Wiki Cardio Help new facility 92928/C9600

[bevans02406]

We have recently added cardio services to our facility and no one seems to know if we are billing correctly to Medicare and the commercial payors.

Do we submit both 92928 & C9600 to both Medicare and commercial payors?
My interpretation is that we bill both codes to Medicare and not to the commercials(only 92928).

However, another opinion is only C9600 to Medicare (leave off 92928), but I have a remit where Medicare paid on 92928 and C9600 wasnt even submitted which is also incorrect. Any insight is much appreciated.

 

[thomas7331]

For Medicare, and payers that accept the Medicare codes, your facility should use C9600 for drug-eluting stents and 92928 for other coronary artery stents. The two procedures are mutually exclusive and bundled, so you would not use both, unless your documentation would support the use of a modifier to unbundle them.

 

[monika1189sharma@gmail.com]

We can't code both CPT together because both are main CPT code for stent placement.
we code
C9600- for hospital billing
92928-for physician billing