# Stents



## armymomryan (Sep 17, 2010)

Dictation for stents

A series of stents were then placed in the proximal and mid LIMA, initially a 2.5X18-mm LIMA and then proximal to that a 2.5X23 LIMA, and ultimately a 2.5X23-mm LIMA from the ostium overlapping with the 2nd stent palced, then a 2.5X18-mm Xience drug-eluting stents were placed - I am reading 4 stents, can anyone confirm and help with the modifiers


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## dpeoples (Sep 17, 2010)

armymomryan said:


> Dictation for stents
> 
> A series of stents were then placed in the proximal and mid LIMA, initially a 2.5X18-mm LIMA and then proximal to that a 2.5X23 LIMA, and ultimately a 2.5X23-mm LIMA from the ostium overlapping with the 2nd stent palced, then a 2.5X18-mm Xience drug-eluting stents were placed - I am reading 4 stents, can anyone confirm and help with the modifiers



The number of stents is irrelevant, it is only the vessel(s) stented that matters, in this case the LIMA. You can however append modifier 22 (increased procedural services  ie complex) to the code for the stent due to the considerable work involved.

My question however is: Was the LIMA part of a coronary graft? If so, to what coronary artery was it grafted? The answer to that questions determines whether the code should be 92980 or 37205/75960. I will add that I have never seen the LIMA stented unless it was grafted to a coronary artery.

HTH


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## KeriH423 (Sep 20, 2010)

armymomryan said:


> Dictation for stents
> 
> A series of stents were then placed in the proximal and mid LIMA, initially a 2.5X18-mm LIMA and then proximal to that a 2.5X23 LIMA, and ultimately a 2.5X23-mm LIMA from the ostium overlapping with the 2nd stent palced, then a 2.5X18-mm Xience drug-eluting stents were placed - I am reading 4 stents, can anyone confirm and help with the modifiers



I agree with Danny. In my LCD, Medicare states that if _four or more stents _are placed in a single vessel (this is following coronary guidelines) then it would be considered an "unusual procedural service" and eligible for additional reimbursement equivalent to that of an additional vessel treated.  To show this, you add the Mod -22 and include a procedure note in box 19 of the HCFA stating how many stents were placed.


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