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Return to cath lab after primary stenting earlier in the day

Date: May 15, 2018

Question:

This patient had left heart cath with selective right and left coronary angiography (93458-26-59) along with PCI with stent to the LAD for STEMI (92941-LD) and stent to the RCA (92928-RC). In the recovery room, while undergoing echocardiography, he developed ventricular fibrillation and was returned to the cath lab, suspecting another cardiac event. He underwent right and left coronary angiography (93454) at this time but no stent. What modifier do I require on the 93454? I do not believe it would be -76 because it isn't the same CPT code. I am now debating between -78 and -59. 

Question ID : 10514
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