# 2 Interventional Procedures on the same day



## 10marty (May 28, 2010)

Can anyone lend their expertise?

My cardiologist does not want to get hit with the 50% rule.  He had a patient in the lab did a heart cath and placed 2 stents in mid the RCA.  Catheters were pulled, and femoral perclosed.  Patient never left the lab, developed chest pain, cath redone with an additional 2 stents placed in the distal RCA.

Thanks for any input.

Marty


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## sbicknell (May 28, 2010)

Sorry, its going to count as one cath session. In other words the patient was not stable and never left the cath room. Stabilizing the patient is expected part of post-procedure work. Dictate one cath report and bill one cath session. Since he put all the stents on the RC he can only code one 92980-RC.

He can try billing with a mod -22 due to the circumstances of having to re-inserting the catheter, the multiple stents etc. And CMS requires an additional separate letter. The documentattion will have to be very specific to show the extra time and work involved in the re-cath and stenting. Of course the payer may still not pay anything extra

If he did a 2nd diagnostic coronary angiography (93508) to identify the cause of the chest pain, be sure it is documented and coded with 786.50. And you will have to use the modifiers either for repeat procedure and the -59

To get this paid, you are going to have to submit the cath report.

Here is what I am thinking for the coding (just an example)
93610-26
93543
93545
93555-26
93556-26
92980-RC
DX for all 414.01 

93508-26
93545 
93556-26
DX 786.50

The payers like to deny 93508 when coded with 92980. But a diagnositic angio is always separately payable from the interventional PTCA/stent. It is only inclusive if the vessel lesion is known (ie diagnostic done earlier or at a different cath lab) and the angio is only done in order to place the cath and do the PTCA/stent

See what other responses you get.


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## arleneg527 (Jun 3, 2010)

You need to add modifier -59 to 93555-26 and 93556-26, when billed with a stent placement


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## sbicknell (Jun 3, 2010)

correct, why I noted..............And you will have to use the modifiers either for repeat procedure and the -59


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## 10marty (Jun 4, 2010)

Thank you all for your responses.  You have all confirmed what i thought.  I really appreciate your expertise and time.

Marty j


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## natfos6 (Jun 22, 2010)

according to Medical Practice Doding Pro 11/09 Vol. 15 No. 11....if 4 or more stents are placed in teh same aretery you can append a 22 modifier and CMS will consider it like there is a 92980 and a 92981 for reimbursement purposes.


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