Wiki CPT CODE 93458 Need help.

[fuzzyrabbit]

Patient had a cardiac cath and the hospital provided the CPT code 93458. the hospital is also charging for supplies. I thought supplies were considered part of the procedure codes. Please help. thank you

 

[cgaston]

PC/TC applies to these codes, so if you are billing for the Physician's services you would add the -26 modifier to your claim.

 

[thomas7331]

Patient had a cardiac cath and the hospital provided the CPT code 93458. the hospital is also charging for supplies. I thought supplies were considered part of the procedure codes. Please help. thank you

I responded to your previous post with this question, but see that you've posted again here. Just to add to what I said in the other thread, hospital coding, billing and reimbursement is very different from physician coding. Hospitals will typically itemize all of their expenses, including supplies, and payer reimbursement systems are set up to handle this and apply the correct rates. For example, under Medicare OPPS reimbursement, all of those supplies are 'packaged' into a case rate that is applied for the principal procedure done during the encounter. The hospital can, and should, report those supplies as line-item charges because they are a part of the facility expense which they are reporting and they are not inclusive to the procedure itself, although the end payment this does not usually affect the payment of the claim. However, other payers may have other requirements for how they want the hospital to report their services and costs, and some payers may require the hospital to roll all of those expenses together into a single line-item. Whether or not it is correct to report the supplies separately from the procedure will depend on the hospital's contract and its method for reporting costs, so unfortunately it's not as easy as just a yes or no answer with facilties.

Are you working for a hospital or process a claim on behalf of a payer? Either way, you'll need to look to your organization for direction on this because how hospitals bill is guided largely by contracts and payer reimbursement policies - you should follow your organization's internal policies and procedures for how the hospital claims should be reported and paid and carry on accordingly. Hope this helps some - if not, feel free to post a little more detail or send a message about the specific situation you're looking at.