# cpt 92941



## bmx1616

Can 92941 be used if only ptca is performed on a MI patient with total occlusion?


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## debcpc

*92941*

92941 was written for an ACUTE MI (total/subtotal occlusion).  Basically the patient is having the AMI - first medical contact to balloon time 90 minutes.


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## scrappingal

*92941*

Can you tell me where you found the 90 minute time frame guidelines?  I'm looking for documenation to support any rules regarding intervention durina an MI and have not found anything. Thank!!


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## dcurtis2012

scrappingal said:


> Can you tell me where you found the 90 minute time frame guidelines?  I'm looking for documenation to support any rules regarding intervention durina an MI and have not found anything. Thank!!



Ditto. I would love to see documentation for this, as well. The office I work for is having us code this for a pt who comes in with MI even if the intervention is not done until the next day.


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## sweatts

*Sweatts*

are there modifiers for the new stent codes ??


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## Marianne1

dcurtis2012 said:


> Ditto. I would love to see documentation for this, as well. The office I work for is having us code this for a pt who comes in with MI even if the intervention is not done until the next day.



I agree.The definition of acute MI is too hard to follow from reading the dictation.
is "emergently triaged to cath lab"  and revascularization an acute mi?  Is unstable angina with elevated troponin emergently taken to the lab and acute MI?    Is a readmision to the cath lab after an emergent initial cath an acute mi?


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## kimmyjwright

dcurtis2012 said:


> Ditto. I would love to see documentation for this, as well. The office I work for is having us code this for a pt who comes in with MI even if the intervention is not done until the next day.



I too, am looking for this "90 min" time frame...does anyone know where this written documentation is?  I have looked everywhere


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## EmilyDingee

The 2013 Cardiology CPT Changes book gives examples for all the new codes. In the example for 92941 the patient is taken from ambulance straight to cath lab and an emaergent catherterization is done for an acute MI with Stenting of a total occlusion. However I think as most of us have found out pateints are meeting the guidelines for "acute MI & Sub/total Occlusion" a day of to after the MI actually took place. I would love to get more clarification on this as well. Maybe the word "during" is what we are overlooking here...


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## jewlz0879

Not sure if this will help but I think it might alleviate some confusion as "timeframe" seems to be a concern. 

Per ICD-9 pg. 125 Vol 1

Any condition classifiable to 414.1X-414.9X specified as acute or with a stated duration of 8 weeks or less. 

So, AMI can be up to 8 weeks (56 days).

In ICD-10 it will be 4 weeks or 28 days. 

HTH


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## dcurtis2012

kimmyjwright said:


> I too, am looking for this "90 min" time frame...does anyone know where this written documentation is?  I have looked everywhere



I was at a cardiology coding seminar last week and the instructor said nothing about a 90 minute window. She said basically what jewlz0879 said above: " AMI can be up to 8 weeks (56 days)."


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## Cheribeaty

*92941*

There may be some confusion as to the diagnosis of an AMI and the guidelines when coding 92941.  The AMI can be coded clinically but for the new CPT code 92941 this is the revascularization DURING the patient experiencing the Acute MI which would usually be within 90 minutes.  First medical contact-to-balloon time within 90 minutes.  The patient may be diagnosed with an AMI (which may be appropriate) but that is not the same as the purpose of this new code.  Hope this helps some.


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## dpeoples

Cherib said:


> There may be some confusion as to the diagnosis of an AMI and the guidelines when coding 92941.  The AMI can be coded clinically but for the new CPT code 92941 this is the revascularization DURING the patient experiencing the Acute MI which would usually be within 90 minutes.  First medical contact-to-balloon time within 90 minutes.  The patient may be diagnosed with an AMI (which may be appropriate) but that is not the same as the purpose of this new code.  Hope this helps some.



This makes sense, however, I would like the source of your information if you have it.


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## coding?4u

*92941 vs. 92941*

If the documentation does not state within 90 mins or you are unable to determine the patient was sent directly to the cath lab from the ED, would you then code the 
chronic code 92943?  If I bill the 92941, the supporting argument  for me would be that I  have an understanding of how the diagnosis coding works for MI's.  And hope that it would be accepted.
Although both codes have the same RVUs, if they are looking for frequency in both acute/chronic there needs to be some clarification.  Otherwise,
the numbers will be misleading and inaccurate.


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## Amanedmaiston

I am confused with the 92941 as well. We have so many patients with NSTEMI but they do not have a procedure till days later.  I do know the 92943 is an established CTO and would not be used if patient is having an AMI.


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## debcpc

I will just try to clarify my original statement - 90 minutes was used as an example.  When the CPT code 92941 was created it was for the emergent procedure regardless of patients with STEMI or NSTEMI.  The vignette for the CPT code 92941 is *"A 56-year-old male calls 911 for sudden onset of crushing substernal chest pain. Pre-hospital 12-lead electrocardiography in the ambulance demonstrates acute anterior myocardial infarction with ST elevation in leads V2-V5. The heart attack alert system is activated. The emergency medical personnel bypass the emergency department and take the patient directly to the cardiac catheterization laboratory, arriving within 50 minutes of symptom onset. After rapid assessment, immediate coronary angiography is performed (reported separately), demonstrating 100% occlusion by a large thrombus in the middle segment of the left anterior descending artery. The patient demonstrates runs of non-sustained ventricular tachycardia. Percutaneous coronary intervention is planned immediately with the goal of achieving first medical contact-to-balloon time of under 90 minutes. This is the first lesion in this coronary territory to be treated.*"  This is where the 90 minutes came from originally and the description of the service also states emergent.  Per the ACC is code is not for cases where the patient is amitted and the procedure done two weeks later for example.
Vignette and Description of Service can be found if you have CodeManager 2013 online.


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## Amanedmaiston

There is a Z Health e learning article you can purchase for around $40.00 on their website. It also states that 92941 is for an URGENT intervention needed during an MI.


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## brandyleigh23

debcpc said:


> 92941 was written for an ACUTE MI (total/subtotal occlusion).  Basically the patient is having the AMI - first medical contact to balloon time 90 minutes.



I found something to support what you found. I was looking for answers regarding the use of 92941 and/or 92928 on a report I was reading and stumbled on this...

http://codingleader.com/debate-on-code-92941

In short, it talks about understanding what "acute" means clinically and if it supports the 90 minute or less timeline vs the 8 week MI. But, "acute" can largely differ from source to source.There was a purpose to creating this code and it looks like there are others asking themselves the same questions we are.

There looks to be some grey area in how to correctly use this new code.90 minutes vs 8 weeks is a huge gap... Hopefully AMA will give some insight. 

Just wanted to share!


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