Receiving Helpdesk

does cpt 93458 need a modifier

by Jake Terry DDS Published 3 years ago Updated 2 years ago

FOR CPT 93458: If you are reporting only the professional component for the service (93458), you should append professional component modifier 26 to this code. As for modifier 53: This modifier is used to indicate that a surgical procedure was terminated before completion. Click to see full answer.

Full Answer

What is Procedure Code 93458?

The Current Procedural Terminology (CPT ®) code 93458 as maintained by American Medical Association, is a medical procedural code under the range - Cardiac Catheterization and Associated Procedures. Subscribe to Codify and get the code details in a flash. Request a Demo 14 Day Free Trial Buy Now Crosswalks MODIFIERS ICD-9-CM Vol1 CrossRef

What does 93458 stand for?

Under Cardiac Catheterization and Associated Procedures. The Current Procedural Terminology (CPT ®) code 93458 as maintained by American Medical Association, is a medical procedural code under the range - Cardiac Catheterization and Associated Procedures.

What is CPT 93458?

CPT code 93458 – Left Heart Catheterization with Coronaries. CPT code 93459 – Left Heart Catheterization along with Coronaries and Bypass. What is the CPT code for a left heart catheterization?

What does 93458 mean?

What does CPT code 93458 mean? 93458. Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging. supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed.

What modifier is used for 93458?

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.

Is CPT code 93458 considered surgery?

The Current Procedural Terminology (CPT®) code 93458 as maintained by American Medical Association, is a medical procedural code under the range - Cardiac Catheterization and Associated Procedures.

What is the CPT code for 93458?

CPT code 93458 – Left Heart Catheterization with Coronaries.

How do you bill for a cardiac catheterization?

CPT codes 93454 and 93455 may be billed only once per catheterization. CPT codes for Cardiac Catheterization include all dye injections for angiography, catheter insertion/replacement and repositioning, and the supervision and interpretation. Component services are no longer separately billable.

What is the 26 modifier?

Current Procedural Terminology (CPT®) modifier 26 represents the professional (provider) component of a global service or procedure and includes the provider work, associated overhead and professional liability insurance costs. This modifier corresponds to the human involvement in a given service or procedure.

What modifier is used to report the termination of a surgery?

Rationale: Modifier 53 is used to indicate the physician has elected to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well-being of the patient. CPT® modifiers are found on the inside front cover and in Appendix A of the CPT® code book.

What is the difference between CPT 93452 and 93458?

It appears that if physician performs a LHC including inj/interp of angios and LV than 93458 would be used and 93452 will be used only when the physician performs an LV with no angio of coronaries or is this backwards. I am pulling my hair out regarding these two codes what they would be replacing.

What is the difference between 93458 & 93454?

Code 93458 actually includes all the verbiage that's in code 93454 PLUS the "with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed".

What is the difference between 93458 and 93454?

93460 involves a left and right heart catheterization, while 93458 involves only an LHC. 93454 does not involve a catheterization, but instead simply a closure device angiography. Make sure you don't code any closure devices separately, as they are included in this code.

What is a vessel modifier?

Survey modifiers are high risk operations and vessel attributes that change the survey and other requirements that would otherwise apply to the vessel.

What is bundled into a cardiac catheterization?

The following services are included in cardiac catheterizations and are not coded separately: Local anesthesia and moderate sedation. Insertion, positioning, repositioning, and removal of catheters into the coronary arteries and/or left and/or right heart. Mapping angiography performed to place the catheters.

Can CPT 93458 and 92928 be billed together?

There are certain circumstances where 92928(PCI stent) and 92458(cardiac cath) can be billed together, I have successfully done this, I code the 92928 first (has the higher RVU) and then the 93458 with 26,xs,51.

Is there a reimbursement for a right heart catheterization?

There is no additional reimbursement for a right heart catheterization done for reasons other than hemodynamic evaluation. Studies done in conjunction with electrophysiologic tests, HIS bundle studies, pacing studies, temporary pacemaker insertion and endomyocardial biopsy are not separately payable.

Is right heart catheterization indicated for heart failure?

This procedure is done in a cardiac catheterization laboratory or interventional radiology laboratory and does not include a “bedside placement” of a flow directed (Swan-Ganz type) catheter. Right heart catheterization is not indicate d for: Atherosclerotic heart disease without heart failure.

Is aortography reimbursable for heart disease?

Aortography is reimbursable only for diagnoses of aortic root disease, valvular heart disease or congenital heart disease. It is not reimbursable for atherosclerotic heart disease. Angiograms to visualize the coronary ostia are included as part of coronary angiography.

Document Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.

Coverage Guidance

Abstract: Cardiac catheterization is the introduction and positioning of a catheter in the heart to assess cardiac function and structure, for diagnosis, treatment planning or to assess therapy.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Article Guidance

This article contains coding and other guidelines that complement the local coverage determination (LCD) for Cardiac Catheterization and Coronary Angiography.

ICD-10-CM Codes that Support Medical Necessity

The use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the attached determination.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

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