Qualifying (parent) CPT Codes

rykin7609

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Does anyone know of a site or reference material where I can find the Quailifying CPT codes to Add On codes? In particular I am looking for all the quailifying codes to the add on code 93571.
I am having problems with denials on these in different circumstances and I am being told it is the quailifying code that is missing.

Thank you for any feedback
Allana
 
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Torilinne

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I don't know about a comprehensive list for all add-on codes but encoderpro lists Medicine Cross codes that go with 93571 as: 93530, 93531, 93532, 93533. Hope this helps!

Torilinne
CPC, CGIC
 

rykin7609

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interesting...

I don't know about a comprehensive list for all add-on codes but encoderpro lists Medicine Cross codes that go with 93571 as: 93530, 93531, 93532, 93533. Hope this helps!

Torilinne
CPC, CGIC
That is pretty interesting. What is happening with me is I have a Cardiologist going in with a Cardiac Catherization such as 93454 thru 93461, he calls in the interventionalist to do an FFR with a PCI however, after the FFR is complete the interventionalist doesn't feel the need for an angioplasty or stent. I was thinking that we were being denied because the same physician doing the cath was not doing the FFR, but the FFR can only be done by an interventionalist and if an interventionalist is not doing the cath then we are out of luck.

Allana
CPC
 

scorrado

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We have the same issue Allana - our cardiologist does the cath and then calls in one of our interventionalist to do the ffr and stent if needed. The ffr is denied for "qualifying procedure". We always appeal these and they get paid. We just point out that the "qualifying procedure" was performed by another cardiologist in our practice and reference the paid claim number. It is a pain because it happens a lot but we have never had an issue with them not getting paid after an appeal. Hope this helps!
 

rykin7609

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We have the same issue Allana - our cardiologist does the cath and then calls in one of our interventionalist to do the ffr and stent if needed. The ffr is denied for "qualifying procedure". We always appeal these and they get paid. We just point out that the "qualifying procedure" was performed by another cardiologist in our practice and reference the paid claim number. It is a pain because it happens a lot but we have never had an issue with them not getting paid after an appeal. Hope this helps!
Susie,
Really?! You got paid. Did it happen to be through Medicare because I have already sent in a reconsideration with all the reports from both doctors and referred them to the cath claim that was paid and I was still denied through Medicare. They are telling me I now have to appeal. :( Sad day....
 

scorrado

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Medicare is probably the one we have to do the most appeals for and we get paid every time. We just explain that the ffr had to be done by an interventionlist because of the possibility of a stent needing to be placed, reference our cardiologist claim for the cath that got paid, and then request payment for the ffr since the "qualifying procedure" was done. Is the cath being done by one of your cardiologist?
 

rykin7609

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Medicare is probably the one we have to do the most appeals for and we get paid every time. We just explain that the ffr had to be done by an interventionlist because of the possibility of a stent needing to be placed, reference our cardiologist claim for the cath that got paid, and then request payment for the ffr since the "qualifying procedure" was done. Is the cath being done by one of your cardiologist?
Yes, the cath was done by one of our Cardiologists. Thank you so much for your input. I will try again only this time do as you say and point out that the interventionalist had to do the FFR and the possible PCI.
This was very incouraging to learn.
 

cristakelley

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Kingston , Georgia
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Does anyone have this issue when the Cardiolgist and Interventionalist are of different practices? If so, how does the interventionalist bill only the FFR with a PCI when no further medical intervention is needed. With some insurance companies no longer accepting paper claims how are the claims submitted. Thank you.

Crista:confused:
 
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