# Denials on Stents with BCBS



## jessica1974 (Jun 18, 2013)

We are having trouble gettting BCBS to pay stent codes where 2 vessels are concerned.  For instance if we do a stent to the LAD and a stent to the LC they are denying the second one as a duplicate.  I have been working with our provider rep here in WV.  We actually have Highmark BCBS.  They are trying to say that we should be billing the add-on code of 92929.  But I disagree with that because CPT states that it is an additional branch off of the main branch (paraphrasing that).  I am trying to explain to them that there isn't even a montary value on 92929 according to the MFS.  I know that as a commerical carrier they set their own fee schedule.  Just wondering if anyone else is having this issue.  If so how did you get it resolved?  And should I be billing it the way they advise?

Thanks for any advice.


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## Jess1125 (Jun 18, 2013)

jessica1974 said:


> We are having trouble gettting BCBS to pay stent codes where 2 vessels are concerned.  For instance if we do a stent to the LAD and a stent to the LC they are denying the second one as a duplicate.  I have been working with our provider rep here in WV.  We actually have Highmark BCBS.  They are trying to say that we should be billing the add-on code of 92929.  But I disagree with that because CPT states that it is an additional branch off of the main branch (paraphrasing that).  I am trying to explain to them that there isn't even a montary value on 92929 according to the MFS.  I know that as a commerical carrier they set their own fee schedule.  Just wondering if anyone else is having this issue.  If so how did you get it resolved?  And should I be billing it the way they advise?
> 
> Thanks for any advice.



No, don't change it to the way the advise! I had a Med Replace plan keep trying to tell me that I should be billing 92929 for subsequent vessels. Keep fighting it! CPT guidelines state there are 5 major coronary vessels and 92928 as well as the other codes are "single vessel" codes. If I had a magic document that said 92928 could be billed more than once I'd let you know! Just going to have to go by CPT guidelines/code description for documentation supporting your code choices and keep fighting! Good luck. 

Jessica CPC, CCC


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## nancy.anselmo@ccrheart.com (Jun 18, 2013)

Keep fighting, I too had trouble w/ a commercial insurance here in New York and I am just now seeing them pay the second STENT. Are you putting the LC or LD on both and a 59 on the second one? Nancy


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## Summer (Jun 21, 2013)

We are seeing this in Florida too!  I just keep writing the appeal letters and sending them the guidelines.


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## leahlhaynie (Jul 25, 2013)

A specific employer plan in Texas just gave me the same argument. She told me they'd only pay for one a day, and scoffed when I asked for that in writing. She suggested I call the AMA for coding advice. 

Do you think reporting this to SCAI would help at all?

Thanks!
Leah


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