# 2 vessel bifurcating circumflex disease



## pducharme (Feb 11, 2013)

Doctor placed stents in the ramus intermedius and the lateral ramus due to 2 vessel bifurcation.  Can we code for both interventions in 2013?

Thanks so much for your help!


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## dpeoples (Feb 12, 2013)

pducharme said:


> Doctor placed stents in the ramus intermedius and the lateral ramus due to 2 vessel bifurcation.  Can we code for both interventions in 2013?
> 
> Thanks so much for your help!



The ramus intermedius is now recognized as a primary coronary artery (modifier RI) but branches of this artery are not (recognized). You can only bill once for treatment to *this *vessel if I understand the new rules correctly.

HTH


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## debcpc (Feb 12, 2013)

The Introductory Guidelines under coronary therapeutic services and procedures state that "When bifurcation lesions are treated, PCI is reported for both vessels treated. For example, when a bifurcation lesion involving the left anterior descending artery and the first diagonal artery is treated by stenting both vessels, 92928 and 92929 are both reported".  Having said that when you bill for both of them you will only get reimbursed for the main code.  The hospital can however bill for both!


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## Jess1125 (Feb 12, 2013)

Danny is right. Up to 2 additional braches are recognized for the LC, LD, and RC. The ramus and left main don't have recognized branches so you can only report one code for the ramus intervention and that's it. 

Jessica CPC, CCC


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## dpeoples (Feb 12, 2013)

debcpc said:


> The Introductory Guidelines under coronary therapeutic services and procedures state that "When bifurcation lesions are treated, PCI is reported for both vessels treated. For example, when a bifurcation lesion involving the left anterior descending artery and the first diagonal artery is treated by stenting both vessels, 92928 and 92929 are both reported".  Having said that when you bill for both of them you will only get reimbursed for the main code.  The hospital can however bill for both!




True, except for the left main and ramus arteries. 

At the beginning of the guidelines:
Major Coronary Arteries..."All PCI procedures performed in all segments (proximal, mid, distal) of a single major coronary artery through the native circulation are reported with one code".
and:
Coronary artery branches..."The left main and ramus intermedius do not have recognized branches for reporting purposes".

HTH


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