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Issue Number - Name
0027 - Improper Payments for Endomyocardial Biopsies and Right Heart Catheterizations that were Not Distinct Services
Review Type
Complex
Claim Type
Outpatient Hospital (OPH), Physician
Region and State
RAC 1-4
All States
Date Approved
2017-03-24

Description

To identify claims where modifier 59 has been inappropriately appended when Endomyocardial Biopsies and Right Heart Catheterizations are billed together.

Affected Codes

  • 93451

Applicable Policy References 

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A)
  • NCCI Manuals, 2015, 2016, and 2017, Chapter 11
  • CPT Manual