Wiki Cardiac Cath For Facility Question

[Breezy]

If I have a physician that performs for example a: Combined Rt heart cath and retrograde Lt heart cath for congenital anomalies and then he injections IVC(total of 2times), LUPVW(left upper pulmonary vein with wedge cath usage and RLPVW(right lower pulmonary vein with wedge cath usage(total of 3times all total), AoA(total of 2times),AoD(total of 1time). How would you code this case?

The physician have selected the following codes
93531
93566 x2
93565x3
93567x3

When I run through the encoder I'm not sure if I need to pick up the codes 93566 (twice), 93565(three times), 93567(three times). I have spoken with the coder hear and she does the physician coding and she says for them she only enter it one time but since I code for the facility I'm confused on how many times I need to capture the charge/cpt code. Please advise

 

[jewlz0879]

I think you should only bill each code once; when you read the descriptions for 93566/93565 they include either right ventricular OR right atrium angiography. I interpret this to mean these codes can only be billed one time. I could be wrong but my reason for this is in the description and the fact that CPT does not list or have a code for 'additional injections.' I definitely do not think you can bill 93567/93565 three times. Why? Did the physician inject three times because he felt the previous injections didn't give him the view he wanted? I would still only code one time. There is no medical necessity for billing these codes three times. I can't think of a reason why you would be able to bill three times unless you had three different cath's on different DOS (but same patient). I could be wrong but I've never billed for multiple injections.

I guess I could see 93566 x 2 since it included ventricle OR atrium but I think it's just that; one or the other. You can't bill for both because you injection both. Just my interpretation.

I reviewed Dr. Z's information on these codes and he makes no mention of being able to bill multiple times during one heart cath.

On the other hand, you could try it and see what happens. Attach -59 to the additional codes, however, all add-on codes are modifier -51 exempt which would cover the 'multiple procedures.' Just seems like you should not bill those codes more than once. Even in the facilty. And no disrespect to your docs or any docs for that matter, but they often think they should be able to bill for things that have been designated otherwise.

 

[jewlz0879]

I found it!

Pg. 13 Dr.Z Cardio packet. "use 93463, 93464, 93563, 93564, 93565, 93566, 93567 and 93568 ONCE per patient encounter."

I will scan it to you if you want. I think I may have already sent it but if not, I have your email.