Ffr 93571

cae

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One of our Cardiologists performed a LHC and after the procedure one of our Interventionalists performed the FFR 93571. Can he bill the 93571-26 along with 93454-76 since the 93571 needs a primary px code billed along with it.

Any ideas would be greatly appreciated-Thanks
 

dimmitta

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Assuming the FFR was done during the same operative session and both doctors are in same practice/tax id? I have come across this where I work as well, there are a couple different ways you can handle this. First, if both doctors are under same tax id number/same specialty, you could submit the 93571 with the 1st doctors LHC and work out reimbursement for the 2nd doctor internally. Not an ideal way to do it but since insurance will consider these doctors as the same doctor for billing purposes, it is legal (at least that's what I was told :) )

Second way, would be to bill under 2nd doctor an unlisted cardiac procedure code and send in the op note. Again, not ideal because we all know that unlisted codes rarely receive reimbursement. However, I would shy away from billing a cardiac cath code just because the procedure performed (93571)requires a primary code. Since this was staged, and a diagnostic cath was already performed, I would not bill the 93454 for the 2nd doctor.

If you see this happening frequently, you might want to discuss protocol on how to bill these with your manager and/or administrator. Not sure if this helps...
 
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