Wiki 93458 with 93010

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coders_rock!

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I have sitiuation where:

Doc A did 93458

Doc B did 93010

There procedures were done by differerent doctors, different diagnoses, but on the same date of service. Doc A is being denied. SShould she be getting paid for the procedure performed?

Can someone also share the guidelines and any resources you may have?

Thank you in advance.
 
Thank you for responding. I understand Per CCI, modifier 59 is allowed on 93010. However, I would like to get a better understanding of the guidelines before doing so. For instance, what are the guidelines for reporting these codes on the same DOS, etc. Also, why would modifier 59 be required on 93010 if these are 2 different physician's in different POS, different diagnosis?

Can you help me?
 
jewlz0879 said:
I'm working on it. I'd really like this answer as well. I can see both sides but I'd like to really understand why
Click to expand...

I think I can help. You need to have medical necessity to bill the ekg on the same day as the cath.

Routine screening EKGs prior to procedures aren't billable, but you can report a preoperative EKG when the physician orders the study for a separately reason, like chest pain or palpitations.

When a patient comes to the emergency department with acute chest pain, the physician sends him to your cardiologist for a consultation. To rule inor out a cardio cause for the patient's symptoms, the cardiologist performs an EKG, which shows an acute myocardial infarction. He might decide to perform an catheterization with possible stent. Because the documentation shows a medically necessary EKG on the same day as a heart catheterization, you can report the appropriate EKG code in addition to the codes for heart catheterization and intervention and append modifier -59 to the EKG code.

You see?
 
Yes, that makes a lot of sense. I guess I was thinking more along the lines of when it's two separate docs with different tx-id's. But in reading the original post again, it seems these docs might be in the same practice. At any rate, I am going to save this information for my records since you so beautifully explained it.

Have a great week. Thanks!
 
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