Wiki Stent in 2 different vessel - Help

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cvand1972

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I'm looking for documentation on this issue I'm having:
We performed a Stent in 2 different vessels; The LC and the LD.
I'm coding 92928-LC and 92928-LD-59.
The insurance is denying the second stent stating that they can't be billed twice.
Has anyone had any issues with this situation yet?
I'm looking for clarification on how to code 2 stents in 2 separate vessels and perhaps some documentation to appeal this. Any help would be greatly appreciated.
 
Same here!

I am also recieving denials from major commericial insurance companies regarding the billing of these two codes together for 2 different vessels. I have posted threads in the past asking abouth this cenario and I am under the impression that we are billing it correctly. I have sent an email to my superviser regarding the stituation however I will most likely be appealing with operative notes, I'm sure I will be lookin for these insructions in writing and will keep you posted on what I find. Has any one seen this written out?
 
I have seen posts on this as well and there are two different directions I have seen.

Dr. Z suggests to bill as you have: initial base code and base code again with modifier 59: 92928 - LD, 92928 - 59, LC.

HOWEVER

Terry Fletcher suggests using modifier 76 - Repeat procedure. I'm not sure I agree with 76 as I use this modifier when multiple EKG's are billed on the same day; that is "repeat" to me but using it for a different vessel just is not the same. IMO. Nevertheless, it is something you can try, if your manager thinks it is a better solution.

I would appeal with verbage from CPT: "Based on direction from CPT the major coronary vessels for 2013 are the left main, left anterior descending, left circumflex, right coronary artery and Ramus intermedius. All PCI procedures performed of a single major coronary artery are reported with ONE code. We cannot utilize the add-on codes for this, again, based on CPT direction as those codes are for branches of the major coronary arteries. Op report included. Please remit payment for additional stent in the approved major coronary artery based on CPT/AMA guidelines and new rules for 2013 - Left Anterior Descending"

Maybe spelling it out for them and educating them will help. They probably have very little understanding of how these codes are to be applied so they are just denying. Also, your modifiers may not be coming across. I have heard some payers want them and other do not. Just a thought.

HTH
 
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