Wiki 92928 and 92929 - New stent codes in 2013

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wegrant630

wegrant630

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We have found that Medicare will only pay for the 92928, and denies the add-on code 92929 when multiple stents are being placed in the patient. So, is anyone else finding this to be true? In other words, Medicare will only pay the physician to place one stent, whether he places one or multiple. That just cannot be right. We are going to appeal, but wanted to see if others have run across the same issue.
 
wegrant630 said:
We have found that Medicare will only pay for the 92928, and denies the add-on code 92929 when multiple stents are being placed in the patient. So, is anyone else finding this to be true? In other words, Medicare will only pay the physician to place one stent, whether he places one or multiple. That just cannot be right. We are going to appeal, but wanted to see if others have run across the same issue.
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Yes, this is true. CMS has decided to give the add-on codes a "bundled" status on the Medicare Physician Fee Schedule. They will only pay for the "base" codes and aren't paying for the additional branches.

Jessica CPC, CCC
 
Hello Wendy,

Medicare will not pay for the add-on codes. In the PFS Final Rule CMS decided not to accept the RUC values for the main codes or add-on codes. What they did do was bundlethe payment for the add-on codes in the main code, increasing the fee slightly for each main code.

Debra
 
CPT code 92928 can be billed multiple time for stents in different vessels, Medicare will pay for more than one stent so long as they are in different vessels, 92929 is reported for the branch stenting and that is what they are bundling in the main procedure code.
 
RVU for New Stent codes

I have not been able to find the RVU's for the new stents codes on the CMS website. Can anyone help me with this.
 
Commercial

Thank you for this webiste. Has anyone found where commercial insurances are paying the Cardiology add on codes (92921, 92925, 92929, 92934, 92938)? i understand that Medicare, Medicaid and BCBS are not paying, but was curious if any other insurance is paying.
 
92928 billed for seperate vessels.

Do you find that when billing 92928/LD, 92928/RC for commercial payors you need to add -59 modifier?
 
I am questioning if you coders are finding they need to add the -59 modifier to 92928 when billing more than one vessel stented along with the RC, LC?
 
In Florida per our medicare fee schoedule the dollar amount is 0.00. It is for tracking purposes only at this point. When billing 92928 mulitple times for different vessels, yes we add the 59 modifier.
 
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