# 92920 and 93458



## kvogel03 (Jun 19, 2019)

Hello,

When the 92920 was performed they passed the wire and dilated it, but when they pulled the wire back the guide wire remained firmly implanted into the artery.  There was good flow in the artery.  It was unsuccessful angioplasty due to the fractured wire in the artery.  I billed 92920 53 RC, and 93458 26,59.  93458 is being denied inclusive.  Is 53 the correct modifier to use on 92920?  

Thanks,

Kayla


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## cpc2007 (Jun 22, 2019)

kvogel03 said:


> Hello,
> 
> When the 92920 was performed they passed the wire and dilated it, but when they pulled the wire back the guide wire remained firmly implanted into the artery.  There was good flow in the artery.  It was unsuccessful angioplasty due to the fractured wire in the artery.  I billed 92920 53 RC, and 93458 26,59.  93458 is being denied inclusive.  Is 53 the correct modifier to use on 92920?
> 
> ...


Based on the circumstances you have described, I would agree with modifier 53 on CPT 92920 for the attempted angioplasty which is ultimately terminated due to the fractured wire. In terms of 93458 bundling to 92920, was the cardiac catheterization diagnostic to support unbundling that code? To be considered diagnostic the Cath would need to be the initial coronary artery angiogram (no prior recent catheterization or CTA); there should be complete finding of the coronary arteries and the left heart with 93458 (noting presence or absence of CAD/stenosis/thrombus in the left and right coronary arteries and noting hemodynamic measurements like an LVEDP or results of a left ventriculogram in the left side of the heart); and the decision to attempt the angioplasty is based on the results of the cardiac cath. Alternatively if there was a recent cardiac cath or CTA one of the following would need to be documented to consider the cath diagnostic: the views on the prior cath or CTA were insufficient requiring a repeat cath; or the patient's condition has changed since the prior study requiring a repeat cath; or there is a change during the planned procedure requiring a repeat cath in an area other than the artery undergoing angioplasty. In addition to this criteria again the note should reflect that the decision to proceed with the attempted angioplasty was based on the cardiac cath findings.

If you have documentation to meet criteria for the cardiac cath to be considered diagnostic, I would appeal the denial on 93458 with your report to support that the cath was diagnostic. If the cardiac cath was for guidance to navigate to the artery requiring angioplasty or to visualize what was happening in the artery when the wire got stuck, I would write off that code as included in the 92920.53.

I hope that helps 

Kim
www.codingmastery.com


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## kvogel03 (Jun 26, 2019)

Kim,

Thanks for your help and input on this.   I have the necessary documentation to appeal heart cath.

Kayla


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## cpc2007 (Jul 4, 2019)

kvogel03 said:


> Kim,
> 
> Thanks for your help and input on this.   I have the necessary documentation to appeal heart cath.
> 
> Kayla


You're welcome!


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