into the anterior and posterior division. The 8 French sheath was then advanced over the 
dilator into the aorta. A completion angiogram was then performed. The bilateral sheaths were removed and the 
Perclose device cinched down over the wire.  
 
For code 75710, although this procedure is documented in the operative report, documentation does not support 
this procedure as separate from CPT 37242 (which includes radiological and interpretation). 
 
Based on this information, we decided that Medicare rules for coverage of procedure codes 36200, 36246, 
36248, and 75710 have not been met. Therefore, we decided that the Plan does not have to pay for procedure 
codes 36200, 36246, 36248, and 75710 billed for date of service June 23, 2021.