Wiki UNPLANNED RETURN TO CATH LAB BY SAME PHYSICIAN

[mitzimarie2001@yahoo.com]

I apologize in advance for how long this is...

SCENARIO: Patient taken to cath lab and received DES to proximal LAD. Shortly after PCI patient began complaining of chest pain again with ST elevations. Patient taken to cath lab again for in-stent restenosis. Vessel was 100% occluded and treated with balloon angioplasty.

I am trying to bill for both procedures. This doctor always gives me crazy codes to bill. I'm going to list what she gave me for each procedure. (These are her codes; not mine). I'm thinking that I have to add a modifier to codes in the 2nd procedure, but all I can think of is mod 78. However, my mod 78 fact sheet says it is inappropriate to use mod 78 on any procedure that does not have global period of 0010 or 0090. These procedure codes don't have a global period.

1st procedure:
93458-26, 59
93567-XU
75710-26, XU
76937-26, XU
36245, XU
92941-LD
99152
2nd procedure:
93454-26
75710-26, XU
76937-26, XU
92920-LD
99152

Following are the procedure notes for both:

 

[Jim Pawloski]

For case #1, I would remove the following codes;
93567- Report does not support the code
75710 - Cannot be billed for closure device and report does not support code
36245 - Report does not support code, what was selected is not documented.

For case #2
75710 - Cannot be billed for closure device and report does not support code
I would add modifier 78 for your procedure codes.

HTH,
Jim