Wiki Preauthorizations for 93454, 93458

[Patricia P Williams]

Good Afternoon, Can you please tell me if any of you are having “issues” when the Cardiologist is ordering a standard left heart cath, what CPT code(s) are being used for billing and pre authorization? If our Cardiologist is ordering Coronary Angiography, we get the auth for 93454. If our Doctor is ordering the Left heart cath with coronary Arteriography we get the authorization for the 93458. The problem we are having is the Cardiologist is ordering the Coronary Cath and when the procedure is done, if there is a blockage, the Cardiologist ends up doing the 93458 and we have authorized the 93454. Anyone else having this problem??? Some Insurances will not do a retro preauth for the 93458 when we get the billing slip for the 93458 and we have pre-authorized 93454, or vice versa. Thanks for any help.



Patricia

 

[leo061108]

We always pre authorize for 93458. Sometimes, he cant cross over to the LV, so then would bill 93454, but the 93458 authorization still covers.

 

[sglamuzina]

Good Afternoon, Can you please tell me if any of you are having “issues” when the Cardiologist is ordering a standard left heart cath, what CPT code(s) are being used for billing and pre authorization? If our Cardiologist is ordering Coronary Angiography, we get the auth for 93454. If our Doctor is ordering the Left heart cath with coronary Arteriography we get the authorization for the 93458. The problem we are having is the Cardiologist is ordering the Coronary Cath and when the procedure is done, if there is a blockage, the Cardiologist ends up doing the 93458 and we have authorized the 93454. Anyone else having this problem??? Some Insurances will not do a retro preauth for the 93458 when we get the billing slip for the 93458 and we have pre-authorized 93454, or vice versa. Thanks for any help.

Good Afternoon, Can you please tell me if any of you are having “issues” when the Cardiologist is ordering a standard left heart cath, what CPT code(s) are being used for billing and pre authorization? If our Cardiologist is ordering Coronary Angiography, we get the auth for 93454. If our Doctor is ordering the Left heart cath with coronary Arteriography we get the authorization for the 93458. The problem we are having is the Cardiologist is ordering the Coronary Cath and when the procedure is done, if there is a blockage, the Cardiologist ends up doing the 93458 and we have authorized the 93454. Anyone else having this problem??? Some Insurances will not do a retro preauth for the 93458 when we get the billing slip for the 93458 and we have pre-authorized 93454, or vice versa. Thanks for any help.



Patricia

Rule of thumb, alway get the pre-cert for 93458.....in the circumstance they do not cross over you bill 93454 which should still be covered under the pre-cert.