Wiki 93454 & 9281 denied to 92980

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coders_rock!

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I have a claim where 92980 was paid and 93454 & 92981 were denied. Is this a fact? What are the guidelines. I am having extreme trouble trying to understand cardiology and interventional rad.

Please help!
 
coders_rock! said:
I have a claim where 92980 was paid and 93454 & 92981 were denied. Is this a fact? What are the guidelines. I am having extreme trouble trying to understand cardiology and interventional rad.

Please help!
Click to expand...

No this is not a fact UNLESS you forgot to add the 59 modifier to 93454 and 92981? did you?

Oh but let me remind you that you should only be billing the cath if it were a diagnostic cath. If the decision to place the stents was based on the results of todays cath, you can bill it. If this was a planned surgery you cannot bill the cath placement but you should still be able to bill the stents if they are in different vessels.
 
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coders_rock! said:
I have a claim where 92980 was paid and 93454 & 92981 were denied. Is this a fact? What are the guidelines. I am having extreme trouble trying to understand cardiology and interventional rad.

Please help!
Click to expand...

As Theresa said above, the 93454 can be paid with a -59 if it was truly a diagnostic study.

What about your stent codes? Did they have the appropriate vessel modifiers on them so insurance knows these were done in different vessels?

Jessica CPC, CCC
 
Jess1125 said:
As Theresa said above, the 93454 can be paid with a -59 if it was truly a diagnostic study.

What about your stent codes? Did they have the appropriate vessel modifiers on them so insurance knows these were done in different vessels?

Jessica CPC, CCC
Click to expand...


Jessica,
oops, Yes this is right. We really do not need a 59 modifier on the second stent code. At one time it was thought we did. Just your LC,LD or RC.
 
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