# Denail 92978



## kvogel03 (Feb 21, 2019)

Hello,

I have billed 93458 26, 92978 LM, and 92978 59 LD.  92978 LM and 92978 59 LD both have been denied by Medicare plus blue.  Any suggestions on how to get this paid and what modifiers to use ? 


Thanks,


Kayla


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## Jim Pawloski (Feb 22, 2019)

kvogel03 said:


> Hello,
> 
> I have billed 93458 26, 92978 LM, and 92978 59 LD.  92978 LM and 92978 59 LD both have been denied by Medicare plus blue.  Any suggestions on how to get this paid and what modifiers to use ?
> 
> ...



Are the stenosis distinct? Is there space between the LM stenosis and the LD stenosis. Medicare may be think that they are the same lesion.
HTH,
Jim Pawloski, CIRCC


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## kvogel03 (Feb 28, 2019)

The stenosis in the left main artery has distal stenosis of 40%- 50% and the left anterior descending artery has stenosis in the distal part 50%- 60%.


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## Jim Pawloski (Mar 1, 2019)

kvogel03 said:


> The stenosis in the left main artery has distal stenosis of 40%- 50% and the left anterior descending artery has stenosis in the distal part 50%- 60%.



I would appeal the decision.

Jim


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## deeva456 (Mar 5, 2019)

Hello
based on the codes you provided, here are the codes.  92978 requires modifier 26

 93458-26  
92978-26 LM    IVUS/OCT initial vessel 
92979- 26 LD   IVUS/OCT additional vessel

Hope this helps!

Dolores


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## kvogel03 (Mar 6, 2019)

And Why does 92978 need a 26 mod ?

Thanks for your help 

Kayla


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## Jim Pawloski (Mar 7, 2019)

kvogel03 said:


> And Why does 92978 need a 26 mod ?
> 
> Thanks for your help
> 
> Kayla



It depends on who you are billing for. If you are billing for the doctor, then modifier -26 is used for professional fee.
HTH,
Jim


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## kvogel03 (Mar 8, 2019)

I am billing for the doctor service that the doctor performed at the hospital.


Thanks for your help,


Kayla Vogel


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