November 2014 Q & A

Question: IVUS Without A Base Code

I thought I read something about a change regarding IVUS without a base code. The patient has known CAD, and the only procedure done was an IVUS of the Left Main and LAD. Patient's groin prepped, 5 French sheath was placed and the guide was advanced. Wire was placed down to the LAD & IVUS of Left Main and LAD was done. I have documentation of the IVUS findings. Catheter as well as sheath were removed. IVUS would be coded as 92978 &92979, but current edits indicate a base code is needed. We don't have a base code. Was there a change so this can be coded, or is there another code that we should add, or is our claim going to be denied?

Answer:

Since the advent of add-on code edits 1/1/13, CMS has followed parentheticals in the CPT codebook for add-on codes. These should be closely adhered to for proper billing since that change. We recommend use of unlisted code 93799 if an add-on code is submitted without a base code, as is the case with isolated IVUS, FFR, OCT or NIR. Do NOT submit a repeat coronary angiogram to get a base code for the IVUS, as almost always, there is a recent coronary angio and it would be inappropriate to bill a repeat study here. Subsequently, the correct coding is an unlisted.