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Stents CPT 92980, 92981

  1. #1
    Unhappy Stents CPT 92980, 92981
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    We are receiving a WPS denial on both of these stents being used with the CPT 93510, 93543 and 93545. This is what our charges look like.

    93510-26
    93543
    93545
    92980
    92981

    The denial specifically states (denial code CO4) The procedure code is inconsistent with modifier used or a required modifier is missing.

    Has anyone else received this denial? Does anyone know why different modifiers would be necessary?

    Thanks

  2. Default
    You are missing the modifiers LD, LC or RC. They need to know what vessel(s) is being stented.

    I was wondering if you code the 93555-26 & 93556-26 with the cath. You can bill those if done just need to add mod 59 bec of the Stent.

    Hope this helps!

  3. #3
    Default 59 Modifier w/93555 and 93556
    We have been following CCI edits. Do you routinely get pd for these for all other insurance companies? We are new at billing these codes.


    Thanks

  4. Default
    Yes, we get paid for these but do check documentation to make sure they are reflected in the report.

    When injection procedures are performed during a heart cath they require an appropriate supervision and interpretation (S & I) code which would be 93555-26 & 93556-26. You must add mod 59 to bypass CCI edit.

    Now if the doctor just does a stent (92980-92984) you would not use any S & I code. The S & I codes go hand in hand with the Heart Catheterization.

    Just little more infor. Lets say your doctors just does a (Coronary artery study) 93508, 93545 the S & I code to be used is 93556-26.

    Good Luck

  5. #5
    Default
    Quote Originally Posted by dpumford View Post
    Yes, we get paid for these but do check documentation to make sure they are reflected in the report.

    When injection procedures are performed during a heart cath they require an appropriate supervision and interpretation (S & I) code which would be 93555-26 & 93556-26. You must add mod 59 to bypass CCI edit.

    Now if the doctor just does a stent (92980-92984) you would not use any S & I code. The S & I codes go hand in hand with the Heart Catheterization.

    Just little more infor. Lets say your doctors just does a (Coronary artery study) 93508, 93545 the S & I code to be used is 93556-26.

    Good Luck

    Would you have something in writing that says you can bill the S&I for the cath when done with the stent? We are having issues in our office agreeing on this being able to be done and it would help settle it. Thanks
    Janine Fawcett, CPC

  6. #6
    Default
    The CCI edits also bundlethe 92980 and 92981. You will need -59 modifier on the S&I codes and the 92981.
    Terri Winsor, CPC, CCC

  7. #7
    Default
    The CCI edits also bundle the 92981with the 92980. You will need -59 modifier on the S&I codes and the 92981.
    Terri Winsor, CPC, CCC

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