Cardiology Coding Alert

Question: We need some clarification on the use of the -59 modifier (distinct procedural service). My administrator feels the -59 modifier should go on the cath code 93510 (left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) when performed with a PTCA on the same day. We feel it should be used on the supervision and interpretation (S&I) codes, 93555 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography) and 93556 (pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]). Who is right?

Anonymous Florida Subscriber

Answer: You are, and you can confirm it with a call to your Medicare carrier. There are no bundling issues associated with the heart cath and the PTCA performed on the same day. Medicare bundles the PTCA S&I codes into the PTCA, however, so you need modifier -59 to indicate that the S&I codes are exclusive to the heart cath and shouldnt be bundled. Because payment for S&I codes are left to the discretion of the local Medicare carrier, however, you should check with yours to make sure they follow this guideline.