Wiki FFR & IVUS issues

[jtb57chevy]

Anybody having recent issues with getting paid for FFR or IVUS? I've always billed both 93571 (FFR) and 92978 (IVUS) with modifier 26 and the vessel modifier and never had any payment problems, but suddenly we started getting denials around the end of November.
For example;
93458 26
93571 26, LC

or
92928 LD
93454 26, 59
92978 26, LD

In both these examples, the 93571 and the 92978 are getting denied for "required modifier missing or modifier inconsistent with procedure". The MAC is Novitas.

Any help will be greatly appreciated!

 

[2210kelly@gmail.com]

FFR and IVUS

I've had the same issue past and present. I had stop using vessel modifiers because of the denials but recently BCBS is requesting them so I thought maybe I should put them on all payers, NOPE, we started getting that denial you mentioned, so as it stands now I only code vessel modifiers for 93571 with BCBS

 

[Chlrtrep]

we do not use anatomical modifies on IVUS or FFR otherwise we get an edit.

 

[j.monday7814]

we do not use anatomical modifies on IVUS or FFR otherwise we get an edit.

I use to use the anatomical modifiers as well but stopped a couple years ago because of denials like that. so we don't use any anatomical modifiers on IVUS of FFR either....only intervention codes.

doesn't really make sense, you would think they would want to know where IVUS and FFR is performed.