# 93458 bundled with 36245



## amym (May 12, 2011)

If a physician performs a cardiac cath 93458 and a Selective Lower Extremity Angiogram 36245 at the same time, is it appropriate to append a modifier -59 to bypass the bundling rule?  If so, what makes it OK to add modifier -59?

Thanks in advance.


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## OliviaPrice (May 12, 2011)

Modifier -59 is appropriate on the 36245 and you may also find it necessary to append the modifier on your S&I code.  

Modifier -59 is supported if:
Medical necessity is supported for the selective procedure (this does not include screening).
And
A complete procedure was performed (meaning everything was done that would have been done if a cath was not performed).

Per Dr. Z's Medical Coding Series Diagnostic & Interventional Cardiovascular Coding Reference:
"When selective catheterization of non-coronary arteries is performed during cardiac catheterization, utilize selective catheter placement codes 36245-36248 and/or 36215-36218 as appropriate per peripheral coding instruction."


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