Fee Navigator®

    Health Service Code 51.59D

    Percutaneous transluminal coronary angioplasty with associated diagnostic angiogram

    NOTE:
    1. May be claimed when the diagnostic angiogram is intended to determine appropriate treatment of the patient's coronary anatomy and is immediately followed by a coronary angioplasty by the same cardiologist.
    2. Benefit includes other angiograms performed on the same date of service.
    3. For each additional coronary vessel, refer to Price List.
    4. Role modifier ASIC may be claimed for assistance at coronary angioplasty by a second interventional cardiologist.
    5. May not be claimed in addition to HSCs 50.91D or 50.91E.
    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$1163.75

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$353.34
    ROLEANESTYesReplace Base$18.39
    ROLEASICYesReplace Base$175.00
    ANEUANEU1For Each Call Pay Base At100%
    ANEUANEU2 - 3For Each Call Increase By$128.53
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 3For Each Call Increase By$300.83
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP75YesReduce Base To75%

    Governing Rules:

    • 6.8.1

      HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.

      1. a consultation benefit may be claimed up to and including the day of surgery.
      2. pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
      3. benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
      4. Deleted
      5. HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.

      The following chart gives the pre-operative and post-operative periods.

      CategoryPre-operativePost-operative
      10 - Days14 - Days
      37 - Days7 - Days
      47 - Days14 - Days
      614 - Days14 - Days
      1430 - Days14 - Days
      150 - Days7 - Days