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Wiki Denials on Stents with BCBS

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jessica1974

jessica1974

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We are having trouble gettting BCBS to pay stent codes where 2 vessels are concerned. For instance if we do a stent to the LAD and a stent to the LC they are denying the second one as a duplicate. I have been working with our provider rep here in WV. We actually have Highmark BCBS. They are trying to say that we should be billing the add-on code of 92929. But I disagree with that because CPT states that it is an additional branch off of the main branch (paraphrasing that). I am trying to explain to them that there isn't even a montary value on 92929 according to the MFS. I know that as a commerical carrier they set their own fee schedule. Just wondering if anyone else is having this issue. If so how did you get it resolved? And should I be billing it the way they advise?

Thanks for any advice.
 
jessica1974 said:
We are having trouble gettting BCBS to pay stent codes where 2 vessels are concerned. For instance if we do a stent to the LAD and a stent to the LC they are denying the second one as a duplicate. I have been working with our provider rep here in WV. We actually have Highmark BCBS. They are trying to say that we should be billing the add-on code of 92929. But I disagree with that because CPT states that it is an additional branch off of the main branch (paraphrasing that). I am trying to explain to them that there isn't even a montary value on 92929 according to the MFS. I know that as a commerical carrier they set their own fee schedule. Just wondering if anyone else is having this issue. If so how did you get it resolved? And should I be billing it the way they advise?

Thanks for any advice.
Click to expand...

No, don't change it to the way the advise! I had a Med Replace plan keep trying to tell me that I should be billing 92929 for subsequent vessels. Keep fighting it! CPT guidelines state there are 5 major coronary vessels and 92928 as well as the other codes are "single vessel" codes. If I had a magic document that said 92928 could be billed more than once I'd let you know! Just going to have to go by CPT guidelines/code description for documentation supporting your code choices and keep fighting! Good luck.

Jessica CPC, CCC
 
Keep fighting, I too had trouble w/ a commercial insurance here in New York and I am just now seeing them pay the second STENT. Are you putting the LC or LD on both and a 59 on the second one? Nancy
 
A specific employer plan in Texas just gave me the same argument. She told me they'd only pay for one a day, and scoffed when I asked for that in writing. She suggested I call the AMA for coding advice.

Do you think reporting this to SCAI would help at all?

Thanks!
Leah
 
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