Wiki Pa catheter/93503

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phenderson

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Hi,
Medicare has a LCD for the 93503 Swan-Ganz to be payable with only certain diagnosis codes. The LCD includes this for open heart as well as heart cath's. If no diagnosis code is found and can you bill just for the 36556 which is a component of the 93503?
Thanks,
Pam
 
Pam,

I would not recommend "down" coding for payment. Down coding is just as inappropriate as up coding services. If the Swan Ganz was successfully placed then 93503 is the correct code. Is this a new LCD? Usually there's a comment period before a LCD becomes effective giving providers an opportunity to suggest additional diagnosis. Since it sounds like the LCD is already in effect I would review the medical record for supporting covered diagnosis and educate your providers of the specifics of the LCD.

Julie D, CPC
 
PA catheter

Hi Julie,
Thanks for your reply. The LCD is not all that new but we just started getting denials recently. We had no idea this pertained to Open Heart Surgeries since the LCD's title was for Heart Catheterizations. I have sent this to the anesthiologists and they are now aware of the ICD-9 codes. As far as billing for the 36556, I was asked if we could do that. My immediate answer was no but I did say I would research it further. I can see I was right. Are you an Anesthesia coder?
Pam
 
Pam,

Yes, I'm an anesthesia coder and have doing anesthesia for 20 years before that and in between I've done family practice, pain management, phychiatry, and some consulting/auditing-- oh how things have changed. I love this specialty.....I get to code from the entire CPT because we enter the CPT code (for reporting purposes).

Julie D, CPC
 
cvp,swans,tees

we bill for both the Swan and the CVP. As long as there are two separate stick and the CVP if not part of the mean for anesthesia you can bill for both. We use a separtate page just for our Swans and CVP that states the 2 separate sticks and the documentation as to whay both are needed. Our Medicare carrier requires a 59 modifer attached to the CVP when it is done with the Swan. We have no problem in getting payment. Also on the TEE question there are alot of LCD edit on those and some will paid the Tee and some will pay for th droppler. We have printed off all the LCD for our area and made a list of apporiate dxs codes for use with these. We alos you hearts, cabgs, and we bill Tees we must put both 26 and 59 on it and we bill a flat rate and do not use a anesthesia time for this, swans, and CVP on most all of our cases. Hope this help.
 
I understand how we may bill 93503 and 36556 if there are separate sites. My MD documented, "Right IJ CVL x 2 placed for vascular access u/s guided" Are these separate sites?
 
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