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New cardiology coder question

  1. Default New cardiology coder question
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    After nearly 12 years of coding for primary care doctors, I have recently started coding for a cardiologist. So here is my question:
    If the physician does a heart cath in a hospital setting, am I supposed to append modifier -26 to the procedure? If so, can someone explain to me why? Because the physician is the one that is actually performing the procedure, so why would he not also receive the technical portion of the procedure?
    Also, what about other procedures that he does? Stenting, intravascular ultrasounds, etc?

  2. #2
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    Yes, you would need the 26. This is because the physician does not own the equipment to do the hearth cath (catheter, sedation drugs ect).

    If he does a stent in addition to the Hearth cath you will need to append modifier 59 to the cath otherwise it will be denied as included in another procedure.

    IVUS 92978 - 26 as well

    If physician does PTCA and Stent, only bill for stent.

    Aortography is also seperately reported 93567
    Julie Graham, BA, CPC, CCC

  3. Default
    Thanks Julie...
    One more question...
    If the physician does a Left heart cath, but without the LV angiogram, how do I code that?

  4. #4
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    Quote Originally Posted by Jalderman View Post
    Thanks Julie...
    One more question...
    If the physician does a Left heart cath, but without the LV angiogram, how do I code that?
    Take a look at 93454-26. This would include the old codes of (93508, 93545, 93556)
    Julie Graham, BA, CPC, CCC

  5. Default
    Thanks so much!

  6. #6
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    Quote Originally Posted by Jalderman View Post
    Thanks Julie...
    One more question...
    If the physician does a Left heart cath, but without the LV angiogram, how do I code that?
    I disagree with 93454-26 response.

    You would be looking at either code 93452-26 or 93458-26 depending on if coronary angiography was done with the study or not.

    Even though the provider didn't do the left ventriculography, a left heart cath can still be performed. As long as the aortic valve was crossed, it's a left heart cath....

    Jessica CPC, CCC

  7. Default
    Quote Originally Posted by Jess1125 View Post
    I disagree with 93454-26 response.

    You would be looking at either code 93452-26 or 93458-26 depending on if coronary angiography was done with the study or not.

    Even though the provider didn't do the left ventriculography, a left heart cath can still be performed. As long as the aortic valve was crossed, it's a left heart cath....

    Jessica CPC, CCC
    Yes I agree with Jessica. 93458-26 is what you will be using. Even without the LV's. 93452 I have only used one time. It is mostly I believe to measure pressures and not evaluate CAD? Jessica is that right?
    Theresa CCS-P CPMA CCC ICDCT-CM

  8. #8
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    Quote Originally Posted by theresa.dix@ethc.com View Post
    Yes I agree with Jessica. 93458-26 is what you will be using. Even without the LV's. 93452 I have only used one time. It is mostly I believe to measure pressures and not evaluate CAD? Jessica is that right?
    You're probably right. I've been doing cardiology coding for 10 years and haven't ever had just a left heart cath without coronary angiography being done along with it.

    Jessica CPC, CCC

  9. #9
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    Quote Originally Posted by Jalderman View Post
    After nearly 12 years of coding for primary care doctors, I have recently started coding for a cardiologist. So here is my question:
    If the physician does a heart cath in a hospital setting, am I supposed to append modifier -26 to the procedure? If so, can someone explain to me why? Because the physician is the one that is actually performing the procedure, so why would he not also receive the technical portion of the procedure?
    Also, what about other procedures that he does? Stenting, intravascular ultrasounds, etc?
    Modifier 26 is the professional component of the charge. The hospital/ clinic also has to get paid for the cath lab machine, all surgical equipment (tray, guide wires, catheters, contrast media,...) and staff. It used to be the "S&I" part of the code, but that is why you have to use the modifier.
    HTH,
    Jim Pawloski, CIRCC

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