December 2016 Q & A

Question: Fractional Flow Reserve without Catheterization

Physician performs LHC at another facility and then transfers the patient to the cath lab at the hospital to perform fractional flow reserve (93571). The physician thinks that 93571-26-XE will get us paid by Medicare and for commercial insurance to bill coronary angiography only with 93571 to get paid.

 

Answer:
You are correct in using unlisted code 93799 for coronary artery FFR without a heart cath procedure. You cannot use 93571 by itself as it is an add-on code and you do not have a base code procedure performed at this facility. Code 93571 is an N-status indicator code and the hospital has no reimbursement for this code (for Medicare patients). Do NOT code a repeat coronary angiogram just to attach the FFR to, as the heart cath/coronary angiogram was already performed and billed at the OP lab the week before.