# Return to cath lab



## hiamywickel (Jul 14, 2011)

Question; 
The physician did a CPT 93458-26/59 and 92982, and while in the recovery area the patient had a recurrence of a massive ST elevation of the inferior leads and had to be brought back the the cath lab. Physician also billing for CPT 93454, 92980,92973 (for the return back to cath lab) however since 93454 is bundle with 93458 would it be appropriate to use modifer 78 on the 93454? 

Thank you for your time.


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## arleneg527 (Jul 14, 2011)

I would not code 93454, was it medically necessary as he had done it earlier?  I would only code 92980-78.


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## mabar1571 (Jul 15, 2011)

I would tend to agree with above poster.  Unless you can show in documentation that there was a radical change between what was seen on first cath.and what was discovered on second cath.


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## dpeoples (Jul 15, 2011)

hiamywickel said:


> Question;
> The physician did a CPT 93458-26/59 and 92982, and while in the recovery area the patient had a recurrence of a massive ST elevation of the inferior leads and had to be brought back the the cath lab. Physician also billing for CPT 93454, 92980,92973 (for the return back to cath lab) however since 93454 is bundle with 93458 would it be appropriate to use modifer 78 on the 93454?
> 
> Thank you for your time.



This seems to be a case where you could could bill for the repeat heart cath (not usually the case) as long as the reason for the repeat is *clearly documented *(acute change in condition/massive ST elevation etc). As for modifiers, 78 would be my first choice, and you may need to append 59 as well, the sequence may depend on the payor.

HTH


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## Jess1125 (Jul 18, 2011)

dpeoples said:


> This seems to be a case where you could could bill for the repeat heart cath (not usually the case) as long as the reason for the repeat is *clearly documented *(acute change in condition/massive ST elevation etc). As for modifiers, 78 would be my first choice, and you may need to append 59 as well, the sequence may depend on the payor.
> 
> HTH



I agree. I would code the 93454 here as well. The patient's condition changed since the cath earlier in the day. 

Jessica CPC, CCC


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## hiamywickel (Jul 18, 2011)

Thank  you for your help.


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