Cardiology Coding Alert

Question: When a physician performs intravascular ultrasound (92978) in a hospital outpatient or inpatient setting, should I append modifier -26 (Professional component)? Also, our carrier is denying claims for intravascular ultrasound when it is performed with a left heart catheterization and no intervention is done. What should we do?

Florida Subscriber

Answer: Yes, you should append modifier -26 to +92978 (Intravascular ultrasound [coronary vessel or graft] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel [list separately in addition to code for primary procedure]) when the cardiologist performs the procedure in a hospital setting.

If you have trouble getting reimbursed when the physician performs the intravascular ultrasound only with a left heart catheterization, you should appeal. In 2000, the CPT wording for 92978 changed from "during therapeutic intervention" to "during diagnostic evaluation and/or therapeutic." So if you have denials, your carrier is behind, and you need to get it up-to-date.

You can educate payers by citing information on CPT's wording change. You can also submit explanations on intravascular ultrasound with left heart catheterizations from the American College of Cardiology's most recent CPT Guide and the AMA's CPT Assistant, as appropriate.