# LH cath with PCI



## choppe (May 9, 2012)

Can someone please explain if and when it would be appropriate to use modifier -59 with a LH cath 93458 done by one physician in a group when a second physician in the group comes in to follow up with a LVgram and PCI?  Shouldn't they just bill for the LVgram and PCI, but not the LH cath?

Likewise, code 93454 bundles with 92995 and 92980.  When is modifier -59 appropriate with 93454 when either of these are done together?

Thanks!


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## dpeoples (May 9, 2012)

choppe said:


> Can someone please explain if and when it would be appropriate to use modifier -59 with a LH cath 93458 done by one physician in a group when a second physician in the group comes in to follow up with a LVgram and PCI?  Shouldn't they just bill for the LVgram and PCI, but not the LH cath?
> 
> Likewise, code 93454 bundles with 92995 and 92980.  When is modifier -59 appropriate with 93454 when either of these are done together?
> 
> Thanks!




Where to start? There is no longer a code just for a LV gram, that is always included with LHC codes (93452,93453,93458-93461). Likewise the arterectomy (92995) is always part of the coronary stent placement  (92980) and should not be billed separately when both are performed in the same vessel.

It is appropriate to bill/code for a *diagnostic* heart cath with a 59 modifier when performed by the same group/facility in the same setting/session even if two different providers are involved. However, it should not be billed/coded if the condition was already known and the heart cath was performed for access and guidance for the interventional procedure.

HTH


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## choppe (May 9, 2012)

Yes, it does!  Thanks.  Just to clarify, is it okay to bill the 93454-59 with a 92980 or 92995 after the 93458 has already been done?

Here's one example:

Doctor A performs a 93458 diagnostic with LVgram and determines need for intervention in the LAD.
Doctor B performs the intervention and wants to bill 93454, 92995, 92978 and 92979.  All was done in the LAD.  We can't bill the 93454, can we?

Thanks,


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## Jess1125 (May 10, 2012)

choppe said:


> Yes, it does!  Thanks.  Just to clarify, is it okay to bill the 93454-59 with a 92980 or 92995 after the 93458 has already been done?
> 
> Here's one example:
> 
> ...



Here would be an instance where, no, you can't bill the 93454 separately with a -59. The diagnostic study was done already and it was known that this stenosis was there and needed to be intervened on. The decision to intervene was made when Dr. A performed his study. Unless the patient's condition had changed since Dr. A did his study this isn't separately billable. 

On a side note, I'm confused by the 92979. You said this was all done in the LAD. Why is there an additional vessel code for the IVUS? 

Jessica CPC, CCC


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## choppe (May 10, 2012)

Sorry, I didn't give the detail on that part.  Under the heading INTRAVASCULAR ULTRASOUND it says:

"IVUS showed that the distal left anterior descending measured 1.9 to 2 mm in diameter.  There was very severe plaquing within the distal end of the stent extending proximally.  In the stent just distal to where the diagonal branch was, the stent was narrowed in comparison to distal and proximally.  Pulling back into the left main showed that there was very little plaquing in the left main."

There was severe stenosis in the mid to distal LAD, at the distal end of the previously placed stent as well as some plaque that was displaced just distal to the origin of the stented diagonal.  It was billed as 92978-26-LD and 92979-26-LC.  I am just cleaning up some else's old A/R and trying to make sense of it all.  I have four similar cases where I think the 93454 should be written off.

#1 is 93454 with 92980, done the day after a cath showing stenosis in the LAD and held overnight for intervention.  
#2 is this patient with the 93458 by Dr. A and then 93454, 92995-LD, 92978-LD and 92979-LC by Dr. B
#3 is another patient with 93459 by Dr. A and then 93454, 92980-LD, 93978-LD and 92979-LC by Dr. B
#4 is pt with possible end stage aortic stenosis with 3 vessel coronary dz.  They started with an angiogram thru the RFA from the descending aorta arch all the way to the femoral arteries to assess safety of using an intraaortic balloon pump, which was then done through the LFA.  It then says they put a guiding catheter in the RFA.  They did the IVUS thru the LAD and left main, then proceeded with stent placements in the LAD and LC, where stents were also placed.  Balloon pump was removed.  Here's what was billed:  36200-59 (bundles, but okay with -59 for diagnostic view?), 75630, 33967, 33968 (bundles), 93454-59 (bundles), 92980-LD, 92981-LC, 92978-LD, 92979-LC.

In this last case, I believe the 33968 and 93454 should be written off/refunded if paid.

Your insight is GREATLY appreciated! 
Thanks!


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## Jess1125 (May 14, 2012)

choppe said:


> Sorry, I didn't give the detail on that part.  Under the heading INTRAVASCULAR ULTRASOUND it says:
> 
> "IVUS showed that the distal left anterior descending measured 1.9 to 2 mm in diameter.  There was very severe plaquing within the distal end of the stent extending proximally.  In the stent just distal to where the diagonal branch was, the stent was narrowed in comparison to distal and proximally.  Pulling back into the left main showed that there was very little plaquing in the left main."
> 
> ...



#1 definitely the 93454 shouldn't have been billed because it is stated that they stayed overnight FOR the intervention.

The other scenarios without I guess knowing exactly what the scenario was they probably need to be written off. If Dr. B is coming in specifically to do the intervention and these were planned interventions and the patient's condition hadn't changed since the diagnostic study then he can't bill the coronaries. 

Jessica CPC, CCC


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