Wiki Rt and Lt Caths

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mvmb2004

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So I just started billing for a cardiologist and he wants me to use 93458-26 and 93456-26. I was paid on the 93456 but denied on the 93458. Should I be using the 93461-26 for both instead of individually?? HELP!

Thank you,
Jennifer
 
mvmb2004 said:
So I just started billing for a cardiologist and he wants me to use 93458-26 and 93456-26. I was paid on the 93456 but denied on the 93458. Should I be using the 93461-26 for both instead of individually?? HELP!

Thank you,
Jennifer
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You want to bill 93460 for right and left heart caths. Doing 93458 and 93456 is unbundling the codes and cannot be done.

HTH,
Jim Pawloski, CIRCC
 
procedure 93458 was denied because is inclusive with cpt 93456 but modifier 59 is allowed

Primary 93456 26
Secondary 93458 goes with modifier 59 26
you need to submit a corrected claim
 
I agree with Jim, you should use 93460-26. That's for the right & left heart cath and the -26 is for the professional component.

Sherry Smith, CPC
 
Probably should be 93460-26. 93460-26 is when he does a right heart cath, coronary angiography, and crosses the aortic valve (always done when left ventriculography is performed, but they can also cross the aortic valve to check LV pressures etc if they don't want to use too much contrast &/or they already know about the LV function). Now if he did NOT cross the aortic valve with the cath, and they did do coronary angiography and right heart cath, only 93456-26 should be reported. The 93458-26 is a left heart cath with coronary angiography and crossing of the aortic valve. So when you report 93458-26 and 93456-26 together, you are contradicting yourself...because 93458-26 is crossing the aortic valve and 93456-26 is not crossing the aortic valve. Using a 59 modifier would not be appropriate if it was just the one procedure and the physician did do two separate procedures (ie went back to the OR a 2nd time). So if the physician does a right and left heart cath at the same time, if he crosses the AV, you'd use 93460-26; if he did not cross the AV, then just the 93456-26. The 93461-26 that you mentioned, would be if he did R & LHC crossing the AV, and also performed Bypass Graft Angiography. So in that case the patient would've had a CABG (Coronary Artery Bypass Graft) in the past. Good Luck!!
 
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