Cardiology Coding Alert
NGS Providers: Take a Close Look at PCI Denials
You may need to add a coronary modifier and resubmit your claim.
Offices in Jurisdictions K and 6 need to take a look back through their percutaneous coronary intervention (PCI) claims.
National Government Services (NGS), the Part B MAC for those jurisdictions, advises providers that coronary artery modifiers are required on specific coronary procedure codes.
The coronary modifiers are listed below:
NGS providers should append the coronary modifiers to these codes:
NGS updated its PCI LCD (L28395) on Feb. 1, 2014, to include these instructions.
Action point: NGS advises providers to resubmit claims that were denied because of the missing modifiers. But this time around, be sure that modifier is where it belongs.
The NGS article is available by going to www.ngsmedicare.com/ngs/portal/ngsmedicare/welcome, choosing a Part B jurisdiction, and then opening www.ngsmedicare.com/ngs/portal/ngsmedicare/news. In the Articles Search box, enter L28395. On the results page, click the link for the article Percutaneous Coronary Intervention (L28395) - Coronary Artery Modifiers.
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