by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
TAVR with Physician Wanting to Bill with a 22 Modifier for Complex Case
Question:
The TAVR delivery went smoothly except our cardiologist also did…
“The origin of the left main was then cannulated with a moderate degree of difficulty given the cephalad course of the left main and a low coronary height. A BMW guidewire was then advanced to the LAD and a 4 mm stent was advanced to the left main and into the mid LAD. A GuideLiner device was left in place to facilitate stent delivery of a stent in the left main in the event of left main occlusion related to valve deployment.”
Unfortunately, the patient has significant disruption of the femoral artery and needed open repair, which was not done by our cardiologist. Can you please advise if the portion that our cardiologist performs would be considered complex? I know that we cannot bill for the stent, and I am not sure we can bill with the -22 modifier.
Answer:
This was prophylactic deployment of an undeployed stent just in case there was LM orifice compromise. If the stent was deployed, report C9600, otherwise no code since it was removed undeployed at the end. We do not recommend -22 modifier here, or any other additional code.
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