December 2015 Q & A

Question: WPS and Popliteal Aneurysm

With the new LCD for ICD-10, popliteal aneurysm I72.4 is not covered for 37236. It also is not covered for 37226. What do you recommend if a patient has a popliteal aneurysm and is MCR or MCR replacement in our area? The particular patient I have now is having thrombosis due to the aneurysm, but by coding guidelines it would be covered for intent, which is the aneurysm. The thrombosis is covered under 37226 if it is okay to code for thrombosis and not aneurysm. We do these all the time, this is just the first one that came up since ICD-10 and I need to be able to educate my physicians on coverage.
Answer:
LCD L35998 does not include popliteal aneurysm as a valid indication for stent placement. However, the definition for the first listed or principal diagnosis has not changed for ICD-10. Unless the aneurysm is acutely ruptured, the thrombosis is the reason for the procedural encounter and should be reported with the procedure. The aneurysm should then be reported as an additional diagnosis.

If there is stenosis of the vessel requiring stent placement after removing the thrombus, the stenosis is reported with the  stent procedure and thrombosis is reported with the thrombectomy procedure. The aneurysm again becomes a secondary diagnosis. If there is no thrombosis or stenosis and the stent is placed specifically to treat the aneurysm, the aneurysm must be reported with the procedure. In those cases, I recommend that the physician thoroughly document why the stent was necessary to treat the aneurysm, and appeal the denial.
CODING UPDATE 1/4/16:
The LCD discussed in the Q&A above has been updated since this question was originally answered. Lower extremity artery aneurysm is now a covered diagnosis by Wisconsin Physician Services. The coding of the thrombus as the principle diagnosis is still applicable in the case discussed.