Appeal type: Practitioner Services
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 36247, 37229, 37253, 75630, and 75716 
rendered on November 28, 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 records do 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 the denied codes is: 
 
CPT 36247: 
 
Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family 
 
CPT 37229: 
 
Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with 
atherectomy, includes angioplasty within the same vessel, when performed 
 
CPT 37253: 
 
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) 
 
CPT 75630: 
 
Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological 
supervision and interpretation 
 
CPT 75716: 
 
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 the services. Our reviewer says that the services at issue in 
this case were not supported by the medical records. Our reviewer found that the documentation does not 
support use of or coverage of the codes in question.  
 
CPT 36247 codes for selective catheterization.  Catheterization codes are bundled in the code for lower 
extremity intervention and are not separately reportable. CPT 37225 for femoral-popliteal atherectomy has 
been coded and covered and this includes the catheterization work. 
 
In terms of CPT 37229, this codes for tibial atherectomy. There is insufficient documentation in the medical 
record that tibial atherectomy was performed. Therefore, the documentation does not justify use of this code. 
 
In terms of CPT 37253, this codes for supervision and interpretation of intravascular ultrasound (IVUS) of an 
additional vessel beyond the initial imaged artery. There is unsatisfactory documentation of IVUS findings to 
justify billing or coverage of this code. 
 
CPT 75630 and CPT 75716 codes for supervision and interpretation of aortogram with iliofemoral runoff and 
bilateral extremity angiography respectively. While diagnostic angiography performed prior to intervention can 
be separately billable if no previous angiography is available, there also needs to be sufficient description of the 
angiographic findings to justify billing of these codes. In this case there is insufficient documentation of a pre-
intervention aortogram or of a pre-intervention bilateral lower extremity angiogram to support use or coverage 
of these codes. 
 
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 36247, 37229, 37253, 75630, and 75716 rendered on November 28, 2022.