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BCBS Denial 93458 with 92941

Debra Posted Thu 23rd of January, 2020 10:29:55 AM
A claim was submitted with 93458 26 59 and 92941 RC. Documentation supports both the diagnostic and intervention. BCBS denied "NCCI edits do not allow billing CPT 93458 with CPT 92941 on the same dos unless the appropriate modifier is present, therefore, CPT 93458 is disallowed." Any information on why this would be denied?
SuperCoder Answered Fri 24th of January, 2020 02:32:09 AM

Hi Debra,

 

Thanks for your question.

 

Diagnostic coronary angiography codes (93454-93461) and injection procedure codes (93563-93564) should not be used with percutaneous coronary revascularization services (92920-92944), when they are used to report:

  1. contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the coronary intervention,
  2. vessel measurement for the coronary intervention, or
  3. post-coronary angioplasty/stent/atherectomy angiography, as this work is captured in the percutaneous coronary revascularization services codes (92920-92944).

Diagnostic coronary angiography performed at the time of a coronary interventional procedure may be separately reported only if the following circumstances apply:

  1.  No prior catheter-based coronary angiography study is available, a full diagnostic study is performed, and a decision to intervene is based on the diagnostic angiography, or
  2. A prior study is available, but as documented in the medical record:
    1. The patient’s condition with respect to the clinical indication has changed since the prior study, or
    2. There is inadequate visualization of the anatomy and/or pathology, or
    3. There is a clinical change during the procedure that requires new evaluation outside the target area of  intervention.

Diagnostic coronary angiography performed during a separate session from an interventional procedure may be reported separately.

 

Conclusion: If your documentation supports billing both codes together, then your modifiers are correct. We advise you to change sequence of modifiers i.e. append modifier 59 first and then 26 and resend the claim to the insurance. If it happens again, please feel free to write to us.

 

Thanks.

Debra Posted Fri 24th of January, 2020 08:53:48 AM
Thank you.
SuperCoder Answered Sun 26th of January, 2020 23:41:00 PM

Thank you, happy to help.

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