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Thread: Pre Cert With New Cath Codes...??

  1. #1

    Smile Pre Cert With New Cath Codes...??

    AAPC: Back to School
    Ok, in my physician office we always had to precert for Cath procedures done in the hospital in 2010 which wasn't an issue because it was one code. Now, in 2011 we have 93458 which is what we bill 9 times out of 10 which is the left cath and coronary angio, and vent. gram, plus S&I. But how do we know for sure what it is our dr. is going to do? He may decide he only needs to perform Left Cath and Vent. 93452, and so on.....

    What are you giving the insurance companies when you pre cert for cath procedures? We feel we are correct in giving the 93458 but it is just not the same as having to worry about one code now that they have bundled everything together. We also noticed and wanted to use 93540 & 93539 which is now= 93564 but 93564 is in an area of the crossover that states "congenital", do we use it anyway? What are we suppose to use for crossover for those two codes? or the 93545 could be= 93563 but again, listed as "Congenital", any help would be appreciated. Thank you, Gail Davis, CPC

  2. #2


    Quote Originally Posted by thomasgail View Post
    93540 & 93539 which is now= 93564 but 93564
    the 93545 could be= 93563
    93540 and 93539 were for svg and internal mammary in 2010. In 2011 if done for non congenital these are bundled into the main cath codes.....you would use one of these if grafts are imaged 93455, 93457, 93459, 93461.

    93545 is also bundled with the primary cath codes...you would use one of the codes in the93454-93461 range is the coronaries are done.

    The only angiography that is billable seperate from a non congenital cath is: (unless you do peripherial angios-70000 codes- which can be billed seperate)
    • right ventricular or right atrial- 93566
    • aortography- 93567
    • pulmonary angiography- 93568

    Basically, you will not have an additional code for any angio's other than the 3 above, you will just have a different CPT code.

    The only time you will have more than one diagnostic cath code is if any of the above 3 codes are performed or if it is a conginital cath and then you would bill out all the angiographies seperate.

    For precerts- I currently do all of the united healthcare notifications for our office...the insurance companies actually have substituion cpt code tables. Where if you pernotify/ precert a specfic cpt code and the procedure changes there are codes that the will allow you to bill instead of the one you actually precerted. (ie if your precert/ notification is for 93458- that precert actually will cover your claim if you bill 93458, 93452- 93457, or 93459-93461)

    If you would like to email me I can send you the cross walk on the cpts precerted vs the cpts actually billed....it is from uhc so you may need to check with your other insurances to make sure the go by that as well

    I also have the 2010-2011 cardiac cath codes crossover if you would like that

    my email is tlalwell@health-partners.org


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