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longweidmanj

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Medicare patient had a left heart cath with PCI. Returns to floor and goes into cardiac arrest. Patient returns to cath lab where a right heart cath is performed with angioplasty. Medicare paid angioplasty but denying right heart cath. This was billed with modifier 26.78.XU. The cardiac codes do have a MUE of 1 but it there is a change in patients condition isnt' a second heart cath allowed on the same day?
 
Can you share us the CPT codes and the modifier submitted for both the procedures?

- It will help to understand if the same vessel was intervened again or a different branch?
- Also, it could be be Modifier issue here:
76 is used to report a repeat procedure or service by the same physician
78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
 
The first procedure was billed with 93458.26.59, 92928.RC (3-stents placed in RC), 92978.26.RC, Medicare paid all three CPT. The patient returned to her room and then went into cardiac arrest and emergently returned to cath lab where she had 93451.26.78.XU, 92920.78.RC, 92979.RC. For the emergent return to cath lab procedure Medicare only paid the 92920.78.RC. So I was inquiring if I can appeal with Medicare for the emergent right heart cath 93451.26.78.XU. My thought is would modifier XE be better than XU in this case?
 
This helps understand the issue in depth.

In regards to - If I can appeal with Medicare for the emergent right heart cath 93451.26.78.XU ?

- I think if there is a clear documentation of the right heart cath, you should give it a try.
- And agree with you on the XE modifier as well because it's more specific for the same day procedure.
Please do post if you receive any updates on this so we can learn too!
 
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