# Business Manager



## jrandhan (May 17, 2013)

I have a "new" added position of helping cardiovascular surgeons with their coding.  I am a certified cardiology coder.  The lead surgeon is a CPC and very knowedgeable.  He wants a "58" modifier on code 33968 which is balloon pump removal.  Our claims scrubber says that we can NOT use modifier "58" with 33968.  The claims scrubber wants modifier "76".  Does anyone have a knowlege of modifier "58" and where I can get an idea of when this code is being used.  The physician doesn't like "76" because it says "return to the operating room" and the balloon pump is pulled at bedside.  

Anyone out there who can help?


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## sheardmd (Jun 12, 2013)

While I don't do any cardiovascular coding I can tell you that we use the 58 modifier for procedures that are considered staged.  We do breast biopsies and when they come back positive we go back and do mastectomy/lumpectomy on them.  We attach the 58 modifier to the mast/lump as there was always the possibility that further surgery would be needed at the first biopsy, and thus it is considered "staged".  I only use 76 for surgical complications that require a return to the OR.


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## magnolia1 (Jun 12, 2013)

I wouldn't use either of those modifiers in that scenario......

Below is a CPT Assistant that concurs:
Surgery: Cardiovascular System 

Question: If an intra-aortic balloon assist device is placed percutaneously during a cardiac intervention and removed at that session, may both the insertion and removal be reported? 

Answer:  Yes. It is appropriate to report both the intra-aortic balloon pump (IAB) insertion and the intra-aortic balloon pump removal on the same day with code 33967, Insertion of intra-aortic balloon assist device, percutaneous, and code 33968, Removal of intra-aortic balloon assist device, percutaneous. One indication for this procedure is an acute myocardial infarction (MI). Other indications could be the intent to do a left main coronary artery percutaneous coronary intervention. Most IAB insertions for cardiogenic shock would not involve removal in the same setting, 

Supporting a patient having an interventional cardiology procedure with an IAB or some of the newer percutaneous assist devices is becoming the standard of care for some higher-risk percutaneous coronary intervention patients. 

CPT Assistant © Copyright 1990-2013, American Medical Association. All rights reserved.


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