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TAMMY Posted Wed 08th of January, 2020 15:22:09 PM
Now that Medicare allows the 92928 in the ASC setting when billing with a LHC will medicare reimbusre 50% on the stent or cath
SuperCoder Answered Thu 09th of January, 2020 09:19:45 AM

Hi Tammy,


Thank you for your patience. Please find the below response for your query.


Per the Medicare Claims Processing Manual, Chapter 14, Section 40.5,  “When the ASC performs multiple surgical procedures in the same operative session that are subject to the multiple procedure discount, contractors pay 100 percent of the highest paying surgical procedure on the claim, plus 50 percent of the applicable payment rate(s) for the other ASC covered surgical procedures subject to the multiple procedure discount that are furnished in the same session.”


Depending on your documentation and which other codes you are billing in addition to 92928, you may determine which code will take the 50% reduction in reimbursement. Keep in mind, depending on which LHC code is involved, there may be an outpatient Medicare NCCI edit bundling the LHC code into 92928. Code 93458 is bundled into 92928, but you can override the edit with a modifier when clinical circumstances and documentation support doing so. There is no 92928/93452 edit, but you still need to be sure that your coding reflects the spirit of the coding guidelines.


Kindly check with your payer for any specific reimbursement guidelines for this type of procedures.


Hope this Helps!

SuperCoder Answered Tue 14th of January, 2020 07:10:48 AM


Hope this Helps!

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