CodeMap® Report 75831
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2018 ICD-10 Diagnosis Code Set Loaded     


10/01/2017 NCD Edits Loaded     


2017-D October DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for rest of 2017     


2017-D October ASC Fee Schedule Updated     


2018-A October APC Fee Schedule Updated     


October 2017 ASP Drug Pricing Updated     


Q1 2018 CCI Edits Loaded     


Q1 2018 MUE Edits Loaded     


LCD Database Current Through 12/11/2017     

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75827
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75833

75831: VEIN X-RAY KIDNEY

CPT® 75831: Venography, renal, unilateral, selective, radiological supervision and interpretation


Short Description: VEIN X-RAY KIDNEY

--

CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2017 Physician
Fee Schedule:

Global Fee $142.12
26 Modifier $ 56.35
TC Modifier $ 85.77

2017 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $2360.60


*Based on National 2013 Medicare Part B submitted claims.
2017 APC Code: 5182
Level 2 Vascular Procedures

2017 OPPS Status Indicator: Q2

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
Percentage
ICD-10 Code
Description
Related DRG(s)
50.0%
I87.1
Compression of vein
299-301
25.0%
I86.4
Gastric varices
299-301
25.0%
N18.9
Chronic kidney disease, unspecified
008
673-675
682-684

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

75831 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 75831

CCI and MUE Edits*         Hide this section.

Column 1 CCI Edits for 75831
Denied Codes (1)
Effective
Modifier
Accepted (2)
01916 ANESTH DX ARTERIOGRAPHY
04/01/2002 No
01924 ANES THER INTERVEN RAD ARTRL
07/01/2002 No
01925 ANES THER INTERVEN RAD CARD
07/01/2002 No
01926 ANES TX INTERV RAD HRT/CRAN
07/01/2002 No
35201 REPAIR BLOOD VESSEL LESION
07/01/1999 Yes
35206 REPAIR BLOOD VESSEL LESION
07/01/1999 Yes
35226 REPAIR BLOOD VESSEL LESION
07/01/1999 Yes
35261 REPAIR BLOOD VESSEL LESION
07/01/1999 Yes
35266 REPAIR BLOOD VESSEL LESION
07/01/1999 Yes
35286 REPAIR BLOOD VESSEL LESION
07/01/1999 Yes
36000 PLACE NEEDLE IN VEIN
07/01/2001 Yes
36005 INJECTION EXT VENOGRAPHY
01/01/2007 Yes
36410 NON-ROUTINE BL DRAW 3/> YRS
07/01/2001 Yes
36500 INSERTION OF CATHETER VEIN
10/01/2006 Yes
36591 DRAW BLOOD OFF VENOUS DEVICE
10/01/2015 No
36592 COLLECT BLOOD FROM PICC
10/01/2015 No
76000 FLUOROSCOPY <1 HR PHYS/QHP
01/01/2003 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
76001 FLUOROSCOPE EXAM EXTENSIVE
01/01/2003 Yes
76942 ECHO GUIDE FOR BIOPSY
04/01/2002 Yes
76970 ULTRASOUND EXAM FOLLOW-UP
01/01/2017 Yes
76998 US GUIDE INTRAOP
01/01/2007 Yes
77001 FLUOROGUIDE FOR VEIN DEVICE
01/01/2011 Yes
77002 NEEDLE LOCALIZATION BY XRAY
01/01/2007 Yes
96360 HYDRATION IV INFUSION INIT
01/01/2009 Yes
96365 THER/PROPH/DIAG IV INF INIT
01/01/2009 Yes
96372 THER/PROPH/DIAG INJ SC/IM
01/01/2009 Yes
96374 THER/PROPH/DIAG INJ IV PUSH
01/01/2009 Yes
96375 TX/PRO/DX INJ NEW DRUG ADDON
01/01/2009 Yes
96376 TX/PRO/DX INJ SAME DRUG ADON
07/01/2009 Yes
96377 APPLICATON ON-BODY INJECTOR
01/01/2017 Yes
99446 INTERPROF PHONE/ONLINE 5-10
01/01/2014 Yes
99447 INTERPROF PHONE/ONLINE 11-20
01/01/2014 Yes
99448 INTERPROF PHONE/ONLINE 21-30
01/01/2014 Yes
99449 INTERPROF PHONE/ONLINE 31/>
01/01/2014 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 75831.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 75831

