Stent placement during left heart cath

[hollie.ehrhardt@yahoo.com]

I feel that my training was all wrong! I was trained to code the 93458-26 for the left heart catheterization and the 92980 for the stent. Now I have cci edit program that says I can not bundle them. However nowhere in the description does it say the 93458 is included in the 92980 and the reimbursement is much lower for the stent than the cath? So according to cci edits he will get paid less for doing more? Please help me understand this! I do not want to be unbundling.

[dpeoples]

Originally Posted by hollie.ehrhardt@yahoo.com

I feel that my training was all wrong! I was trained to code the 93458-26 for the left heart catheterization and the 92980 for the stent. Now I have cci edit program that says I can not bundle them. However nowhere in the description does it say the 93458 is included in the 92980 and the reimbursement is much lower for the stent than the cath? So according to cci edits he will get paid less for doing more? Please help me understand this! I do not want to be unbundling.

If the physician knew the condition or disease and was planning to intervene (provide atherectomy, angioplasty and/or stent), and the LHC (left heart cath) was for guiding purposes, then it should not be billed.


If the LHC (93458) was performed for diagnostic purposes ,condition/disease was unknown, or there was no recent coronary angiography, or the patients condition/disease had changed since the last angiography, then it is appropriate to bill for this procedure (unbundle). You will need to assign modifier 59 to the LHC to get it through the edits.

HTH

[CPCCODERII]

Per the CCC study guide that I purchased from the AAPC it states this:

'Interventions require catheter placement and angiography. Reimbursement for catheter placement and angio is included in the intervention payment and as such, it is usually inappropriate to bill for the catheter placement and imaging (93454-93461) at the time of a "scheduled" coronary intervention.

If, however, a diagnostic cardiac catheterization leads to urgent intervention (which is usually the case), you may report, and get paid for both the cardiac cath/imaging and the intervention. '

This is what we have been doing. We look back to make sure the patient didnt have a recent heart cath for the same dx and if we find the LT heart cath was medically necessary we will bill these in addition to the stenting with a 59 modifier. Some insurances do deny, and I believe they do this just to verify documentation supports billing for the heart cath...so we send in records.

HTH

[hollie.ehrhardt@yahoo.com]

Thank you so much! It makes much more sense now!