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graft and lima only

  1. #1
    Default graft and lima only
    Medical Coding Books
    I have a cath report where the vein graft and lima aortography were done. The coronaries were not viewed because the doctor reviewed a previous report from that day done at a different hospital. Our doctor is doing an evaluation for inferior ST-elevation myocardia infarction, post bypass surgery. Does anyone have an idea on how to code this.

    Thank you,
    Cindy

  2. #2
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    Richardson, TX
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    Do you have the report? It would be easier to interpret what the correct code would be. I do know the code for an aortography is +93567.
    Julie Graham, BA, CPC, CCC

  3. #3
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    Yes, I do have the report and that is the only views he did were the grafts and lima. He didn't do the coronaries. He has left heart cath under the procedure list but his procedure report doesn't mention it and the impressions are only of the graft and lima.

  4. #4
    Location
    Richardson, TX
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    Hmmmm I've never had one without the coronaries but with the Lima and SV graft. The only codes without Coronary Arteries are: 93452 & 93453 but they do not include the SV/Lima Grafts and the codes for those have since been deleted.

    I wonder if you could bill 93459 (as long as AV was crossed) but with a 52? I'm not sure. Maybe someone else has encountered this?
    Julie Graham, BA, CPC, CCC

  5. #5
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    Quote Originally Posted by haugen View Post
    I have a cath report where the vein graft and lima aortography were done. The coronaries were not viewed because the doctor reviewed a previous report from that day done at a different hospital. Our doctor is doing an evaluation for inferior ST-elevation myocardia infarction, post bypass surgery. Does anyone have an idea on how to code this.

    Thank you,
    Cindy
    Personally, I would do code 93455 with modifier -52. This is what I was told to do at a MedLearn webinar if only grafts were looked at.

    Jessica CPC, CCC

  6. #6
    Smile
    Thank you both for your help with my coding question.

    Have a great weekend!
    Thanks again.

  7. #7
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    Quote Originally Posted by Jess1125 View Post
    Personally, I would do code 93455 with modifier -52. This is what I was told to do at a MedLearn webinar if only grafts were looked at.

    Jessica CPC, CCC
    When I look it up in encoder and in AAPCs procedural coding expert, it says you cannot append 52 modifier to that code.
    Also
    ZHealth Online Q&A 2612

    Date: Friday, March 11, 2011

    Question: Is modifier 52 ever appended to cath codes if documentation does not meet the full description of the CPT code? thank you

    Answer: I would not use -52 for the new heart cath codes if there is a component missing, such as the native coronary angiography at the time of a graft angiography (93455), I would just code 93455 as is without the modifier. Remember, that for Medicare, hospital billing, all heart caths fall into the same APC and are all paid exactly the same (a right heart cath pays the same as a right and left heart cath with native and graft angiography). In 2010, if we did less than a right and left heart cath with coronaries (e.g., in a patient with a metallic aortic valve), we actually "coded" more with 93501 and 93508. A -52 modifier would inappropriately decrease payment 50% in the first example. I cannot think of a time that I have used the -52 with a heart cath yet. If one of societies produce and article concerning this, we will be sure to let you know. Dr.z

  8. Default
    Quote Originally Posted by Misty Dawn View Post
    When I look it up in encoder and in AAPCs procedural coding expert, it says you cannot append 52 modifier to that code.
    Also
    ZHealth Online Q&A 2612

    Date: Friday, March 11, 2011

    Question: Is modifier 52 ever appended to cath codes if documentation does not meet the full description of the CPT code? thank you

    Answer: I would not use -52 for the new heart cath codes if there is a component missing, such as the native coronary angiography at the time of a graft angiography (93455), I would just code 93455 as is without the modifier. Remember, that for Medicare, hospital billing, all heart caths fall into the same APC and are all paid exactly the same (a right heart cath pays the same as a right and left heart cath with native and graft angiography). In 2010, if we did less than a right and left heart cath with coronaries (e.g., in a patient with a metallic aortic valve), we actually "coded" more with 93501 and 93508. A -52 modifier would inappropriately decrease payment 50% in the first example. I cannot think of a time that I have used the -52 with a heart cath yet. If one of societies produce and article concerning this, we will be sure to let you know. Dr.z

    This is true Medlearn did say this
    Here is the Q & A

    January 17, 2011
    Question:
    Historically, we could report the imaging of the IMA with a heart cath whether the IMA was used as a graft or native. With the inception of the new codes 93455, 93457, 93459, and 93461, is that still true?


    Answer:
    If a bundled/collapsed code exists for the graft injection with other services, it cannot be fragmented out into a separate charge. If only the grafts are imaged without coronaries, we believe the best code to assign is 93455-52.


    But If It were me coding this I would NOT append modifier 52 and go with Dr Z. Misty Id like to see the encoder you have that says 52 cannot be appended to the 93455? Can you copy and paste it here?
    Theresa CCS-P CPMA CCC ICDCT-CM

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