Description
Documentation will be reviewed to determine if diagnostic (aka stand-alone) renal and peripheral angiography procedures meet Medicare coverage criteria, meet applicable coding guidelines, and/or are medically reasonable and necessary.
Affected Code(s)
36245, 36246, 36247, 36248, 36251, 36252, 36253, 36254
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3. 42 CFR §405.929- Post-Payment Review
4. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.986- Good Cause for Reopening
7. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
8. First Coast LCD L36767 - Aortography and Peripheral Angiography; Effective 10/31/2016; Revised 10/01/2019
9. First Coast LCA A55847 – Aortography and Peripheral Angiography Coding Guidelines; Effective 10/31/16; Retired 10/01/2019
10. First Coast LCA A57056 – Billing and Coding: Aortography and Peripheral Angiography; Effective 10/03/18; Revised date 10/01/2023
11. Novitas LCD L35092 - Diagnostic Abdominal Aortography and Renal Angiography Effective 10/01/2015; Revised date 11/7/2019
12. Novitas LCA A56682- Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography; Effective date 7/11/2019; Revised date 10/01/2023
13. AMA CPT Codebook