# CTO Stent help



## econnolly (Jan 9, 2013)

Hello,
 I thought I had these new PTCI codes down, but now I'm confused.- please HELP!

This patient had CTO of the LAD with multiple stents placed.  
Same session- He also had significant disease (NO CTO) of the RCA and PDA branch, which also received multiple stents.

 I coded 92943-LD for the CTO of the LAD and 92928-RC, 92929-RC for the stents of the RCA and PDA branch.

 Now I'm confused about when to code 92944 (CTO...each additional...)

Could you explain the correct coding for this procedure?

Another question: 
In CPT, the "introduction" section (prior to the list of codes) that explains the guidelines for using the new codes, states the "hierarchy" of the base codes as "92943, 92941, 92933, 92924, 92937, 92928, 92920".

However, immediately following each of the  -add on codes (including 92944) there is a notation that states to "use this code in conjunction with (base) codes "92924, 92928, 92933, 92937, 92941, and 92943". 

This makes no sense if we are to code the PCI according the the "hirerarchy" of the "base vessels" as previously described in the introduction.

I'm confused- please help??!

Thank you!
Elizabeth


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## mlreedy (Jan 10, 2013)

*Kissing Balloon Technique*

I know i used the 92982 for the old kissing balloon code, but i am unsure of which code to use now for this same technique. Could someone help me, please.
Thank You


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## dpeoples (Jan 10, 2013)

econnolly said:


> