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Cath and IVUS by different providers, same day

  1. Default Cath and IVUS by different providers, same day
    Medical Coding Books
    We have 6 Cardiologists in our practice, one does the cath and the other does the IVUS. How do you code for this since the IVUS code (92978) is an add-on code?

    Any documentation or links to support the billing would be great.

    Thanks!

  2. #2
    Location
    Richardson, TX
    Posts
    823
    Default
    There's not much of a work around here since IVUS requires a primary code to be billed, also, it is not modifier 80 eligible. My suggestion (which is what we do): bill the primary (parent) and add-on (orphan) under physician performing diagnostic cath, then once payment is received, the physician whom performed the IVUS is paid his RVUs for the IVUS.

    CPT 92978 is AS modifier elgible, so if your office had a PA or NP, then the cardiologist performing the cath could bill for cath and IVUS while the PA/NP bills 92978-AS.
    Julie Graham, BA, CPC, CCC

  3. Default
    Quote Originally Posted by jewlz0879 View Post
    There's not much of a work around here since IVUS requires a primary code to be billed, also, it is not modifier 80 eligible. My suggestion (which is what we do): bill the primary (parent) and add-on (orphan) under physician performing diagnostic cath, then once payment is received, the physician whom performed the IVUS is paid his RVUs for the IVUS.

    CPT 92978 is AS modifier elgible, so if your office had a PA or NP, then the cardiologist performing the cath could bill for cath and IVUS while the PA/NP bills 92978-AS.
    Would that be legal?
    Theresa Dix CCS-P CPMA CCC ICDCT-CM

  4. #4
    Location
    Charlotte, NC
    Posts
    30
    Default
    We bill them seperately, then when we get a denial for the add on code we send an appeal indicating that the primary was already billed and they are of the same practice.

  5. Default
    Quote Originally Posted by lovelyadd View Post
    We bill them seperately, then when we get a denial for the add on code we send an appeal indicating that the primary was already billed and they are of the same practice.
    Amanda,
    we do the same. Do you get the payment?
    Theresa Dix CCS-P CPMA CCC ICDCT-CM

  6. #6
    Location
    Charlotte, NC
    Posts
    30
    Default
    most of the time we do

  7. Default
    Quote Originally Posted by lovelyadd View Post
    most of the time we do
    We do too.
    Theresa Dix CCS-P CPMA CCC ICDCT-CM

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