RaeToll
Networker
I'm a utilization nurse reviewing a denial for missing modifiers. Procedure codes billed are 92928 x2, 92978 x1, 92979 x1, and 93458-59 x1.
I have my CPC, but it was more so I could get some idea of some of the denials I audit. Based off what I'm understanding with the coding and the op report, I think it should have been 92928-LD x1, 92928-LC x1, 92978-LD, and 92979-LC.
I would truly appreciate someone's input or guidance on this denial.
This is what the operative report states:
Procedures performed:
Left heart catheterization, LV Gram, Coronary Angiography, IVUS, PCI
Access Site: Right Radial Artery
Arterial Closure: TR Band
Findings:
1. Coronary artery disease (as described below) including an 85-95% proximal LAD ISR
and a 70-80% mid LCx stenosis..
2. Elevated left ventricular filling pressures (LVEDP = 19 mm Hg).
3. Normal left ventricular systolic function (estimated LVEF = 50-55 %).
4. Successful PCI to the proximal LAD with the placement of two overlapping
3.5x20mm+3x8mm Synergy DES with excellent angiographic result and TIMI 3 flow.
5. Successful PCI to mid LCx with the placement of a 3.5x12mm Synergy DES with
excellent angiographic result and TIMI 3 flow.
Additional coding for supply/implants: C1725 x 6, C1753 x 1, C1769 x 3, C1874 x 3, C1887 x 2, C1894 x 1
Left Heart Catheterization (Radial): Under local anesthesia, a 6F Terumo Glidesheath was placed in the right radial artery using modified Seldinger technique. 5 mg of verapamil were given via the sheath intra-arterially. A
0.035 Sub J-wire was used to guide the advancement of the coronary catheter for engagement. 5000 units of IV heparin were given after the wire and catheter crossed the aortic arch into the ascending aorta. Left heart catheterization was performed by advancing a 5F Jacky catheter across the aortic valve. The LVEDP was obtained. A left ventriculogram was performed by hand injection of Omnipaque using the 5F Jacky catheter. Selective
coronary angiography was then performed in multiple views by hand injections of Omnipaque using a 5F Jacky catheter to engage the right coronary artery and a 5F Jacky catheter to engage the left coronary artery.
Following the procedure, the sheath was removed, and a TR band was applied to achieve hemostasis. The TR band was subsequently removed with staged removal of air as per protocol. The patient tolerated the procedure well without any complications.
Pre-dilatation balloon: 2.5x12mm, 2.5x6mm Wolverine cutting balloon, 3x12mm Wolverine cutting balloon.
Stent: 3.5x20mm+3x8mm Synergy DES
IVUS showed good stent wall apposition, no evidence of dissection.
Guide Catheter: 6F EBU 3.5
Guidewire: Runthrough
Stent: 3.5x12mm Synergy DES
Results: Excellent angiographic result with TIMI 3 flow and 0% residual stenosis.
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I have my CPC, but it was more so I could get some idea of some of the denials I audit. Based off what I'm understanding with the coding and the op report, I think it should have been 92928-LD x1, 92928-LC x1, 92978-LD, and 92979-LC.
I would truly appreciate someone's input or guidance on this denial.
This is what the operative report states:
Procedures performed:
Left heart catheterization, LV Gram, Coronary Angiography, IVUS, PCI
Access Site: Right Radial Artery
Arterial Closure: TR Band
Findings:
1. Coronary artery disease (as described below) including an 85-95% proximal LAD ISR
and a 70-80% mid LCx stenosis..
2. Elevated left ventricular filling pressures (LVEDP = 19 mm Hg).
3. Normal left ventricular systolic function (estimated LVEF = 50-55 %).
4. Successful PCI to the proximal LAD with the placement of two overlapping
3.5x20mm+3x8mm Synergy DES with excellent angiographic result and TIMI 3 flow.
5. Successful PCI to mid LCx with the placement of a 3.5x12mm Synergy DES with
excellent angiographic result and TIMI 3 flow.
Additional coding for supply/implants: C1725 x 6, C1753 x 1, C1769 x 3, C1874 x 3, C1887 x 2, C1894 x 1
Left Heart Catheterization (Radial): Under local anesthesia, a 6F Terumo Glidesheath was placed in the right radial artery using modified Seldinger technique. 5 mg of verapamil were given via the sheath intra-arterially. A
0.035 Sub J-wire was used to guide the advancement of the coronary catheter for engagement. 5000 units of IV heparin were given after the wire and catheter crossed the aortic arch into the ascending aorta. Left heart catheterization was performed by advancing a 5F Jacky catheter across the aortic valve. The LVEDP was obtained. A left ventriculogram was performed by hand injection of Omnipaque using the 5F Jacky catheter. Selective
coronary angiography was then performed in multiple views by hand injections of Omnipaque using a 5F Jacky catheter to engage the right coronary artery and a 5F Jacky catheter to engage the left coronary artery.
Following the procedure, the sheath was removed, and a TR band was applied to achieve hemostasis. The TR band was subsequently removed with staged removal of air as per protocol. The patient tolerated the procedure well without any complications.
Pre-dilatation balloon: 2.5x12mm, 2.5x6mm Wolverine cutting balloon, 3x12mm Wolverine cutting balloon.
Stent: 3.5x20mm+3x8mm Synergy DES
IVUS showed good stent wall apposition, no evidence of dissection.
Guide Catheter: 6F EBU 3.5
Guidewire: Runthrough
Stent: 3.5x12mm Synergy DES
Results: Excellent angiographic result with TIMI 3 flow and 0% residual stenosis.
_________________________________________________________________________