1. Cris Camacho
   Posted 1 year ago #
   

   The cardiologist did a stent and a left heart cath. I submitted 92980 and 93458. Medicare paid 92980(stent) but denied 93458 (LHC). REASON: B15-this service/procedure requires that a qualifying service/procedure be covered. Please advise. Thank you.

2. SuperCoder
   Posted 1 year ago #
   

   Have you used any modifier with the denied service while you have billed those procedures? First of all 93458 (LHC) bundles with 92980, so you cannot bill LHC procedure without any modifier. In this case, you could add -59 modifier in the column 2 code (93458) to override the edits. So please bill
   92980
   93458-59
   Remember: Modifier -59 should be used if it is in differnt seesion, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion or separate injury.
   -------
   If a more specific modifier describes the situation, you should not use modifier -59.
   -------
   Modifier -59 should be the modifier of last resort and only should be used when there is no other modifier to compliantly bypass the bundling edit and the procedure is clearly distinct and different from that of the other procedure.

3. SuperCoder
   Posted 1 year ago #
   

   Sorry typo error in (different session)

RSS feed for this Question