How should providers document the use of the 2024 add-on code for Coronary Shockwave Lithotripsy to address payer denials citing “lack of medical necessity” or insufficient documentation, and how can they demonstrate that the procedure is not incidental but a medically necessary addition to PCI?
Even though 2024 gave us an add-on code for Coronary Shockwave Lithotripsy, many payers are denying the code as not “medically necessary” or that the documentation did not have enough information to support the use of the code. Remember, this used to be “bundled” into the angioplasty procedure, so for reimbursement, we strongly advise provider to include in their procedural documentation why this was not incidental, but an additional medically necessary service to the PCI.
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