Wiki 93458 and 93571 different day billing..???

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brandyleigh23

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I have a scenario in which a Left Heart Cath was performed by Cardiologist A @ hospital A. Patient needed an FFR but could not be flown out to the hospital 30 minutes away because of inclement weather. The next day weather permitted patient to be transported to hospital B where Cardiologist B performed the FFR.

I know 93571 is an add on code and 93458 was performed on a different day. Can we still bill for the FFR?? Right now it is being denied because it is in fact an add on code that has no primary code to bill along with it. I can't find anything online, can someone help?:confused:
 
I have run into this situation, more because I had a provider that wasn't credentialed to perform the FFR procedure, so we always had to have a the patient come back to the lab just for the FFR. And in those situations, when you don't have indication to bill the patient for a second heart cath, I got the same denials and had to eat those charges.

But you situation is so unique that if I were you I would call your provider relations number on this account and explain the situation to the carrier or file a redetermination on the denial.
 
Thank you so much, that helps alot :) I did not include the fact that both Cardiologists A and B are from the same office. One of the docs is not credentialed to perform FFR's so he sends one of his partners come in to perform them. From reading your reply I gather that we will have to "eat" the charge for the FFR unfortunately. Thank you again for your response.
 
Yeah its a bummer. But don't give up so soon, if that FFR was really medically necessary (and by the way, bravo to the provider group for using the FFR to determine whether the stenosis was flow limiting prior to moving to PCI) you really may have a chance to get it paid if you call on it.
Good luck!
 
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