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93454 & 92981 denied to 92980

  1. Question 93454 & 92981 denied to 92980
    Medical Coding Books
    I have a claim where 92980 was paid and 93454 & 92981 were denied. Is this a fact? What are the guidelines. I am having extreme trouble trying to understand cardiology and interventional rad.

    Please help!

  2. #2
    Alexandria, LA
    Did you have all the necessary modifiers?
    92980 includes catheterization and imaging necessary for placement of the stent, but if a separate diagnostic coronary angiogram was performed prior to the stent placement (and based on that it was determined to place the stent), the modifier 59 needs to go on 93454. 92980 and 92981 need to have the appropriate vessel modifier (LD, LC, RC) to indicate which vessels the stents were in. (92981 can only be coded if a 2nd stent is placed in another vessel, not in the same vessel as the initial stent.)
    So, you would need something like this:
    93454-59 (add -26 if billing for physician at a hospital)

  3. #3
    Donna is correct, modifiers need to be attached to the heart cath. The second intervention (92981) also requires a 59 modifier to unbundle it from the initial intervention.
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

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