Medical Billing Forum

Coding => Coding => Topic started by: GingerD on May 20, 2015, 10:38:15 PM

Title: Left Heart Catheterization
Post by: GingerD on May 20, 2015, 10:38:15 PM
Hi! I'm new to cardiac coding and I couldn't see any previous conversations regarding left heart catheterizations.  I am wondering what the correct coding is--I am a biller, not a coder, but the doctor is putting a -26 modifier on all his procedures and that doesn't seem correct. Any help would be appreciated.
Title: Re: Left Heart Catheterization
Post by: kristin on May 21, 2015, 11:21:42 AM
If the doctor is appending the 26 modifier, what that means is that he is only doing the professional component of the procedure/test/diagnostic service. And what that means is that he is the one receiving and interpreting the results, and that someone else actually performed the procedure/test/diagnostic service, and they billed for it with a TC modifier, meaning they did the technical component.

If he is in fact performing the procedure, and then reading/interpreting the results, he should not use the 26 modifier. He would just bill the procedure with no 26 or TC modifier.
Title: Re: Left Heart Catheterization
Post by: GingerD on May 21, 2015, 03:11:45 PM
Could you provide the appropriate CPT codes along with modifiers for a left heart catheterization? Any help you can provide would be appreciated.
Title: Re: Left Heart Catheterization
Post by: PMRNC on May 21, 2015, 03:58:21 PM
Is your provider not providing you with appropriate coding? If not, you need to let them know they need to give you appropriate coding that matches the documentation. since you are not a coder, it's vital that the provider do his do diligence with respect to coding.
Title: Re: Left Heart Catheterization
Post by: kristin on May 21, 2015, 08:06:38 PM
Ginger,

I don't bill/code cardiac, so I can't help you there. Modifiers are one thing, specific CPT codes are something else. As Linda says, the provider is responsible for providing you with the proper codes, if they don't have a coder on staff.
Title: Re: Left Heart Catheterization
Post by: GingerD on May 21, 2015, 10:15:36 PM
The provider has given me 93458, 76937, 92928 and his long time biller insists that the -26 modifier must be appended to all the codes in order for them to be paid. I tried to explain to her that the -26 is only used if the doctor is interpretting a test, not performing a procedure.