Medical Billing Coding - 93458 CPT-cardiology, cpt, codes
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Thread Topic: 93458 CPT-cardiology
Topic Originator: sasha
Post Date February 13, 2013 @ 10:32 AM
93458 CPT-cardiology


sasha
February 13, 2013 @ 10:32 AM Reply  |  Email Friend   |  |Print  |  Top

I bill for a cardiology practice and have a question.  My provider does heart cath and the cpt is 93458, but medicare when they reimburse they are adding modifier 26 automatically and reimbursement is low around $225.  I called medicare and told them that provider is performing the actual hearth cath procedure an reimbursement per their physicians fee schedule is $1298.  He said he would call me back. I need to know if any other cardiology biller having this issue.  I am in Wash Dc area.  I need to know how to appeal this?  I don't understand why their system automatically adding 26 modifier as that is interpretation and he is doing actual surgery.  Is their anyone else I can talk to in medicare other than customer service reps?

Arlene
February 14, 2013 @ 1:18 PM Reply  |  Email Friend   |  |Print  |  Top

Where is he doing the cath?  If in the hospital then you do add modifier 26.

sasha
February 14, 2013 @ 1:35 PM Reply  |  Email Friend   |  |Print  |  Top

He is doing in hospital but 26 is only used if he interprating the cath, but he doing actual procedure and if the medicare rep I talked to said that medicare eob should not be automatically adding the modifer 26 to the cpt.

Heather
February 26, 2013 @ 8:09 PM Reply  |  Email Friend   |  |Print  |  Top

What you can try doing is billing two separate lines with the -26 modifier on one and the -TC modifier on the other. I also use box 19 a lot. So, I would indicate in box 19 that doctor performed both the technical component and the interpretation.

You can email me at newgenerationbilling@gmail.com if you would like a more thorough explanation.

LORENA
March 2, 2013 @ 7:12 PM Reply  |  Email Friend   |  |Print  |  Top

I do billing for Cardiology physicians both interventional and non-interventional. Adding modifier 26 is correct. If the cath is being performed in a cath lab, then you can not bill for the TC of the cath. The physician does not own the lab nor the equipment. He is using the resources of the hospital to obtain his diagnostic imaging, therefore interperting the images. Hope this helps.

Theresa
May 16, 2013 @ 5:49 AM Reply  |  Email Friend   |  |Print  |  Top

Lorena is exactly right. Add 26 modifier

kari
September 17, 2013 @ 11:36 AM Reply  |  Email Friend   |  |Print  |  Top

Why do we add modifier 26? Is the facility billing code 93458, etc, also? The physician is using the equipment, but isn't every physician using hospital equipment when they do surgeries/procedures? I'm new to Cardiology billing and have never had to use modifier 26 on a surgery that my provider was actually performing. This is very confusing.

kari
September 17, 2013 @ 11:36 AM Reply  |  Email Friend   |  |Print  |  Top

Why do we add modifier 26? Is the facility billing code 93458, etc, also? The physician is using the equipment, but isn't every physician using hospital equipment when they do surgeries/procedures? I'm new to Cardiology billing and have never had to use modifier 26 on a surgery that my provider was actually performing. This is very confusing.

Francis
September 18, 2013 @ 6:02 PM Reply  |  Email Friend   |  |Print  |  Top

We use modifier 59.  We used 26 and never got paid.  Once we used 59 we were paid.



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