Wiki Failed Stent Billing Question

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I am new to cardiology billing and I am hoping someone can help me with a physician inpatient hospital claim denial from United Healthcare Complete. Anesthesia was administered to the patient and our cardiologist attempted a PTCA in the left circumflex coronary artery with two different types of wires and was unable to cross even with balloon support. He also completed a stent in the right coronary artery. We billed 92920 with modifiers 53 and LC along with 93454 with modifiers 26 and 59.

I have been told by a supervisor at Optum that per Medicare guidelines, we cannot bill modifier 53 with CPT 92920. I am unable to find these guidelines and was hoping someone can help. Also, since there is a conflict with the CCI edits, they cannot review CPT 93454 with the use of 59 modifier. I have verified in the Procedural Coding Expert book, these modifiers can be billed with these CPT codes.

Also, I see modifier 53 cannot be billed when a service is discontinued when the patient is in an outpatient setting. If the above scenario was outpatient instead of inpatient, what modifier can be used? I see modifiers 73 and 74 are for facility use only.
Thanks in advance!
 
I won't address the UHC problems as I have no advice there as far as I have done in the past I have been able to bill 92920 to Medicare with 53 modifier. I work in Kentucky, so I don't know your MAC.
I do have some advice on your coding of the case. I don't see in the information you gave for the 53 modifier reason. 53 is used when continuing will adversely affect the patient heath. I didn't see that. 52 modifier (reduced service) would have been a better choice.
I personally would not have coded the 92920 as I don't consider enough of the PTCA in the LC was done to bill 92920. I require the wires and catheter to cross the lesion before I would bill the 92920. I would have just billed the selective coronary angiogram, 93454 with modifiers 26, 59 and 22. I would also include a line comment that we attempted PTCA but were unable to cross the lesion. all of this with the 92928-RC for the stent in the RC as the primary procedure.
 
I won't address the UHC problems as I have no advice there as far as I have done in the past I have been able to bill 92920 to Medicare with 53 modifier. I work in Kentucky, so I don't know your MAC.
I do have some advice on your coding of the case. I don't see in the information you gave for the 53 modifier reason. 53 is used when continuing will adversely affect the patient heath. I didn't see that. 52 modifier (reduced service) would have been a better choice.
I personally would not have coded the 92920 as I don't consider enough of the PTCA in the LC was done to bill 92920. I require the wires and catheter to cross the lesion before I would bill the 92920. I would have just billed the selective coronary angiogram, 93454 with modifiers 26, 59 and 22. I would also include a line comment that we attempted PTCA but were unable to cross the lesion. all of this with the 92928-RC for the stent in the RC as the primary procedure.
Thank you so much!!!
 
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