Thank you,
Cindy
I have a cath report where the vein graft and lima aortography were done. The coronaries were not viewed because the doctor reviewed a previous report from that day done at a different hospital. Our doctor is doing an evaluation for inferior ST-elevation myocardia infarction, post bypass surgery. Does anyone have an idea on how to code this.
Thank you,
Cindy
Personally, I would do code 93455 with modifier -52. This is what I was told to do at a MedLearn webinar if only grafts were looked at.
Jessica CPC, CCC
When I look it up in encoder and in AAPCs procedural coding expert, it says you cannot append 52 modifier to that code.
Also
ZHealth Online Q&A 2612
Date: Friday, March 11, 2011
Question: Is modifier 52 ever appended to cath codes if documentation does not meet the full description of the CPT code? thank you
Answer: I would not use -52 for the new heart cath codes if there is a component missing, such as the native coronary angiography at the time of a graft angiography (93455), I would just code 93455 as is without the modifier. Remember, that for Medicare, hospital billing, all heart caths fall into the same APC and are all paid exactly the same (a right heart cath pays the same as a right and left heart cath with native and graft angiography). In 2010, if we did less than a right and left heart cath with coronaries (e.g., in a patient with a metallic aortic valve), we actually "coded" more with 93501 and 93508. A -52 modifier would inappropriately decrease payment 50% in the first example. I cannot think of a time that I have used the -52 with a heart cath yet. If one of societies produce and article concerning this, we will be sure to let you know. Dr.z