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Prahlad Posted Fri 15th of November, 2019 06:42:35 AM
1. Selective cornory angiogram 2. Attempt to access the right radial artery and sheath placement in the right common femoral artery. 3. modified 22 for multiple cathter exchanges..............PLS CODE
SuperCoder Answered Mon 18th of November, 2019 08:49:50 AM

Hi Prahlad,

For coronary angiography, CPT 93454 can be used. In this procedure, the provider introduces a catheter through the skin and moves the guide wire into the peripheral artery under fluoroscopic guidance. He advances the tip of the catheter to the coronary artery opening and secures the catheter tip at the beginning of the coronary artery. The provider then injects contrast material through the catheter into the artery to check the position of the catheter and produces angiographic images. The provider removes the catheter and applies pressure on the wound to stop the bleeding. The provider who performs imaging supervision and interpretation for this procedure reports this code. On the other hand, if right common femoral artery is used as an access artery, then it will be considered a part of the main procedure, i.e. coronary angiography. However, unsuccessful attempts to the radial artery access should not be billed separately.

Modifier 22 can be used for the multiple catheter exchange with the support of medical necessity.

In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

  • Increased intensity
  • Additional time
  • Technical difficulty
  • Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician

An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.

Hope this helps!

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