Wiki More help! Cardiac cath and stent done on same day!!

[lpick]

I need more help. If ANYONE knows, when a cardiac cath 93458 and a stent 92980 are done on the same day, my boss says I bill cath with modifier 26/51. We have ALWAYS billed with modifier 26/59. She says not 59 because its same site. If 59 is in fact right, I need documentation to prove so. PLEASE help. Lynn Pickett CPC

 

[abyrne]

modifier 59 is correct. Per medicare's NCCI edits, cpt 92980 & 93458 can be billed together with a 59 modifier appended to cpt 93458.
The NCCI edits can be found on CMS medicare website http://www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp?listpage=2

WPS Medicare website also has some helpful modifier info.
http://www.wpsmedicare.com/part_b/resources/modifiers/modifier-59.shtml
WPS medicare states the following regarding modifier 59:
"Definition
Distinct Procedural Service identifies procedures/services not normally reported together, but appropriately billable under the circumstances.
Appropriate Usage
Documentation indicates two separate procedures performed on the same day by the same physician Represented by a different session or patient encounter, different procedure or surgery, different site, or separate injury (or area of injury)Use Modifier 59 with the secondary, additional or lesser procedure of combinations listed in Correct Coding Initiative (CCI) edits.
Use Modifier 59 when there is NO other appropriate modifier. "

I hope this helps.

Alaina M. Boncher, CPC

 

[Vcurtis11]

Health America

When we have a cath and stent on the same day with using the 26 and the 59 modifier we are getting denied as bundled. Even after appeal level 1 we are still getting denied. We want to go to second level and need supporting documentation that the patient needs to have stent on same day to to medical necessity. Can anyone give me resources to back this up?

 

[theresa.dix@tennova.com]

When we have a cath and stent on the same day with using the 26 and the 59 modifier we are getting denied as bundled. Even after appeal level 1 we are still getting denied. We want to go to second level and need supporting documentation that the patient needs to have stent on same day to to medical necessity. Can anyone give me resources to back this up?

You need to send the operative report and highlight where the report says this was a diagnostic heart cath and from that the decision was made to place a stent. If you scroll down to the cardiology list and post your cardiology questions there are a ton of expert coders who will help you out. As far as the modifiers needed to report cath/stent same session, 59 is the modifier to add to (93458-26-59) and then your stent would need either LD,LC or RC .