Q: Stent Codes.
"I have been billing heart cath and angioplasty and stent codes 93458 with modifier-26 and
-59, and 92928.
I added modifier-59 to indicate that these were two different procedures but I am still
getting denials, in the EOB it says they are bundled codes.
So my question is how can I get paid for these two procedures if they are done the same day?"
A: The first thing that I do whenever someone is talking about getting a denial is I would
pop the two codes or however many there are.
I have a new SuperCoder; I use their CCI Edit Check.
So, here's the 93458 and here's the 92928.
Basically, we're getting this little yellow flag here and it's saying the 93458, this
is the catheter placement for coronary artery.
Is a column 2 code for 92928, so basically it's saying that 58 is bundled into 28.
But, a modifier is allowed in order to differentiate between the services provided.
And it's very nice in letting Now, the other code was the 92928, which is the percutaneous
transcatheter placement of intracoronary stent(s).
She's heading: no CCI Edit in there.
Normally, when you get a CCI edit 59 will work to tell the story that this is separate
and significant.
Here's a little reminder that: "Distinct Procedural Service: Under certain circumstances, it may
be necessary to indicate that a procedure or service was distinct or independent from
other.
Here's in red though: "However, when another already established modifier is appropriate
it should be used rather than modifier 59.
Only if no more descriptive modifier is available and the use of modifier 59 best explains the
circumstances should modifier 59 be used."
We call this a modifier of last resort.
I kind of thought, is there any other way that we could have told the story without
59 and it will be payer specific, but you might want to try the vessel- specific modifiers.
These are HCPCS modifiers, there're two new ones as of this year.
LC is your left circumflex coronary artery, LC is left anterior descending coronary artery,
LM (the new one) is left main coronary artery, RC for right coronary artery, and RI for ramus
intermedius coronary artery.
If you're trying to say that these are done in two different vessels, you might want to
try and use those modifiers to help explain that.
If that doesn't work, then your only other step is to appeal it but make sure you have
really good documentation to do that.
Now, I didn't have much documentation to go on, so I can give a more thorough answer if
you can provide me documentation with obviously patient info and provider info.
This is just a reminder that we do have on our freebies, part of our site this cardiac
cath coding sheet.
I'll show you how to get there.
If you go to CodingCertificaiton.Org, these are lovely new menu, and you click on "Info"
you'll see "Free Guides and Tools."
Click on here and this is all the stuff that we've created overtime that you can get for
free.
This is the one that I'm talking about here, the cardiac catheter answer sheet.
It has some good info, if you're dealing with cardiac cath and things like that.