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Use of Modifier 26, 59, XS or XU in PCI and bundles

Carl Posted Mon 01st of February, 2016 03:14:12 AM

Dx: I20.9

The patient has recurrent chest pain and probable angina pectoris.
He underwent (2015/10) left heart catheterization, selective coronary angiography and left ventriculography.
A severe LAD lesion was documented as well as chronic total occlusion (CTO) of the CxOM2.

Decision was made during the procedure to proceed with two vessel coronary angioplasty and drug eluting stents in the LAD along with optical coherence tomography OCT of the vessel.
Then the CTO of the CxOM2 was recanalyzed with 2 drug eluting stents. Right radial vascular access.

Is this the appropriate CPT sequence?
93458, 92943-LC, 92928-LD, 0291T
When and where are the modifier 26, 59, XU or XS appropriate for these procedure?

SuperCoder Answered Tue 02nd of February, 2016 02:30:43 AM

Codes 92928 and 92943 have a CCI conflict with code 93458. A modifier is allowed to override these relationships.
Also, Code 92943 has a CCI conflict with code 92928. A modifier is allowed to override this relationship.
NCCI code pair edits show which procedures you should not report together for the same patient. However, if the provider performs these two procedures together, and the documentation supports the rationale for performing them, you can append modifier 59 to the second procedure.

Generally, you may append modifiers 26, 59, XU, or XS in the following situations:

Append modifier 59 to identify a procedure that is distinct or independent from other non E/M services that the provider performs on the same day. Modifier 59 applies to procedures or services not typically reported together but are appropriate in specific situations. Use of modifier 59 tells the payer that the provider does not ordinarily perform the procedure with another procedure for the same patient, on the same day, by the same provider. The procedures would normally be bundled under one code. In order to report modifier 59, the provider’s documentation must support a different encounter or session, surgery or procedure, organ system or body site, separate incision or excision, lesion, or injury.

Append modifier 26 to a code to show that the physician provided the supervision and interpretation portion of the service. The professional component represents the physician’s supervision and interpretation of a service, also called S & I, including supervision and interpretation of a radiology service. In the facility setting, if a physician conducts diagnostic tests or other services using equipment she doesn't own, you should append modifier 26, Professional component, to indicate that she provided only the physician component, the administration or interpretation, of the service.

Append modifier XU to a service that is distinct because it does not overlap with the usual components of the main service.

Append modifier XS to a service that the provider performs for a patient on a separate organ or structure.

Carl Posted Wed 10th of February, 2016 16:59:54 PM

So, is this the proper CPT Codes sequence for this procedure?
93458, 92943-LC, 92928-LD-59, 0291T-LD

SuperCoder Answered Thu 11th of February, 2016 01:19:02 AM

Yes, the sequence seems correct for this particular procedure.

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