FFR 93571 done by a different provider than the one performing LHC

mquiroz

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Chandler, Arizona
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Hello,
I need help coding for an FFR 93571 performed by a different provider than the one performing the LHC. Any advise is greatly appreciated. :confused:
 

mquiroz

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Location
Chandler, Arizona
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I only code for one group of cardiologists and haven't had any issues billing in this circumstance.

My question is, What is the correct way to bill it? I have billed the LHC under the provider performing it, but I am not sure4 what is the correct way to bill for 93571 since it is an add on code and does not stand alone. I was told before that it should be coded as 93799 but I am having so much trouble trying to get the insurance companies to understand what I am billing for even when I put the description on box 19.

Would you be so kind to advise?

Thank you
 

cpc2007

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If both providers are in the same specialty in the same group practice billing under the same tax ID number (TIN) then they are typically considered "one" for purposes of coding and billing (this is a guideline from CMS but in my experience, other payers generally follow suit). If your payer follows the CMS guideline, you could still bill the add on code 93571 for the second physician because the LHC billed by the first physician serves as the valid primary code on the claim since they are in the same specialty under the same TIN. If your providers are in different specialties or credentialed under different group practices though you would have to code an unlisted instead.
 
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