Sadna Posted Mon 22nd of July, 2019 16:07:19 PM
We billed for 93458 with modifier 26, 99152 for sedation with no modifier, PTCA 1 which was coded as 92920 with modifier 26 and we billed for balloon pump insert 33967 with no modifier. We have a denial for 92920 from Medicare of Illinois stating "missing incomplete invalid HCPCS" and "procedure code billed is incorrect for the DOS". Can you please let us know what is the proper way to billed and get paid for 92920.
SuperCoder Answered Tue 23rd of July, 2019 08:56:45 AM
As per the provided documentation, the modifier 26 is incorrect modifier for CPT 92920.
The provider has performed PTCA, so the appropriate modifiers for CPT 92920 are as follows:
LC - Left circumflex coronary artery
LD - Left anterior descending coronary artery
RC - Right coronary artery.
LM - Left main coronary artery
RI - Ramus intermedius coronary artery.
Use these modifiers to indicate the specific vessel involved in the procedure. For correct modifier go through with operative report documentation and check which artery is involved in the procedure and bill modifier accordingly.
Hope this helps.