Cardiology Coding Alert

Question: The cardiologist performed a right and left heart cath (93526, combined right heart catheterization and retrograde left heart catheterization) on a patient covered by a commercial carrier. The payer denied 93526 because modifier -26 had been appended, stating that they no longer require modifier -26 on 93526. S&I codes 93555 and 93556 also had -26 appended and were paid. Is this correct?

Maryland Subscriber
Answer: If thats how the carrier wants it, and you get it in writing, it is correct for that carrier, says Terry Fletcher, BS, CPC, CCS-P, an independent cardiology coding and reimbursement specialist in Laguna Beach, Calif.

According to Medicare guidelines, if the procedure is performed in a facility, modifier -26 (professional component) should be appended to both the catheterization procedure (93501-93536) and any accompanying supervision and interpretation (S&I) codes (i.e., 93555 and 93556). The associated injection codes do not require modifier -26.

Private carriers, however, are not obliged to adhere to Medicare guidelines. Like Medicare, private carriers can audit physician practices. Therefore, you should get this new policy regarding modifier -26 in writing. If the carriers policy changes again, you will be protected.