When billing codes 33249 and 93461-26?

[johnsonsr]

I am new to cardiology coding and need some help. Our doctors do the coding and I billed 33249 and 93641-26 together to Medicare and they responded with non covered for medical necessity. I am not sure if a 59 modifier should also be placed on the 93641-26 or what to do from here. Any information will be appreciated.

Thanks,
MJohnson

 

[espressoguy]

There is no CCI edit requiring a 59 modifier. A denial for medical necessity indicates an issue with your diagnosis.

 

[johnsonsr]

Denial for medical necessity when billing 33249 and 93641-26 to Medicare

Thank you so much for your response. Can you direct me to where I can find a list of the diagnosis to use with this procedure and where I might find the CCI edits.

Thanks so much,
Melissa

 

[Chlrtrep]

Just curious did the physician mean CPT 93641-26 for DFT Testing during ICD implant instead of 93461-26 right and left heart catheterization, coronary angio, LV, bypass graft angiography

 

[Jim Pawloski]

Just curious did the physician mean CPT 93641-26 for DFT Testing during ICD implant instead of 93461-26 right and left heart catheterization, coronary angio, LV, bypass graft angiography

ICD testing (placing the patient in V-Fib to see if the ICD will shock the paient and how many jules do it take to convert the patient) is 93641. Right and Left Heart is 93460.

Thanks,
Jim Pawloski (CIRCC)

 

[Chlrtrep]

ICD testing (placing the patient in V-Fib to see if the ICD will shock the paient and how many jules do it take to convert the patient) is 93641. Right and Left Heart is 93460.

Thanks,
Jim Pawloski (CIRCC)

Jim,

I was just seeking clarification from the original poster. Since there were two different CPT codes listed in the post.

In the title of the post CPT Code 93461-26 is listed
In the body of the post CPT Code 93641-26 is listed

CPT Code 93641 yes is for the DFT testing

CPT Code 93461 is a RHC/LHC/Corns/Bypass Grafts Angio LV gram if performed
CPT Code 93460 is RHC/LHC/Corns Lv if performed