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93567 denials

  1. #1
    Default 93567 denials
    Medical Coding Books
    Is anyone getting denials for 93567 when biiled with a cath the denial is for missing modifier. If so could you email me if you any suggestions as to how to get this add on code paid. mmunsey@mc.utmck.edu

    Thanks
    mdm58

  2. Default
    Quote Originally Posted by denisemunsey View Post
    Is anyone getting denials for 93567 when biiled with a cath the denial is for missing modifier. If so could you email me if you any suggestions as to how to get this add on code paid. mmunsey@mc.utmck.edu

    Thanks

    Denise,
    please read below. This is off of Trailblazer. A few years ago I attended a seminar where the presenter told us that 93544 was going to start getting denied for dx. And now this may be the reason. Even tho they say a modifier is needed!.

    Angiography
    Indications and Limitations for Angiography:

    Angiograms of the individual cardiac chambers will be reimbursed based on medical necessity.

    Aortography is reimbursable only for diagnoses of aortic root disease, valvular heart disease or congenital heart disease. It is not reimbursable for atherosclerotic heart disease. Angiograms to visualize the coronary ostia are included as part of coronary angiography. A diagnosis of "rule out (valvular lesion)" is not reimbursable.

    in other words you need a "good" dx for the aortography these days. 424.1 maybe. If you do not have one they will possible deny it since it is an "aortic root shot" it isnt used to diagnose CAD. and of course the code has changed to 93567.
    Last edited by theresa.dix@tennova.com; 09-06-2011 at 12:31 PM.
    Theresa CCS-P CPMA CCC ICDCT-CM

  3. #3
    Default
    I agree with Theresa, it may be more likely that it's denied for medical necessity than a missing modifier. I'm not sure why they're indicating a missing modifier, I'm not aware of 93567 having an NCCI edit with a heart cath.
    ____________

    Rich Carrillo, CCS, CPC

  4. #4
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    Default
    Quote Originally Posted by denisemunsey View Post
    Is anyone getting denials for 93567 when biiled with a cath the denial is for missing modifier. If so could you email me if you any suggestions as to how to get this add on code paid. mmunsey@mc.utmck.edu

    Thanks
    What other codes were billed on that same date of service?

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