csorensen21@yahoo.com
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Hello fellow Cardiology coders,
I have been coding cardiology for many years and recently payers in Michigan have been denying 93458 (with or without) modifier 59 when bundled with with stent 92928-43. We have corrected claims, made sure diagnosis were there, checked specific plan benefits, etc. We had no choice but to appeal with documentation and some of our commercial carriers are denying the appeal stating there is no evidence of heart cath being performed but our documentation clearly states all components of the LHC are there. I am really stumped on why this is happening. Is anyone else experiencing this issue or has some guidance. I want to make sure our cardiologists get paid for work done.
Thanks a lot!
I have been coding cardiology for many years and recently payers in Michigan have been denying 93458 (with or without) modifier 59 when bundled with with stent 92928-43. We have corrected claims, made sure diagnosis were there, checked specific plan benefits, etc. We had no choice but to appeal with documentation and some of our commercial carriers are denying the appeal stating there is no evidence of heart cath being performed but our documentation clearly states all components of the LHC are there. I am really stumped on why this is happening. Is anyone else experiencing this issue or has some guidance. I want to make sure our cardiologists get paid for work done.
Thanks a lot!