Denied Codes (1)
Effective
Modifier
Accepted (2)
35221 REPAIR BLOOD VESSEL LESION
04/01/2011 Yes
35251 REPAIR BLOOD VESSEL LESION
04/01/2011 Yes
35281 REPAIR BLOOD VESSEL LESION
04/01/2011 Yes
35840 EXPLORE ABDOMINAL VESSELS
04/01/2011 Yes
35875 REMOVAL OF CLOT IN GRAFT
04/01/2011 Yes
35876 REMOVAL OF CLOT IN GRAFT
04/01/2011 Yes
35907 EXCISION GRAFT ABDOMEN
04/01/2011 Yes
36251 INS CATH REN ART 1ST UNILAT
01/01/2012 Yes
36252 INS CATH REN ART 1ST BILAT
01/01/2012 Yes
36253 INS CATH REN ART 2ND+ UNILAT
01/01/2012 Yes
36254 INS CATH REN ART 2ND+ BILAT
01/01/2012 Yes
37187 VENOUS MECH THROMBECTOMY
04/01/2011 Yes
37188 VENOUS M-THROMBECTOMY ADD-ON
04/01/2011 Yes
37193 REM ENDOVAS VENA CAVA FILTER
01/01/2012 Yes
37197 REMOVE INTRVAS FOREIGN BODY
01/01/2013 Yes
37200 TRANSCATHETER BIOPSY
04/01/2011 Yes
37211 THROMBOLYTIC ART THERAPY
01/01/2013 Yes
37212 THROMBOLYTIC VENOUS THERAPY
01/01/2013 Yes
37213 THROMBLYTIC ART/VEN THERAPY
01/01/2013 Yes
37214 CESSJ THERAPY CATH REMOVAL
01/01/2013 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
37236 OPEN/PERQ PLACE STENT 1ST
01/01/2014 Yes
37237 OPEN/PERQ PLACE STENT EA ADD
01/01/2014 Yes
37238 OPEN/PERQ PLACE STENT SAME
01/01/2014 Yes
37239 OPEN/PERQ PLACE STENT EA ADD
01/01/2014 Yes
37241 VASC EMBOLIZE/OCCLUDE VENOUS
10/01/2014 Yes
37244 VASC EMBOLIZE/OCCLUDE BLEED
10/01/2014 Yes
37248 TRLUML BALO ANGIOP 1ST VEIN
01/01/2017 Yes
37249 TRLUML BALO ANGIOP ADDL VEIN
01/01/2017 Yes
61645 PERQ ART M-THROMBECT &/NFS
01/01/2016 Yes
61650 EVASC PRLNG ADMN RX AGNT 1ST
01/01/2016 Yes
61651 EVASC PRLNG ADMN RX AGNT ADD
01/01/2016 Yes
75833 VEIN X-RAY KIDNEYS
01/01/1996 Yes
75893 VENOUS SAMPLING BY CATHETER
10/01/2006 Yes
75894 X-RAYS TRANSCATH THERAPY
04/01/2011 Yes
75898 FOLLOW-UP ANGIOGRAPHY
04/01/2011 Yes
75970 VASCULAR BIOPSY
10/01/2004 Yes
78445 VASCULAR FLOW IMAGING
07/01/2001 Yes
78456 ACUTE VENOUS THROMBUS IMAGE
07/01/2001 Yes
78457 VENOUS THROMBOSIS IMAGING
07/01/2001 Yes
78458 VEN THROMBOSIS IMAGES BILAT
07/01/2001 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 75831.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for 75831


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   75831 Top 5 Ordering Providers National*
THOMAS WHITTLE -LINCOLN,NE 28
MICHAEL ARATA -NEWPORT BEACH,CA 25
MAN HON -MINEOLA,NY 14

*Based on 2015 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 75831*         Hide this section.



Annual Procedures - Tests Performed / Denied


Total National Services (all modifiers) Submitted 2016: 564
Total Services Denied 2016: 104 (18.4%)
National Charges Submitted 2016: $ 157,522.54
National Charges Allowed 2016: $ 36,285.91
National Average (No Modifier) Fee Submitted 2016: $488.83
National Average (No Modifier) Fee Allowed 2016: $137.63
National Average (26) Fee Submitted 2016: $236.99
National Average (26) Fee Allowed 2016: $ 56.60


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 259 45.9% $229.06 52 20.1%
Interventional radiology
(eff 5/92)
138 24.5% $331.36 24 17.4%
Cardiology 76 13.5% $259.54 13 17.1%
Vascular surgery
(eff 5/92)
71 12.6% $366.61 11 15.5%
General surgery 11 2.0% $400.23 2 18.2%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Inpatient hospital 258 45.7% $223.31 43 16.7%
Outpatient hospital 165 29.3% $251.79 32 19.4%
Office 137 24.3% $417.90 28 20.4%
Emergency room - hospital 1 0.2% $146.00 0 0.0%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 430 76.2% $236.99 76 17.7%
59 - Distinct Procedural Service 74 13.1% $331.63 8 10.8%
XU 52 9.2% $506.10 16 30.8%
No Modifier 6 1.1% $488.83 4 66.7%
XE 1 0.2% $1425.00 0 0.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

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12/16/2017 01:19:28 54.91.171.137

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