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Left Heart Cath and Stent Placement

  1. Question Left Heart Cath and Stent Placement
    Medical Coding Books
    I just got a denial. The doctor performed a Left Heart Cath 93458 -26 modifier and a stent 92980. They paid for the 92980 but not the 93458?

    The denial states Procedure code inclusive to the Primary Procedure. Member not liable?

    Did I code something wrong? Has anyone gotten this denial?

    The report is as follows:

    The patient went underwent left heart catherization and coronary arteriography.Description of Procedure:
    Under sterilie conditions, the right inguinal space was prepped and draped. Xylocaine 1% was injected locally over the right femoral artery. A needle was inserted in the femoral artery. Introducer placed and a pigtail catheter was inserted. It was passed to the left ventricle. Left ventricular pressures were recorded and pullback pressures from the left ventricle to the aortic root were recorded. Next, a left Judkins catheter was inserted and passed the orifice of the left coronary. Two views of the left coronary were obtained. Next, a right Judkins catheter was inserted and passed the orifice of the right coronary. One view of the right coronary was obtained. The patient tolerated the prodedure well and there were no complications.

    Coronay angioplasty note. After discussion with the patient it was decided to proceed with angioplasty of the proximal circumflex. A 6-French introducer was put in place of the 4- French introducer and an EBU guiding catheter was passed to te orifice of the left coronary. A guidewire was passed down the circumflex and then a 2.5x 15-mm balloon catheter was passed to the side of the lesion and dilated to 14 atmospheres for 40 seconds. Results were fair but there was still a significant lesion in the anteromedial portion of the lesion. Therefore, a 2.5mmx 8mm stent ballon catheter was passed to the site of the lesion and dialted to 14 atmospheres for seconds. Another view of the left coronary was obtained. Results were good, and the prodedure was discontinued at that point.

    Results:
    Left ventricular pressure was 140 systolic with end-diastolic pressure of 18 aortic pressure was 140/80 with a mean of 95. The left ventriculogram was not obtained. The coronary artery showed patent stents in the proxial and mid LAD and the proximal circumflex and in the proximal right coronar. The left main and LAD showed no significant stenotic disease. The circumflex had a 90% stenosis near its orifice and there was some plaque disease in the midportion of the circumflex. The right coronary was widely patent throughout.

    Clinical Inpression:
    1. Severe single-vessel coronary artery disease
    2. Successful angioplasty and stent of the proximal left circumflex

  2. #2
    Default
    Quote Originally Posted by mcollins007 View Post
    I just got a denial. The doctor performed a Left Heart Cath 93458 -26 modifier and a stent 92980. They paid for the 92980 but not the 93458?

    The denial states Procedure code inclusive to the Primary Procedure. Member not liable?

    Did I code something wrong? Has anyone gotten this denial?

    The report is as follows:

    The patient went underwent left heart catherization and coronary arteriography.Description of Procedure:
    Under sterilie conditions, the right inguinal space was prepped and draped. Xylocaine 1% was injected locally over the right femoral artery. A needle was inserted in the femoral artery. Introducer placed and a pigtail catheter was inserted. It was passed to the left ventricle. Left ventricular pressures were recorded and pullback pressures from the left ventricle to the aortic root were recorded. Next, a left Judkins catheter was inserted and passed the orifice of the left coronary. Two views of the left coronary were obtained. Next, a right Judkins catheter was inserted and passed the orifice of the right coronary. One view of the right coronary was obtained. The patient tolerated the prodedure well and there were no complications.

    Coronay angioplasty note. After discussion with the patient it was decided to proceed with angioplasty of the proximal circumflex. A 6-French introducer was put in place of the 4- French introducer and an EBU guiding catheter was passed to te orifice of the left coronary. A guidewire was passed down the circumflex and then a 2.5x 15-mm balloon catheter was passed to the side of the lesion and dilated to 14 atmospheres for 40 seconds. Results were fair but there was still a significant lesion in the anteromedial portion of the lesion. Therefore, a 2.5mmx 8mm stent ballon catheter was passed to the site of the lesion and dialted to 14 atmospheres for seconds. Another view of the left coronary was obtained. Results were good, and the prodedure was discontinued at that point.

    Results:
    Left ventricular pressure was 140 systolic with end-diastolic pressure of 18 aortic pressure was 140/80 with a mean of 95. The left ventriculogram was not obtained. The coronary artery showed patent stents in the proxial and mid LAD and the proximal circumflex and in the proximal right coronar. The left main and LAD showed no significant stenotic disease. The circumflex had a 90% stenosis near its orifice and there was some plaque disease in the midportion of the circumflex. The right coronary was widely patent throughout.

    Clinical Inpression:
    1. Severe single-vessel coronary artery disease
    2. Successful angioplasty and stent of the proximal left circumflex
    You need modifier -59 to the LHC, showing that you did a diagnostic heart cath first, which then made the decision for the stent placement.
    HTH,
    Jim Pawloski, CIRCC

  3. Default
    Okay so I should do 93458 59 do not include the 26 mod?

  4. #4
    Location
    Alexandria, LA
    Posts
    518
    Default
    Assuming this was done at the hospital, you need both. These are not mutually exclusive modifiers. The 26 says the doctor did this heart cath at a hospital or other facility and he is coding/billing only for the professional component of the procedure. Modifier 59 says the heart cath was a diagnostic study separate from the catheterization/imaging necessary for placing the stent.

  5. Thumbs up
    Thanks so much for the information.

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