RA Messages for November 27, 2001
PHARMACY PROVIDERS, PLEASE NOTE!!!
IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT
THE PBM HELP DESK AT 1-800-648-0790.
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
CPT CODE 93508 (CATHETER PLACEMENT IN CORONARY ARTERY(S), ARTERIAL
CORONARY CONDUIT(S), AND/OR VENOUS CORONARY BYPASS GRAFT(S) FOR CORONARY ANGIOGRAPHY WITHOUT CONCOMITANT LEFT HEART CATHETERIZATION) SHOULD BE
INCLUDED IN THE PERFORMANCE OF CPT CODE 92980 (TRANSCATHETER PLACEMENT OF INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER
THERAPEUTIC INTERVENTION, ANY METHOD; SINGLE VESSEL). THE ONLY TIME BOTH PROCEDURES MAY JUSTIFIABLY BE BILLED ON THE SAME DATE OF SERVICE FOR
THE SAME RECIPIENT IS WHEN THE PATIENT EXPERIENCES CHEST PAIN AFTER
PLACEMENT AND THE POSSIBILITY EXISTS THAT THE STENT HAS CLOSED. IN THESE CASES, THE PROVIDER MUST REQUEST THE CLAIM BE RECONSIDERED FOR PAYMENT,
AS EDITS WILL SOON BE PLACED IN THE SYSTEM TO DENY CODE 93508 IF THERE IS ALREADY A PAID CLAIM FOR CODE 92982, 92995, OR 92980 IN HISTORY FOR
THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT. LIKEWISE, A CLAIM FOR 92980, 92982, AND 92995 WILL DENY IF THERE IS A PAID
93508 IN HISTORY.