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Reversibility Study

Kaitlyn Posted Tue 04th of March, 2014 11:32:08 AM

Can you bill for a reversibility study with adenosine and if so can you direct me where I should be looking for the CPT codes

SuperCoder Answered Wed 05th of March, 2014 19:17:58 PM

Check +93463 (which has 93451 as one of its primary codes) against the documentation. E.g., This Cigna policy, which lists +93463 as a relevant code, states:
“CIGNA covers inhaled nitric oxide as medically necessary for ANY of the following indications:
… pulmonary hypertension during heart catheterization to determine pulmonary vasoreactivity.”
http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0453_coveragepositioncriteria_inhaled_nitric_oxide.pdf

Here's another resource on adenosine and 93463: http://www.zhealthpublishing.com/QA-Engine.asp?ID=2921
Date: Thursday, June 09, 2011

Question: Does the new code 93463 include adenosine?

Answer: Yes, if given and a repeat heart Cath is done. Code 93463 is for repeating the heart cath after infusion of a drug, not just giving a drug. Dr Z

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