September 2014 Q & A

Question: Vertebral Artery Stenting

Rt. vertebral artery origin has severe flow-limiting stenosis at level of C-6 and intracranially 50% and 40%. Procedure codes used are 0075T, 76937 x2, G0269, 36140. Impression: Rt. vertebral artery origin severe stenosis reduced to minimal residual after balloon mounted stent placement. Basilar artery flow is improved with lower blood pressure after the intra-arterial administration of vasodilator and rt. vertebral artery origin stent placement. Lt. superficial femoral artery arterial monitoring catheter placement.

Medicare is denying 0075T for modifier incompatibility. I am getting this message regularly for this HCPCS code. I am very new to neurointerventional coding and am in need of help. Could you lend me some insight into this issue? My M.D. uses this code quite frequently of late and I am at a loss. Sometimes it will get kicked back as needing a modifier 26 also.

Answer:

If the site of service is hospital, code 0075T requires a -26 modifier for physician billing. This may seem odd since the other stent placements do not, but it is how Medicare set up the RVU file for physician billing for code 0075T. Category III CPT code 0075T is for placement of an extracranial vertebral artery or intrathoracic common carotid stent placement in 2014. In 2015, 0075T will only apply to extracranial vertebral stent placement, as a new CPT code (37218) will describe intrathoracic common carotid stent placement.