Cardiology Question for the Week of November 27, 2017

Question:

Can a right heart catheterization (RHC) be billed on the same claim as a heart biopsy?

Answer:

Typically, a National Correct Coding Initiative (NCCI) edit would prevent the payment for a right heart catheterization (RHC) when billed on the same claim as a heart biopsy. However, under certain circumstances, a hospital may bill and get paid for both services in a NCCI code pair by including a modifier on the claim. If a hospital included modifier -59, it would bypass the NCCI edit and receive payment for both procedures as though they were performed separately. A hospital should not append modifier -59 to the HCPCS code representing a diagnostic RHC when it is performed with a heart biopsy unless the procedures are separate and distinct and when the medical record documentation supports the use of the modifier.