Wiki Cta & catheter based arteriograms

[suela923@aol.com]

We billed a dx arteriogram for a patient but a NCCI edit dropped it back to us due to the patient having a prior CTA. We were given the following documentation:

Diagnostic angiography (arteriogram/venogram) performed on the same date of service by the same provider as a percutaneous intravascular interventional procedure should be reported with modifier 59. If a diagnostic angiogram (fluoroscopic or computed tomographic) was performed prior to the date of the percutaneous intravascular interventional procedure, a second diagnostic angiogram cannot be reported on the date of the percutaneous intravascular interventional procedure unless it is medically reasonable and necessary to repeat the study to further define the anatomy and pathology. Report the repeat angiogram with modifier 59. If it is medically reasonable and necessary to repeat only a portion of the diagnostic angiogram, append modifier 52 to the angiogram CPT code. If the prior diagnostic angiogram (fluoroscopic or computed tomographic) was complete, the provider should not report a second angiogram for the dye injections necessary to perform the percutaneous intravascular interventional procedure.

We just want to see if other coders are understanding this the same way we are....that we can't bill for the catheter based dx study unless the doctor states in his dictation reasonable medical necessity, etc.

Thank you.
Sue

 

[dpeoples]

We billed a dx arteriogram for a patient but a NCCI edit dropped it back to us due to the patient having a prior CTA. We were given the following documentation:

Diagnostic angiography (arteriogram/venogram) performed on the same date of service by the same provider as a percutaneous intravascular interventional procedure should be reported with modifier 59. If a diagnostic angiogram (fluoroscopic or computed tomographic) was performed prior to the date of the percutaneous intravascular interventional procedure, a second diagnostic angiogram cannot be reported on the date of the percutaneous intravascular interventional procedure unless it is medically reasonable and necessary to repeat the study to further define the anatomy and pathology. Report the repeat angiogram with modifier 59. If it is medically reasonable and necessary to repeat only a portion of the diagnostic angiogram, append modifier 52 to the angiogram CPT code. If the prior diagnostic angiogram (fluoroscopic or computed tomographic) was complete, the provider should not report a second angiogram for the dye injections necessary to perform the percutaneous intravascular interventional procedure.


I had not read about the modifier 52 possibility, that is interesting.
We just want to see if other coders are understanding this the same way we are....that we can't bill for the catheter based dx study unless the doctor states in his dictation reasonable medical necessity, etc.

Thank you.
Sue

Prior diagnostic tests such as CTA and MRA's preclude the medical necessity for additional catheter based angiography performed in conjunction with an interventional procedure.
This has always been my understanding. The problem of course for coders is that we don't always know that a prior diagnostic test has been performed. If my docs perform a diagnostic and intervention I usually code both and append modier 59 as instructed above.
There are of course exceptions, and the examples of this can be found in the cpt book at the begining of the section concering interventional procedures (radiology and/or cardiology).

HTH

 

[suela923@aol.com]

Thanks!