# Modifiers for Coronary Arteries



## jessica1974 (Jan 15, 2013)

We have just starting coding and billing out the new cpt codes for stents. Today I received denials on all my stent codes.  The denials were for the modifiers of RC, LD, and LC. I spoke to a Medicare representative who is stating that these modifiers are no longer required for these codes.  Is anyone else getting denials with these modifiers?  If not you might want to start looking because you probably will.  Just wondering if anyone was aware that these are no longer needed.  According to the research I have done it looks like maybe you use them when doing 2 different artery. However Medicare is stating they aren't being used at all.  Anyone have any information on this new development?


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## j.monday7814 (Jan 21, 2013)

We haven't received any denials or payments so far from Medicare or any commercial payers. I haven't heard of this at all and I'm surprised they are doing it. Maybe its MAC specific and not CMS specific?? What MAC do you have in West Virginia?? We have Noridian out here.


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## Cyndi113 (Jan 21, 2013)

Yes, we've been receiving them for a while. Just delete and rebill your corrected claim


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## jessica1974 (Jan 22, 2013)

Our MAC is Palmetto GBA.  They deny any of the intervention codes that have modifiers appended.  I have been deleting the modifiers and resubmitting. Waiting to see if we receive payment this way.  It is surprising that when you are coding 2 interventions on the same DOS they do not want the modifiers.  I even called the Provider Service line and they looked up the code.  I was told that under those codes only the LM and RI were listed as modifiers that could be used.  I have researched and there is no mention of this anywhere. But when you submit the claim they reject it.  I wish they had put out a policy or a forum that made people aware of this new change. Oh well..hoping that things get payed once the modifiers are deleted.


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## j.monday7814 (Jan 22, 2013)

yeah, hopefully that will solve the issue but it still doesn't make sense. Maybe its an error on their part?? they are thinking since the new modifiers came out this year that those are the only modifiers now?? I don't know but please keep us updated and I will too as soon as we receive payments or denials.


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## TWinsor (Jan 28, 2013)

I am having this issue also.  Our MAC is First Coast. I have researched hours and cannot find anything on the CMS site or First Coast.  Does anyone have any updates to this issue?

Thanks,


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## sandya (Jan 28, 2013)

*Modifiers with new stent codes*

We are Noviats in PA, anybody else in PA getting denials for using the modifiers with the new stent codes?  thanks.  Sandy


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## Jess1125 (Feb 4, 2013)

I'm in Wisconsin and finding out as well now that all my interventions with the vessel modifiers are being denied. Can't imagine why they wouldn't want them!

Jessica CPC, CCC


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## jessica1974 (Feb 4, 2013)

I have been using Jim Collins crosswalk and he states when you do 2 stents in different vessels to use the modifiers for those vessels.  So I have been adding them only when I am coding 2 stents in different vessels.  Today I received my first denial from Medicare on 2 stents with the modifiers LD and LC appended. Denied for inconsistent modifier.again.. just like when you code for one stent.  It appers they don't want any modifiers on any interventions.  
As terrible as this sounds I am glad that I am not the only one receiving denials on this issue. If anyone has any suggestions or any tips for this situation please keep me posted. 
Thanks.


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## Jess1125 (Feb 4, 2013)

jessica1974 said:


> I have been using Jim Collins crosswalk and he states when you do 2 stents in different vessels to use the modifiers for those vessels.  So I have been adding them only when I am coding 2 stents in different vessels.  Today I received my first denial from Medicare on 2 stents with the modifiers LD and LC appended. Denied for inconsistent modifier.again.. just like when you code for one stent.  It appers they don't want any modifiers on any interventions.
> As terrible as this sounds I am glad that I am not the only one receiving denials on this issue. If anyone has any suggestions or any tips for this situation please keep me posted.
> Thanks.



I likewise would like any suggestions myself. This is ridiculous. I had our Medicare clerks contact Medicare and they were told that the modifier I used (LC & RC) for a particular patient were invalid modifiers and we need to correct the modifiers and re-submit. Uggh what a pain. 

Jessica CPC, CCC


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## pertalad (Feb 4, 2013)

We are also receiving denials. I was referred to MLN matters Number::  MM8141.
I reading but just getting myself confused. I'm new to Cardiology.


Pertalad


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## Jess1125 (Feb 4, 2013)

Found this on First Coast's website (Part B carrier I believe for FL, Puerto Rico, and Virgin Islands) Maybe some relief in sight soon?????????? One can only hope.

Incorrect claim denials for codes 92920 - 92944

Effective date: January 1, 2013

Implementation date: January 7, 2013

First Coast Service Options Inc. (First Coast) has discovered that providers may be receiving inappropriate denials. As a result of a processing issue, Current Procedural Terminology (CPT®) codes 92920-92944 with modifiers LC, LD, and RC have been denied in error. This processing issue was corrected on January 30, 2013.

No action is required by providers at this time

First Coast is working to identify all services that have been denied in error and will make the appropriate adjustments. First Coast requests that providers do not submit appeal or reopening request; it is unnecessary to call the customer service lines in regards to these incorrect denials. First Coast apologizes for any inconvenience this may have caused.


