Appeal type: Practitioner Services
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 36245, 36246, 37244, 75726, 75774, and 
99152 rendered on August 15, 2022. 
 
You asked the Plan to pay for the services. You say that this should be paid for. The Plan denied your request. 
The Plan says the denied codes remain not supported. 
 
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 the denied codes is: 
 
CPT 36245: 
 
Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family 
 
CPT 36246: 
 
Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery 
branch, within a vascular family 
 
CPT 37244: 
 
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural 
roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage 
or lymphatic extravasation 
 
CPT 75726: 
 
Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision 
and interpretation 
 
CPT 75774: 
 
Angiography, selective, each additional vessel studied after basic examination, radiological supervision and 
interpretation (List separately in addition to code for primary procedure) 
 
CPT 99152: 
 
Moderate sedation services provided by the same physician or other qualified health care professional 
performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an 
independent trained observer to assist in the monitoring of the patient's level of consciousness and 
physiological status; initial 15 minutes of intraservice time, patient age 5 years or older 
 
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 the services. Our reviewer says that the services at issue in 
this case were not supported by the medical records. Our reviewer found that documentation does not support 
that the procedures indicated by the codes in question were rendered. 36245 indicates a first order selective 
cannulation and 36246 a second order selective cannulation.  Typically, 36245 is a component of 36246 and is 
not separately billable unless there is documentation of a completely separate catheterization area.  However, in 
this case, there is unsatisfactory documentation of cannulation and therefore does not support that either of 
these services were provided.  Photos of angiographic images in the absence of the corresponding operative 
note do not satisfy these criteria.  
 
CPT 75726 and 75774 indicate supervision and interpretation of angiographic images of a visceral vessel or a 
catheterized separate vessel respectively. As the documentation does not include interpretation of images, 
coverage of these codes cannot be justified or supported even though they could potentially be separately 
billable. 
 
CPT 37244 indicates embolization for hemorrhage.  The documentation does not include a description of an 
embolization procedure to satisfy use of this code. 
 
CPT 99152 indicates moderate sedation for the first 15 minutes provided there is a separate individual 
monitoring the patient under the supervision of the physician.  The documentation does not satisfactorily 
substantiate use of this code. 
 We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have not been met. Therefore, we decided that the Plan does not 
have to pay for procedure codes 36245, 36246, 37244, 75726, 75774, and 99152 rendered on August 15, 2022.