# 93508 with a Stent



## howland6 (Oct 6, 2008)

My physician is an interventional cardiologist who is called in after a diagnostic heart cath by another cardiologist to perform stenting.  The cardiologist who performs the left heart cath, coronary angiography and left ventriculogram bills his 93510 while we bill 93508 for the catheter placement  during our procedure.  We are getting rejections on the 93508 and are trying to determine how to get paid for the catheter placement during our procedure.  These are both done on the same day, different physicians, not in the same practice.  I realize there are other codes with the heart caths.  I am only concernced with the rejection of the 93508.


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## mshelly87 (Oct 7, 2008)

You are getting a denial for the 93508 because when your physician goes in and places the stent the catheter placement codes are considered part of the stent. You can only bill the stent code 92980. My physicians are interventional cardiologists as well and we do the same exact thing, we go in alot of the time after the diagnostic heart cath has been done. Hope this helps


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## howland6 (Oct 8, 2008)

*93508 With A Stent*

Thank you for your help!  I didn't ask this question originally, but do you also bill the S & I codes (93555-56) if documentation supports them?  I was told you can with the Modifier 59 to differentiate from the diagnostic heart cath (already billed by the other provider).  We would also use Modifier 26 for our physicians.


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## Davistm (Oct 16, 2008)

No. Your physician is doing an intervention not a diagnostic study. The stent code includes all catheter movement, injections and imaging necessary to accomplish the intervention.

Terry Davis
CPC


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## levyad (Oct 19, 2008)

I am working for Cardiology Facility Based Practice and faced this issue too. If Diagnosstic Cardiac Cath turned to the coronary intervention (unplanned) we can bill both, dx. Cardiac Cath and stent. Please see this Medicare guidlines:

http://www.ngsmedicare.com/NGSMedicare/lcd/L28395_active_sia.htm

"Coronary angiography procedures performed during a therapeutic coronary artery procedure that are integral part of the procedure (e.g., guiding arteriograms), are considered to be part of the percutaneous coronary intervention and not a separately reportable diagnostic procedure. *However, when a diagnostic cardiac catheterization or angiography is performed on the same day but as a separate procedure prior to percutaneous coronary intervention, then the 59 modifier should be appended to the codes 93555 and 93556 when reported with the diagnostic catheterization procedures.*"

Per NCCI 93508 is not bundled with 92980, but some insurances still deny these procedures together.  Resently our Managed Care department reached agreeement with OXFORD, that we can bill 93508-26-59 with stent.  So, I am billing Dx. Cardiac Cath together with UNPLANNED coronary intervention (if propely documented) and using modifier -59- with 93508 for non-Medicare vendors.  

If still denied, you could write an appeal using Medicare guidlines quoted above.

I hope, it will be helpful.


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## terri l davis (Nov 5, 2008)

You are not going to get paid for the 93508 with the stent placement.
These cath codes (93508 and 93510) are diagnostic in nature.  There is no separate billing for cath placement in coronary artery stenting.  That is only accepted in peripheral stenting.
The fact that the first doctor billed the diagnostic evaluation (93510) to determine the need for the stent placement is all that would be allowed.
Your physician can only bill for the stenting.


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