Cardiology Question for the Week of November 27, 2017

Cardiology Compliance Question of the Week

Question:

Can a right heart catheterization (RHC) be billed on the same claim as a heart biopsy?

Answer:

Typically, a National Correct Coding Initiative (NCCI) edit would prevent the payment for a right heart catheterization (RHC) when billed on the same claim as a heart biopsy. However, under certain circumstances, a hospital may bill and get paid for both services in a NCCI code pair by including a modifier on the claim. If a hospital included modifier -59, it would bypass the NCCI edit and receive payment for both procedures as though they were performed separately. A hospital should not append modifier -59 to the HCPCS code representing a diagnostic RHC when it is performed with a heart biopsy unless the procedures are separate and distinct and when the medical record documentation supports the use of the modifier.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.