Wiki Arch Aorta 93567

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BonnieJ123

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If this has already been addressed recently, I apologize. Medicare has a new LCD on this cpt code effective August 30,2012. In order for reimubursement , 93567 needs to be billed with a congenital heart cath cpt code. Usually I have billed 93567 with a left heart cpt code of 93458 without problem. However, the new LCD does not want this. Has anyone billed 93458 with 93567 and a modifier 59 on the arch aorta? I would think the noncongenital dx would still be a problem. Any advice on this?
 
Bonnie Owen said:
If this has already been addressed recently, I apologize. Medicare has a new LCD on this cpt code effective August 30,2012. In order for reimubursement , 93567 needs to be billed with a congenital heart cath cpt code. Usually I have billed 93567 with a left heart cpt code of 93458 without problem. However, the new LCD does not want this. Has anyone billed 93458 with 93567 and a modifier 59 on the arch aorta? I would think the noncongenital dx would still be a problem. Any advice on this?
Click to expand...

Bonnie,
I had not heard of this. Aortic root injection code 93567 should be used as a diagnostic test to determine the competency of the aortic valve or the anatomy of the ascending aorta. To me the aortic arch is a different cpt code. Three separate vascular families branch from the aortic arch. If you can please give a link for that LCD I have searched and cannot find it.

This may be something new I have not heard about yet. hmmm
 
Arch Aorta

theresa.dix@ethc.com said:
Bonnie,
I had not heard of this. Aortic root injection code 93567 should be used as a diagnostic test to determine the competency of the aortic valve or the anatomy of the ascending aorta. To me the aortic arch is a different cpt code. Three separate vascular families branch from the aortic arch. If you can please give a link for that LCD I have searched and cannot find it.

This may be something new I have not heard about yet. hmmm
Click to expand...

I cannot attach the link but this is the LCD # L30719 with policy #CV-006 and ID# 252537. Hope this helps, Thank you very much.
 
93567, Aorta Arch

Theresa I will work on it this weekend to get you the information. Thank you for being patient with me.:)
 
HCPCS: 93567 ICD9: 414.01

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The codes you have entered are included in a policy that requires two CPT/HCPCS codes and an ICD9 code to meet medical necessity. If you are checking a claim prior to a patient encounter, click policy link to check additional coding requirements. If you are checking a claim after a patient encounter, the codes entered do not meet medical necessity according to this policy.
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Advice Text
You have chosen a code pair (HCPCS/ICD9) that requires a primary code to be used with a secondary HCPCS code. HCPCS Add-on codes 93563 93564 93565 93566 93567 93568 are to be used in conjunction with 93530 93531 93532 93533 in order to meet medical necessity requirements. Review the policy text to determine coverage guidelines.

Click here to read policy

Close -This is a copy and paste from a program I use called MedAssets. When I plug in a lt hc 93458 and 95367 aorta arch I get this Text Advice and then can pull up the LCD. At one time I could have sworn the LCD stated this also but cannot find it now. Maybe this was what I was seeing all the time. What do you think at this point?
 
Bonnie Owen said:
HCPCS: 93567 ICD9: 414.01

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The codes you have entered are included in a policy that requires two CPT/HCPCS codes and an ICD9 code to meet medical necessity. If you are checking a claim prior to a patient encounter, click policy link to check additional coding requirements. If you are checking a claim after a patient encounter, the codes entered do not meet medical necessity according to this policy.
--------------------------------------------------------------------------------

Advice Text
You have chosen a code pair (HCPCS/ICD9) that requires a primary code to be used with a secondary HCPCS code. HCPCS Add-on codes 93563 93564 93565 93566 93567 93568 are to be used in conjunction with 93530 93531 93532 93533 in order to meet medical necessity requirements. Review the policy text to determine coverage guidelines.


.

Click here to read policy

Close -This is a copy and paste from a program I use called MedAssets. When I plug in a lt hc 93458 and 95367 aorta arch I get this Text Advice and then can pull up the LCD. At one time I could have sworn the LCD stated this also but cannot find it now. Maybe this was what I was seeing all the time. What do you think at this point?
Click to expand...



Bonnie,
Oh Boy! I see why you are confused ,this confuses me too. What I think is this.
I am not sure what the MedAssets is trying to tell you.

Do this. Turn to your CPT book and check out the "Table of Catheterization Codes". On page 493 in my book.(professional edition) See the codes on the left and across the top codes with x's. You will see that 93567(across the top) is able to be used with 93458.


Then go to the section "injection procedures" after your list of cpt codes for heart caths in your CPT book. Read that portion carefully. It will tell you which injection codes can be used with which cath codes.You will see what I am talking about.

Then under CPT( in your book) 93565 read the notes in the parenthesis.

Do NOT USE 93563-93565 (which are injection procedures) with 93452-93461( non congenital codes)

Use 93563-93565 with 93530-93533( Congenital cath codes)

But then you see 93567 and it only says list separately in additon to primary procedure.

It does not list a congenital heart cath code as the only cath code 93567 can be used with. Right?

Study this and if you still have a question I will find more for you. Let me know what you think.
:)
 
Last edited:
Aorta Arch

Thank you so much. I have an e-mail to MedAssets. I think maybe they have it wrong. I have not heard back from them yet. Again, I could swear that the LCD at one time also had it listed this way. HMMM. I will do what you suggested. Thanks again.
 
Bonnie Owen said:
Thank you so much. I have an e-mail to MedAssets. I think maybe they have it wrong. I have not heard back from them yet. Again, I could swear that the LCD at one time also had it listed this way. HMMM. I will do what you suggested. Thanks again.
Click to expand...

Bonnie,

I think you may be right. Let me know what you hear back from MedAssets.
 
Bonnie Owen said:
Thank you so much. I have an e-mail to MedAssets. I think maybe they have it wrong. I have not heard back from them yet. Again, I could swear that the LCD at one time also had it listed this way. HMMM. I will do what you suggested. Thanks again.
Click to expand...

There is still the question of whether you are asking about arch or supravalvular (ascending) aorta. 93567 does not include the arch.
 
donnajrichmond said:
There is still the question of whether you are asking about arch or supravalvular (ascending) aorta. 93567 does not include the arch.
Click to expand...

Donna,
yes I was wondering the same thing. I re read Bonnies first post again and she does write 93567 but says Arch. I see that quite a bit. 93567 isnt an arch aortogram. If she were talking about Arch aortogram do you know of the LCD where this can only be billed with congenital heart cath codes? Btw I love reading your answers to the questions here because you teach me so much.
Thank you
 
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