Margaret George, Medicare Account Representative Regional Cardiology Associates, Sacramento, CA
Answer: Medicare, along with an increasing number of other third-party payers, is denying payment for diagnostic heart cath supervision and interpretation codes.
They are trying to say these codes are included in the interventional PTCA procedure when done with a cath on the same day, points out Sueanne Bicknell, RRA, CCS-P, reimbursement and compliance specialist, Cardiovascular Provider Resources-Heart Place in Dallas, TX. But that is just not accurate.
Based on HCFAs multiple surgery policy, services for diagnostic caths can and should be separately reimbursed from PTCAs. The diagnostic cathwith all its related componentsis fully billable by itself even though a PTCA is done afterward, she explains.
The confusion has occurred because the National Correct Coding Initiative (CCI) says that when only a PTCA is performed, you should not be reimbursed also for the supervision and interpretation because these services are inherent in the PTCA.
Heres how Bicknell has advised her staff to obtain reimbursement: Append the modifier -59 with S & I codes 93555 and 93556 for the diagnostic cath. This modifier identifies the diagnostic imaging services as separate from the interventional procedures and therefore eligible for separate additional reimbursement, she says.
Therefore, you are correct in appending modifier -59 to the diagnostic cath, and not to the PTCA. In this case, modifier -59 should not trigger an audit.
Note: As with the injection cath codes, the American College of Cardiology (ACC) and the 1999 CPT manual consider the supervision, interpretation (S & I) services as not incidental to or bundled into the catheter placement codes. Therefore, they are separately payable. If you find carriers or other payers that dont agree, the ACC asks that you notify their Health Policy Division at 800-253-4636.