# return trip to cath lab for second stent



## jlb102780 (Jan 21, 2010)

Need some advice on this:

Pt had L Heart Cath with Stent to the RC, pt was then put in obs care. During the cath, the doctor states that the pt had 2 lesions in the RC. After a period of time the pt had questionable EKG changes, so the same dr decided to return the pt to the cath lab and stent the other lesion in the RC. 

Is the second trip billable since its in the same artery?

1st procedure: 92980-RC
                     93510-26
                     93545
                     93556-26,59
                     93543
                     93555-26,59

2nd procedure: ?


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## Jim Pawloski (Jan 21, 2010)

I would bill for the intervention only, since the patient already had a diagnostic heart cath.

HTH,
Jim Pawloski, CIRCC, R.T. (CV)


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## rpeterson (Jan 21, 2010)

Although your other reply thinks that you should bill the intervention only, I would have to disagree. The patient had new ekg changes which is a new sign or symptom. Although the doc knew that the RCA was occluded, the stent he just placed could have reoccluded or another "culprit" vessell needed to be attended to sooner than originally thought - he wouldn't know until he did another diagnostic cath (it really depends on how he worded things in his dictation also). We code the diagnostic cath in these situations with the 76 modifier plus the new stent that was placed. It may be an appeal but we've always been successfull with our appeals on this.


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