Cardiology Coding Alert
Private Carriers Set Own Rules
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.
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