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modifiers

Janice Posted Thu 31st of August, 2017 09:46:52 AM
93458,26,53 75608,26,59 Payer has indicated that the modifier is either invalid, incorrect or missing for this charge. what am i doing wrong
SuperCoder Answered Fri 01st of September, 2017 02:23:55 AM

HELLO

FOR CPT 93458:

  • If you are reporting only the professional component for the service (93458), you should append professional component modifier 26 to this code.
  • If you are reporting only the technical component for the service (93458), you should append technical component modifier TC to the code unless the hospital provided the technical component. In that case, do not append modifier TC because the hospital’s portion is inherently technical.
  • Do not append a professional or technical modifier to the code when reporting a global service in which one provider renders both the professional and technical components.
  • As for modifier 53: This modifier is used to indicate that a surgical procedure was terminated before completion. Modifier 53 is to be appended to the surgeon’s fee only. Most Medicare carriers require a claim for a discontinued procedure to be submitted on paper with a copy of the operative note explaining in detail the reason the procedure was discontinued. Remember, a procedure can be aborted only if it has begun. In other words, if the surgical opening has not been prepared, there can be no billing by the surgeon. 

AS FOR CPT 75608: No such CPT code exist, there seems to be some typo error. Please check if that is the reason for denial. Secondly, following are the services considered included in cardiac catheterization/angiography procedures (93452-93461) when indicated through which one can make out if any additional CPT code from 70000series should be included or not:

  • Local anesthesia and/or sedation.
  • Introduction, positioning, and repositioning of catheters.
  • Recording of intracardiac and intravascular pressures.
  • Obtaining blood samples for blood gases.
  • Cardiac output measurements.
  • Monitoring services, e.g., ECCS, arterial pressures, oxygen saturation.
  • Vascular catheter and line removal.
  • Final Evaluation.
  • Written Report.
  • Swan Ganz Placement (93503).

Please also confirm from your payer the exact reason for denial, since 26, TC, and 53 modifers are allowable modifiers to be used with CPT code 93458.

HOPE THIS HELPS!

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