# CPT 92928 with 93458



## mooney2013

There are certain circumstances where 92928(PCI stent) and 92458(cardiac cath) can be billed together, I have successfully done this, I code the 92928 first (has the higher RVU) and then the 93458 with 26,xs,51. Today I received EOB from healthteam advantage where they made the 93458 the primary code and removed the 51 modifier.  This will mean a decreased payment.  According to my billing book the higher RVU should go first.  I have looked on the CMS website trying to find a guideline on this, but have not found anything. Can anyone point me in the right direction or can they do this.
Thanks, Kay


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## danskangel313

If you read the guidelines in your CPT book for Coronary Therapeutic Services and Procedures, it states "Diagnostic coronary angiography codes (93454-93461) and injection procedure codes (93563-93564) should not be used with percutaneous coronary revascularization services (92920-92944) to report...". It goes on a while, so I'm not going to type it all out. 

I checked and 92928 is bundled with 93458, but has an indicator of 1.


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## mooney2013

*Cpt 92928 with 93458*

The CPT book also states that a Diagnostic angiography performed at the time of a coronary interventional procedure may be reported separately if... and gives 2 scenarios which is what I had. My issue is in what order they are placed for billing. I was taught through the AAPC that the highest RVU is the primary procedure.  I would like to know if CMS has guidelines for this.


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## danskangel313

You are correct about the RVUs. 

(I'm retyping this so I can make sure I have it right)
You billed:
92928
93458-26-XS-51

The claim came back with:
93458-26-XS
92928
Right?

The edit says "Code 93458 is a column 2 code for 92928 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier with code 93458. 
The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, LM, RC, RI, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, XE, XP, XS, XU, 24, 25, 27, 57, 58, 59, 78, 79, and 91"

Here's my thoughts; I assume the XS allowed the codes to go through (although it surprises me that they'd allow XS on the same structure/organ). 
The multiple procedure rules apply, so if they ranked 93458 first (for whatever reason), then 92928 would get the 50% reduction.
93458-26 has around 9 RVUs
92928 has around 17, but cut in half for multiple procedures, that becomes 8.5, which again, places it second.

I've read in a few places that 93458 with a 26 can cause troubles because the description of that code includes "supervision _and interpretation_", which is linked to the POS billed apparently...? If that's the case, then they could have dropped the 26 also, leaving 93458-XS with 30 RVUs, give or take. Even if they didn't halve the 92928, the 17 RVUs would still come in second. 

If I were to take a guess, I'd say they removed both the 51 and 26 and ended up with 93458-XS, 92928-51, which would explain why they ranked it like they did. I think the multiple procedure rule might be where the payer is getting you caught up. If they allowed the 26 on 93458, the only possible way it could be ranked first is if they cut the 92928 in half. Maybe it's the way the modifiers are ranked? Without personally seeing the RA, that's where I'd end up in my thought process.


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