Wiki Denial 92941/92928/92973

NM36

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Hello, I am new to Cardiology coding, and this claim was corrected 3 times with different codes. It paid for some at first, then after payer review, they took back everything saying the documentation does not support the codes. I can't correct the claim any more, but am appealing to see if we can get at least something, and I need to learn the detailed reasons for denial.
The latest claim reported codes 92928-RC, 92973-RC-59, 93454-59-26, 99152, 92941-(missed modifier LC).
I know now that these probably weren't the most accurate codes, but my question is Why wouldn't any of these codes have paid?? (I originally reported only 92928-RC, 92973-59-RC, 93454-59-26, 99152; and they paid everything except the 93454).
Any feedback much appreciated!!

This is a shortened version of the Catheterization Report;

PROCEDURES PERFORMED:
-- Left coronary angiography.
-- Right coronary angiography.
-- Stent Placement.
-- Coronary Thrombectomy.
-- Impella.
-- Intervention on mid circumflex: percutaneous intervention.
-- Intervention on proximal RCA: drug-eluting stent.

SUMMARY:
-- CORONARY CIRCULATION: … Proximal circumflex: There was a 100 % stenosis. This lesion is a chronic total occlusion. Proximal RCA: There was a 95 %
stenosis. The lesion was moderately calcified and was associated with a small filling defect consistent with thrombus.
-- Summary: Late presentation NSTEMI with cardiogenic shock. Troponin 26 R femoral cath: Normal LM; serial 75% prox and mid LAD.
80% diagonal. LCX occluded with Right to left collaterals. Large OM, from collaterals. 95% poximal RCA. We wired LCX with Fielder XT and
EBU 3.5 guide. PTCA with 2.0X 12 balloon. Lost wire position attempting thrombectomy for large thrombus burden. Unable to rewire.
Hockey stick guide; Short Scion blue to wire RCA. PTCA with 2.0X 12 balloon. Placed 3.0X 20 Synergy. hoping to restore colateral flow to
OM1. Intubated with anesthesia support. Remained in cardiogenic shock. Placed Impella via right femoral access. Hemodynamically
stable at end of case on decreasing pressor support Transfer to (other hospital) for further care.

Precath diagnosis:NSTEMI, cardiogenic shock
Post cath diagnosis: same; RCA PCI with stent; Impella.

I directed moderate sedation for 30 minutes with the cath lab nursing
staff.

LESION #1 INTERVENTION: A percutaneous intervention was performed on the lesion in the mid circumflex. There was no dissection.
-- Balloon angioplasty was performed, using a EMERGE MR 2.00 x 12mm balloon, with 2 inflations and a maximum inflation pressure of 12 atm.
LESION #2 INTERVENTION: A drug-eluting stent was performed on the lesion in the proximal RCA. There was no dissection.
-- Balloon angioplasty was performed, with 2 inflations and a maximum inflation pressure of 15 atm.
-- A Promus ELITE MR 3.00 x 20mm drug-eluting stent was placed across the lesion and deployed at a maximum inflation pressure of 15
atm.

CARDIAC INTERVENTIONS:
-- Stent Placement.
-- Coronary Thrombectomy.

-- Impella.

Thanks for any feedback you can give!
NM
 
I have 93454-59-26, 92928-RC, 92941-LC, 33990. I didn't code 92973 because there is no evidence that an AngioJet catheter was used. I used 92941 for revascularization of occlusion during acute MI, single artery w/ or w/o thrombectomy. You cannot code 99152 because anesthesia was present and they will bill their own charge.
HTH,
Jim Pawloski, CIRCC
 
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