Wiki Dx for Swan Ganz 93503

[kasullivan2]

Medicare has a list of payable code for the swan ganz that is reasonable. However, Medicare says it is also reasonable to use the swan ganz to monitor patients during open hearts and AAA repair. However, the dx for CAD 414.00 and AAA 441.4 are not on the list and we are getting denials when our aneshesia providers place these invasive lines for monitoring. Any idea of how to go about fixing this? Is there a modifier to the CPT or additional diagnosis that would be appropriate.

 

[sbicknell]

You need to show medical necessity for the monitoring, Swan-Ganz. What is the patient's condition that puts him at risk that the physician feels he needs the intra-op SG monitoring. That's the DX you should be using and not the surgery DX.

The payer wants to know the medical necessity of the SG so you need a DX that supports that. Hopefully the surgeon has documented this in the OP report