# graft and lima only



## haugen (Aug 18, 2011)

I have a cath report where the vein graft and lima aortography were done.  The coronaries were not viewed because the doctor reviewed a previous report from that day done at a different hospital.  Our doctor is doing an evaluation for inferior ST-elevation myocardia infarction, post bypass surgery.  Does anyone have an idea on how to code this.  

Thank you,
Cindy


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## jewlz0879 (Aug 18, 2011)

Do you have the report? It would be easier to interpret what the correct code would be. I do know the code for an aortography is +93567.


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## haugen (Aug 18, 2011)

Yes,  I do have the report and that is the only views he did were the grafts and lima.  He didn't do the coronaries.  He has left heart cath under the procedure list but his procedure report doesn't mention it and the impressions are only of the graft and lima.


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## jewlz0879 (Aug 18, 2011)

Hmmmm I've never had one without the coronaries but with the Lima and SV graft. The only codes without Coronary Arteries are: 93452 & 93453 but they do not include the SV/Lima Grafts and the codes for those have since been deleted. 

I wonder if you could bill 93459 (as long as AV was crossed) but with a 52? I'm not sure. Maybe someone else has encountered this?


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## Jess1125 (Aug 18, 2011)

haugen said:


> I have a cath report where the vein graft and lima aortography were done.  The coronaries were not viewed because the doctor reviewed a previous report from that day done at a different hospital.  Our doctor is doing an evaluation for inferior ST-elevation myocardia infarction, post bypass surgery.  Does anyone have an idea on how to code this.
> 
> Thank you,
> Cindy



Personally, I would do code 93455 with modifier -52. This is what I was told to do at a MedLearn webinar if only grafts were looked at. 

Jessica CPC, CCC


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## haugen (Aug 19, 2011)

Thank you both for your help with my coding question. 

Have a great weekend!
Thanks again.


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## Misty Dawn (Oct 26, 2011)

Jess1125 said:


> Personally, I would do code 93455 with modifier -52. This is what I was told to do at a MedLearn webinar if only grafts were looked at.
> 
> Jessica CPC, CCC



When I look it up in encoder and in AAPCs procedural coding expert, it says you cannot append 52 modifier to that code.  
Also 
ZHealth Online Q&A 2612

Date: Friday, March 11, 2011

Question:  Is modifier 52 ever appended to cath codes if documentation does not meet the full description of the CPT code? thank you

Answer: I would not use -52 for the new heart cath codes if there is a component missing, such as the native coronary angiography at the time of a graft angiography (93455), I would just code 93455 as is without the modifier. Remember, that for Medicare, hospital billing, all heart caths fall into the same APC and are all paid exactly the same (a right heart cath pays the same as a right and left heart cath with native and graft angiography). In 2010, if we did less than a right and left heart cath with coronaries (e.g., in a patient with a metallic aortic valve), we actually "coded" more with 93501 and 93508. A -52 modifier would inappropriately decrease payment 50% in the first example. I cannot think of a time that I have used the -52 with a heart cath yet. If one of societies produce and article concerning this, we will be sure to let you know. Dr.z


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## theresa.dix@tennova.com (Oct 28, 2011)

Misty Dawn said:


> When I look it up in encoder and in AAPCs procedural coding expert, it says you cannot append 52 modifier to that code.
> Also
> ZHealth Online Q&A 2612
> 
> ...




This is true Medlearn did say this 
 Here is the Q & A

January 17, 2011
Question:
Historically, we could report the imaging of the IMA with a heart cath whether the IMA was used as a graft or native. With the inception of the new codes 93455, 93457, 93459, and 93461, is that still true? 


Answer:
If a bundled/collapsed code exists for the graft injection with other services, it cannot be fragmented out into a separate charge. If only the grafts are imaged without coronaries, we believe the best code to assign is 93455-52.


But If It were me coding this I would NOT append modifier 52 and go with Dr Z. Misty Id like to see the encoder you have that says 52 cannot be appended to the 93455? Can you copy and paste it here?


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