Wiki Highmark denial for 93458

[mcgraws]

Our office has billed the 92980.LD, 92978.26 and the 93458.26. Highmark paid the 92980 and the 92978 but denied the 93458 as not covered by same session or date. I looked at CMS website and cannot find any CCI edits for 93458. Can i just add 59 modifier to the 93458.26? Any suggestions on how I can get this paid?

Thank you

Tonya CPC

 

[scorrado]

If you do a stent then the cath code needs to have the 26 and 59 modifier. Hope this helps!

 

[donnajrichmond]

Our office has billed the 92980.LD, 92978.26 and the 93458.26. Highmark paid the 92980 and the 92978 but denied the 93458 as not covered by same session or date. I looked at CMS website and cannot find any CCI edits for 93458. Can i just add 59 modifier to the 93458.26? Any suggestions on how I can get this paid?

Thank you

Tonya CPC

In CCI 93458 is a Column 2 code to 92980. If this was a separate diagnostic heart cath then add modifier 59.

 

[mcgraws]

Thank you all for your help