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93454 & 9281 denied to 92980

  1. Question 93454 & 9281 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. Default
    Quote Originally Posted by coders_rock! View Post
    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!
    No this is not a fact UNLESS you forgot to add the 59 modifier to 93454 and 92981? did you?

    Oh but let me remind you that you should only be billing the cath if it were a diagnostic cath. If the decision to place the stents was based on the results of todays cath, you can bill it. If this was a planned surgery you cannot bill the cath placement but you should still be able to bill the stents if they are in different vessels.
    Last edited by theresa.dix@tennova.com; 08-23-2011 at 10:36 AM.
    Theresa CCS-P CPMA CCC ICDCT-CM

  3. #3
    Default
    Quote Originally Posted by coders_rock! View Post
    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!
    As Theresa said above, the 93454 can be paid with a -59 if it was truly a diagnostic study.

    What about your stent codes? Did they have the appropriate vessel modifiers on them so insurance knows these were done in different vessels?

    Jessica CPC, CCC

  4. Red face
    Quote Originally Posted by Jess1125 View Post
    As Theresa said above, the 93454 can be paid with a -59 if it was truly a diagnostic study.

    What about your stent codes? Did they have the appropriate vessel modifiers on them so insurance knows these were done in different vessels?

    Jessica CPC, CCC

    Jessica,
    oops, Yes this is right. We really do not need a 59 modifier on the second stent code. At one time it was thought we did. Just your LC,LD or RC.
    Last edited by theresa.dix@tennova.com; 08-23-2011 at 11:38 AM.
    Theresa CCS-P CPMA CCC ICDCT-CM

  5. Default
    It was billed like this,

    93454
    92980-RC
    92981-LC

    What should I do?

  6. #6
    Default
    I would bill it like this:

    93454/2659
    92980/rc
    92981/lc

    We haven't had any problems so I hope this helps you too!
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

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