Wiki Ffr

[Jenna000]

Anyone have comments on this? We have been getting denials but we send in the records and have been getting paid. Is it different when they are under the same group or practice?

Thanks!!

Cardiology
For the Week of August 4, 2014
Question:
Cardiologist A performs a left heart catheterization (CPT 93458), but, if there is something wrong, he would like to bring in another physician to insert a flow wire (because cardiologist A cannot perform the flow wire). Can we bill this as an add-procedure with code 93571?
Answer:
Codes 93571 and 93572 are add-on codes according to the CPT book, and they are only billable if the additional procedure is performed by the same provider who performs the base procedure. This is a CPT rule, which the Centers for Medicare & Medicaid Services (CMS) follow. There is no way to bypass the problem.
CPT 2014 instructions regarding add-on codes say that they ?are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code.?

 

[Griffith_Tiffany]

If they are part of the same practice could you attach a modifier to the charges showing what each physician performed?

 

[theresa.dix@tennova.com]

Anyone have comments on this? We have been getting denials but we send in the records and have been getting paid. Is it different when they are under the same group or practice?

Thanks!!

Cardiology
For the Week of August 4, 2014
Question:
Cardiologist A performs a left heart catheterization (CPT 93458), but, if there is something wrong, he would like to bring in another physician to insert a flow wire (because cardiologist A cannot perform the flow wire). Can we bill this as an add-procedure with code 93571?
Answer:
Codes 93571 and 93572 are add-on codes according to the CPT book, and they are only billable if the additional procedure is performed by the same provider who performs the base procedure. This is a CPT rule, which the Centers for Medicare & Medicaid Services (CMS) follow. There is no way to bypass the problem.
CPT 2014 instructions regarding add-on codes say that they ?are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code.?

We have billed these when a different physician from a different group performs ffr alone and we also send in records and get paid. Letting the insurance company know what the situation is. If a different physician in the same group performs the 93571 we bill which procedure each physician did under each physicians name and no problem since they have the same tax id.But I also did read the Q/A you posted.