billing 93571 iFR only

VelshAS

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93571 is an add on code and can be used with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454-93461, 93563, 93564 per CPT guidelines. We have Provider A performed 93458 and Provider B performed 93571 only. The claim for provider B doesn't go out due to it needs a main procedure as above. Should I force the claim out due to provider A performed qualified procedure or should I bill 93571 to provider A? Appreciate any suggestion. Anna
 

Jennarw

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We force it to go out and get denied. We also make sure our providers know that this isn't payable this way, they occasionally still do it, but it happens way less now that they know.
 
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I work with a large multispecialty practice. We’ve had this issue for years. When we force the claims through, they get denied. I appeal, we get denied. This year we’ve resorted to using an unlisted code for the 93571 for this scenario. Of course, those claims are also being denied by the carriers. But I am going to push back very hard this year. It’s nonsense that these claims get denied. In any other circumstance of multiple docs managing the patients together, they treat the docs as if they are one and the same. I have to appeal with taxonomies to point out the difference between cardiologists and pulmonologists.

If anyone has had success with getting the carriers to understand and pay the claims, please let me know how you did it. I've appealed to Medicare and commercial carrriers with no luck.
 
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