you may NOT always bill 93454-93461 with PCI
Per CPT:
"Diagnostic angiography performed at the time of a coronary interventional procedure may be separately reported if:
1. No prior catheter-based coronary angiography study is available, and a full diagnostic study is performed, and a decision to intervene is based on the diagnostic angiography, or
2. A prior study is available, but as documented in the medical record:
a.) the patient's condition with respect to the clinical indication has changed since the prior study, or
b.) there is inadequate visualization of the anatomy and/or pathology, or
c.) there is a clinical change during the procedure that requires new evaluation outside the target area of intervention
Diagnostic coronary angiography performed at a separate session from an interventional procedure is separately reportable"
^^^ of course, the above needs to be concisely documented in the patient's medical record.
Just because your physician(s) want the claims to be paid does not entitle s/he to reimbursement.
In addition, different payers may have different rules.
I encourage you to utilize your MAC LCD tool (My cardiologists reside in Noridian JE) for guidance.
FYI - Modifier 59, or X[EPSU], is the most widely abused and improperly reported modifier per OIG. I would heed applying this just to "have the claim approved," of course doing so would constitute the "f" word (5 letters not 4).
I help code all Cardiology for Kaiser Permanente in Northern CA, the majority of the time that LHC/RHC/CABG/COR cath placements are being captured with PCIs is when our patients have been admitted through the ED for acute coronary ischemia (of course that doesn't always warrant a 92941 as well..)
**Be wary of generalizations/ blanket statement/ rules**
**Documentation in the record is everything**
I hope this helps.