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Jalderman

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After nearly 12 years of coding for primary care doctors, I have recently started coding for a cardiologist. So here is my question:
If the physician does a heart cath in a hospital setting, am I supposed to append modifier -26 to the procedure? If so, can someone explain to me why? Because the physician is the one that is actually performing the procedure, so why would he not also receive the technical portion of the procedure?
Also, what about other procedures that he does? Stenting, intravascular ultrasounds, etc?
:confused:
 
Yes, you would need the 26. This is because the physician does not own the equipment to do the hearth cath (catheter, sedation drugs ect).

If he does a stent in addition to the Hearth cath you will need to append modifier 59 to the cath otherwise it will be denied as included in another procedure.

IVUS 92978 - 26 as well

If physician does PTCA and Stent, only bill for stent.

Aortography is also seperately reported 93567
 
Thanks Julie...
One more question...
If the physician does a Left heart cath, but without the LV angiogram, how do I code that?
 
Jalderman said:
Thanks Julie...
One more question...
If the physician does a Left heart cath, but without the LV angiogram, how do I code that?
Click to expand...

I disagree with 93454-26 response.

You would be looking at either code 93452-26 or 93458-26 depending on if coronary angiography was done with the study or not.

Even though the provider didn't do the left ventriculography, a left heart cath can still be performed. As long as the aortic valve was crossed, it's a left heart cath....

Jessica CPC, CCC
 
Jess1125 said:
I disagree with 93454-26 response.

You would be looking at either code 93452-26 or 93458-26 depending on if coronary angiography was done with the study or not.

Even though the provider didn't do the left ventriculography, a left heart cath can still be performed. As long as the aortic valve was crossed, it's a left heart cath....

Jessica CPC, CCC
Click to expand...

Yes I agree with Jessica. 93458-26 is what you will be using. Even without the LV's. 93452 I have only used one time. It is mostly I believe to measure pressures and not evaluate CAD? Jessica is that right?
 
theresa.dix@ethc.com said:
Yes I agree with Jessica. 93458-26 is what you will be using. Even without the LV's. 93452 I have only used one time. It is mostly I believe to measure pressures and not evaluate CAD? Jessica is that right?
Click to expand...

You're probably right. I've been doing cardiology coding for 10 years and haven't ever had just a left heart cath without coronary angiography being done along with it.

Jessica CPC, CCC
 
Jalderman said:
After nearly 12 years of coding for primary care doctors, I have recently started coding for a cardiologist. So here is my question:
If the physician does a heart cath in a hospital setting, am I supposed to append modifier -26 to the procedure? If so, can someone explain to me why? Because the physician is the one that is actually performing the procedure, so why would he not also receive the technical portion of the procedure?
Also, what about other procedures that he does? Stenting, intravascular ultrasounds, etc?
:confused:
Click to expand...

Modifier 26 is the professional component of the charge. The hospital/ clinic also has to get paid for the cath lab machine, all surgical equipment (tray, guide wires, catheters, contrast media,...) and staff. It used to be the "S&I" part of the code, but that is why you have to use the modifier.
HTH,
Jim Pawloski, CIRCC
 
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