AMA Clinical Examples in Radiology - 2007 Bulletin 2
Clarification on Percutaneous Transluminal Angioplasty Billing
Clarification on Percutaneous Transluminal Angioplasty Billing On August 10, 2007, the Centers for Medicare and Medicaid Services (CMS) released Transmittal 1315 (Change request 5667) for clarification of CR 3811 dated April 22, 2005. The purpose of this clarification is to add ICD-9-CM code 433.11 , Occlusion and stenosis of carotid artery with cerebral infarction , to the National Coverage Determination (NCD) list of approved diagnosis for percutaneous transluminal angioplasty (PTA). Not including diagnosis 433.11 as part of the original coverage criteria, which was effective on March 17, 2005, is considered an administrative error by CMS. Therefore, CMS is instructing...
Subscribe or sign in to view the full article.
Article Overview
This article explains a Medicare billing clarification issued by CMS for percutaneous transluminal angioplasty and describes the coverage update tied to a specific diagnosis code. It is relevant to radiology and vascular procedure coding professionals who monitor national coverage determinations, transmittals, and claim adjustment guidance. The article also notes the effective dates and the administrative reason for the correction, making it useful for anyone tracking historical Medicare policy changes.
Why This Topic Matters
Coverage updates and claim-processing clarifications can affect how PTA-related claims are reviewed and adjusted under Medicare policy. Understanding the scope of the CMS change helps coding and billing staff recognize when a clarification may impact reimbursement and claim correction workflows.
Article Sections
-
CMS transmittal and coverage clarification
Introduces the Medicare administrative update and identifies the policy action being clarified. The section places the clarification in the context of national coverage guidance for the procedure.
-
Diagnosis list update and claim handling
Describes the coverage-related correction and the billing implications discussed in the notice. It also notes the timing and administrative context of the update.
What You Will Learn
- The CMS policy context surrounding the billing clarification
- How the article frames the coverage update for the procedure
- Why the notice is relevant to Medicare claim review and adjustment processes
- Which organizations and policy documents are referenced in the clarification
Who Should Read This
- Medical coders
- Radiology billing staff
- Hospital revenue cycle teams
- Compliance professionals
- Health information management specialists
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com
