Wiki Heart Cath

[Melonyw]

I am new to billing and coding of cardio, I just have a few questions

I have noticed from BCBS that when we bill a heart cath they always deny the 93545 or 93543 when they are billed with say example:

93510-26
93543
93545
92980-LD
93555-2659
93556-2659

Do they require a modifier on the 93543 & 93545? If medicare is primary they pay then BCBS will pay.

Also lets say a patient has a Heart Cath on 6/14/09 and then turns around and they do another on 7/20/09 how would this be billed?


On 6/14/09:

93510-26
93543
93545
92980-LD
93555
93556

Then the same pt on 7/20/09 has

93508-26
93545
92980-LC
935562659

This is what the Dr's want billed but I am seeing that Ins wont pay the 93508-26 or the 93545, they did pay the stent placement and the imaging.

I am confused which dont take much so any help explaining this to me is greatly appreciated!!!!!

 

[Jess1125]

A modifier shouldn't be needed on the 93543 or the 93545.

I have a question about your second case, though. Was the 7/20 intervention a planned intervention? Did the doctor plan on bringing the patient back for a staged intervention of the -LC? If so, you can't bill for the coronary angiography separately. You could only bill out the 92980.LC on that day then.

If the coronary angiography was purely diagnostic then your codes would be fine and no extra modifier should be needed on the 93508-26 or 93545.

Hope this helps. Jessica

 

[deeva456]

I am new to billing and coding of cardio, I just have a few questions

I have noticed from BCBS that when we bill a heart cath they always deny the 93545 or 93543 when they are billed with say example:

93510-26
93543
93545
92980-LD
93555-2659
93556-2659

Do they require a modifier on the 93543 & 93545? If medicare is primary they pay then BCBS will pay.

Also lets say a patient has a Heart Cath on 6/14/09 and then turns around and they do another on 7/20/09 how would this be billed?


On 6/14/09:

93510-26
93543
93545
92980-LD
93555
93556

Then the same pt on 7/20/09 has

93508-26
93545
92980-LC
935562659

This is what the Dr's want billed but I am seeing that Ins wont pay the 93508-26 or the 93545, they did pay the stent placement and the imaging.

I am confused which dont take much so any help explaining this to me is greatly appreciated!!!!!

Hi Melanie,

Some BCBS plans will bundle 93543 or 93545 when performed the same day as a Stent placement. If the heart cath is performed the same day, separate session then you can rebill 93545 or 93543 with modifier 59. Some insurance payers started denying these codes a few years ago when billed with a stent. For your charges on 7/20, you can only bill the cath portion if medically necessary. If the dr did only stent placement he cannot bill for the catheter (93508 93543 & 93556-26). Also, LC or LD modifiers are not required unless more than one coronary artery is being stented.

Good luck!

Dolores, CPC-CCC