Wiki FFR and IVUS

[reac2005]

Our practice has both general cardiology and interventional cardiology. When our general cardiologist starts a heart cath and decides to call in the interventional cardiologist to perform an FFR or IVUS, Medicare is denying FFR and/or IVUS for primary procedure missing. We have appealed stating facts. Medicare is response is still denied stating, we do not show that the required primary service has been paid to physician performing FFR or IVUS.
I remember reading in November of 2014 that Medicare was going to start to pay for these procedures in this instance. But cannot find any documentation. Does anyone else have this problem, or suggestions?
Thanks

 

[Jim Pawloski]

Our practice has both general cardiology and interventional cardiology. When our general cardiologist starts a heart cath and decides to call in the interventional cardiologist to perform an FFR or IVUS, Medicare is denying FFR and/or IVUS for primary procedure missing. We have appealed stating facts. Medicare is response is still denied stating, we do not show that the required primary service has been paid to physician performing FFR or IVUS.
I remember reading in November of 2014 that Medicare was going to start to pay for these procedures in this instance. But cannot find any documentation. Does anyone else have this problem, or suggestions?
Thanks

Medicare may be considering both doctors are of the same group. May have to use modifier -62 for the procedure.
HTH,
Jim Pawloski, CIRCC

 

[j.monday7814]

Medicare may be considering both doctors are of the same group. May have to use modifier -62 for the procedure.
HTH,
Jim Pawloski, CIRCC

can't use modifier 62, not allowed on any of the CCLV, IVUS, or FFR codes. We would bill the CCLV for the first cardiologist and then the IVUS or FFR code for the second cardiologist. When the second claim denies since it is missing the qualifying code we would appeal with records from both cardiologists stating that the interventional cardiologist was called in to evaluate the disease before deciding to intervene but based on the results he decided intervention was not necessary. I don't think it would be appropriate to bill another CCLV but you could try doing that with a modifier 52, I really don't like that idea though. Our claims did get paid eventually but we only had a couple and that was a couple years ago.