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## jessica1974 (Feb 5, 2013)

If anyone starts getting these paid with the modifiers appended please post on here.  I called yesterday to Palmetto, our MAC, on an intervention we did on 1-7-13.  It had no modifiers appended. I was told it was being processed but not showing when it would be released to pay.  We have yet to receive any reimbursment for the intervention codes. I hope this situation clears up soon.  This is crazy.


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## mdm58 (Feb 6, 2013)

*Coronary artery stent modifier denials*

I just found out today that our medicare carrier said they are having a Claims issue with the new codes and the modifiers. We were told to hold for a couple of weeks and resubmit and they should have the porblem taking care of. So we are coding correctly it's just an error in their system!!


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## Jess1125 (Feb 6, 2013)

denisemunsey said:


> I just found out today that our medicare carrier said they are having a Claims issue with the new codes and the modifiers. We were told to hold for a couple of weeks and resubmit and they should have the porblem taking care of. So we are coding correctly it's just an error in their system!!



What state are you in? I'm waiting for our Medicare carrier to figure out they are the ones in error and not us!!!!!!

Jessica CPC, CCC


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## mdm58 (Feb 6, 2013)

*Cardiac Stent modifier denials*

I am in TN


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## mdm58 (Feb 6, 2013)

Jess1125 said:


> What state are you in? I'm waiting for our Medicare carrier to figure out they are the ones in error and not us!!!!!!
> 
> Jessica CPC, CCC





I am in TN


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## Cathy59 (Feb 6, 2013)

*Cardiac Cath Coding*

Hi, I was not aware that the RC, LC and LD modifiers for medicare were no longer required; with exception of the new ones LM and RI (I have not found any information on this).  I did read over the payment changes for physicians, summary of the final Medicare 2013 policy: http://www.ofr.gov/OFRUpload/OFRData/2012-26900_PI.pdf
Page 15&16 is stating the CMS is rebundling the branch level stents into the base code.  My question is, following the CPT guidelines, do we bill for the vessel branches with other insurances?


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## jzick01 (Feb 11, 2013)

Palmetto posted on 2/8 that they have a pending mass adjustment for all claims rejected for this modifier issue. They stated that there was an error in their system and they are working on updating it. 

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%2011%20Part%20B~Browse%20by%20Topic~Claims%20Processing%20Issues%20Log~94QRV41887?open&navmenu=Browse^by^Topic||||

Finally an answer!


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## jessica1974 (Feb 12, 2013)

Thank you for posting the information from Palmetto.  After seeing your post I went onto the website and found the notice.  Shew.. I hope how soon this gets fixed. It has been a nightmare to try to figure out.  I wondered how they were going to distiguish the vessels without the modifiers.  So glad they are fixing this issue.  Hopefully it will be corrected soon and we can get back to coding the correct way.


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## GBielskis (Mar 19, 2013)

*Modifiers for stents*

I am in Michigan - we are also receiving denials on stent codes for the modifiers for the arteries.  We are re-submitting the codes without any modifiers. 

My coding software states the artery modifiers are valid with the new stent codes.  Page 185 of the Perpheral and Cardiology Coder states the modifiers are valid with the new stent codes.  I guess CMS have different rules.


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## katfitzpat (Mar 19, 2013)

*1st Medicare Payment Received*

I am happy to report I received my first payment from Medicare for one of our coro stent (92928-LC) billed with the modifier today.
I am in Northern California and our MAC is Palmetto GBA Jurisdiction 1. I checked status on couple of the other claims (92941 etc) and those are in their system and "pending". 
I would suggest contacting your MAC re: claims in their system awaiting reprocessing rather than continued claim submission.
I'll be happy to post another reply once the other codes are paid!


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## jewlz0879 (Mar 20, 2013)

Does anyone else have Novitas as their MAC? I can't seem to find anything in regards to the modifiers and Novitas. If so, can you please share?

Thanks!


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## rykin7609 (Mar 20, 2013)

We had a few denials with the old and new modifiers but when I called MCR the gal, after a little bit of digging, said that their system was having problems. In other words they may have needed to do an update in the system or as she actually said, fix a glich. She told me to just refile the claim as is. Haven't heard anything back and that has been about 3-4 weeks ago. 

Also, today I called MCR about a denied 92973 (add on code) that was billed with a 92941. The EOB and MCR at first said that the add on code was not billed with the appropriate CPT base code. I started reciting all the codes the Guidelines say to bill 92973 with (18 of them). She told me that MCR only accepts 2 CPT codes with 92973. When I asked her which ones were those she put me on hold for I swear, 15 minutes. When she came back she apologized and said that their system had to do an upgrade to accept those new codes. 

So you see, I believe this is a problem on MCR's side, not the Guidelines or ours.


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## Cyndi113 (Mar 22, 2013)

Allana, 

its defnitely a Medicare problem. I've had to appeal interventions done with the appropriate diagnostic cath, etc. I was told that the edit is correct. I started sending a copy of the CPT page stating which codes can be used with which base codes. It's a pain. I'm hoping its fixed now!! TY for the info!


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