Coding, Classification & Reimbursement

Modifiers for 92928 and 93458 ---transcatheter placement of intracoronary stent..

  • 1.  Modifiers for 92928 and 93458 ---transcatheter placement of intracoronary stent..

    Posted 10-10-2018 18:34

    We are debating the proper use of modifiers and how to properly bill it for the following scenario, basically we want to make sure is a clean claim before submitting.

    We are looking into submitting as follows:
    99223 mod 25   (Initial hospital care, per day, for the evaluation and management of a patient...)
    92928 mod LD   (Percutaneous transcatheter placement of intracoronary stent...)
    93458 mod 26 and XU     (Catheter placement in coronary artery(s) ...)
    G0269      (Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure ..)
    G0278      (iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as ...)

    what we are comparing is the following ( we believe this is not complete):
    99223 mod 25
    92928 mod LD
    93458 mod 25
    G0269
    G0278

    Thank you in advance for your help and input on this matter.



    --

    Alejandro A. Cardona

    E. Alex@BIL-Force.com


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  • 2.  RE: Modifiers for 92928 and 93458 ---transcatheter placement of intracoronary stent..

    Posted 10-11-2018 00:44
    I don't recommend placing a modifier -25 on the 93458.  Per CPT guidelines, modifier -25  (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) is only applicable for E/M codes.

    The modifier -26 and XU are applicable and necessary.  I believe the set you are currently referencing:

    99223 mod 25   (Initial hospital care, per day, for the evaluation and management of a patient...)
    92928 mod LD   (Percutaneous transcatheter placement of intracoronary stent...)
    93458 mod 26 and XU     (Catheter placement in coronary artery(s) ...)
    G0269      (Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure ..)
    G0278      (iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as ...)

    to be the correct set of codes.  Be sure to double check any CCI edits.


    ------------------------------
    Lamon Willis
    Director of Coding
    ------------------------------



  • 3.  RE: Modifiers for 92928 and 93458 ---transcatheter placement of intracoronary stent..

    Posted 10-11-2018 12:16
    Hi Alejandro.  The first thing to ask before considering modifiers is who is the payer.  If it is not Medicare, the LD, XU and perhaps even the G codes would not be relevant.  Like Lamon wrote, modifier 25 can only be placed on E&M codes.

    So, who is the payer?

    ------------------------------
    Cheryl Anderson, CCS, CCS-P
    Coding Auditor
    ------------------------------



  • 4.  RE: Modifiers for 92928 and 93458 ---transcatheter placement of intracoronary stent..

    Posted 10-11-2018 13:07
    Thanks for your Input Cheryl/ Lamon
    In this Case is Meridian ( A medicaid sub product to what we understand)
    Most of the time we believe it will be medicare.



    --

    Alejandro A. Cardona


       P please don't print this e-mail unless you really need to.

     This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to which they are addressed. If you have received this email in error please contact Info@BIL-Force.com, and shift+delete from your email. This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this email.