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Thread: 92928 and 92929 - New stent codes in 2013

  1. #1
    Join Date
    Apr 2007
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    Little Rock Arkansas
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    Default 92928 and 92929 - New stent codes in 2013

    AAPC: CPC Promo
    We have found that Medicare will only pay for the 92928, and denies the add-on code 92929 when multiple stents are being placed in the patient. So, is anyone else finding this to be true? In other words, Medicare will only pay the physician to place one stent, whether he places one or multiple. That just cannot be right. We are going to appeal, but wanted to see if others have run across the same issue.
    Wendy E. Grant CPC
    AAPC-CA Board of Directors 2009-2012
    Region 4 - FL, GA, AL, TN, Puerto Rico, Bahamas

  2. #2
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    Green Bay
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    Default

    Quote Originally Posted by wegrant630 View Post
    We have found that Medicare will only pay for the 92928, and denies the add-on code 92929 when multiple stents are being placed in the patient. So, is anyone else finding this to be true? In other words, Medicare will only pay the physician to place one stent, whether he places one or multiple. That just cannot be right. We are going to appeal, but wanted to see if others have run across the same issue.
    Yes, this is true. CMS has decided to give the add-on codes a "bundled" status on the Medicare Physician Fee Schedule. They will only pay for the "base" codes and aren't paying for the additional branches.

    Jessica CPC, CCC

  3. #3
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    Default

    Hello Wendy,

    Medicare will not pay for the add-on codes. In the PFS Final Rule CMS decided not to accept the RUC values for the main codes or add-on codes. What they did do was bundlethe payment for the add-on codes in the main code, increasing the fee slightly for each main code.

    Debra

  4. #4
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    Default

    CPT code 92928 can be billed multiple time for stents in different vessels, Medicare will pay for more than one stent so long as they are in different vessels, 92929 is reported for the branch stenting and that is what they are bundling in the main procedure code.

  5. #5

    Default RVU for New Stent codes

    I have not been able to find the RVU's for the new stents codes on the CMS website. Can anyone help me with this.

  6. #6

    Default

    Where can we find this where it states will only pay for the add on code.

    TIA

  7. #7
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    Apr 2007
    Location
    Richardson, TX
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    Default

    This has the RVUs listed on pgs 55-56. Is from AMA. And pg 57 for CMS stance to NOT pay add-on PCI codes

    http://www.ama-assn.org/resources/do...ology-brin.pdf

    HTH
    Last edited by jewlz0879; 03-01-2013 at 07:27 AM.
    Julie Graham, BA, CPC, CCC

  8. #8

    Default Commercial

    Thank you for this webiste. Has anyone found where commercial insurances are paying the Cardiology add on codes (92921, 92925, 92929, 92934, 92938)? i understand that Medicare, Medicaid and BCBS are not paying, but was curious if any other insurance is paying.

  9. #9

    Default Anthem 92928 and 92929

    Has anyone found any resolution to resolving denials for 92929 from Anthem?

  10. #10
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    Apr 2007
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    Glens Falls, NY
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    68

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    We got pricing from our CDPHP rep.!

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