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Vascular Correct Coding

Reimbursement Policy:

Vascular Correct Coding

Effective Date:

November 1, 2022

Purpose:

Provide guidelines for the appropriate billing of vascular embolization/occlusion services using revenue codes 360 and 361. This policy applies to institutional providers.

Scope:

All products are included, except

  • Products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap).
  • COB
  • FEP, SHBP, ITS

Definition:

Endovascular Revascularization and Vascular Embolization/Occlusion: Surgical procedures that are performed in an operating room by vascular surgeons. These procedures are performed under local anesthesia with moderate conscious sedation. Therefore, billing with Surgical Revenue Code 360 or 361 would be more appropriate.

Policy:

In order to be consistent with correct coding, Horizon BCBSNJ shall consider for reimbursement vascular embolization/occlusion services (procedure codes 37220, 37239 and 37241-37244) when billed with revenue codes 360 or 361 exclusively. Horizon BCBSNJ shall not consider vascular embolization/occlusion services eligible for reimbursement when billed with revenue codes other than 360 or 361.

The procedure codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.

Procedure:

Horizon BCSNJ shall consider for reimbursement vascular embolization/occlusion services when submitted with revenue code 360 or 361.

Horizon BCBSNJ shall deny same day surgical outpatient claims when vascular embolization/occlusion services are billed with any other revenue code(s).

Limitations and Exclusions:

While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.

History:

11/22/2021: Policy approved

Policy 153_v3.0_11222021