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 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!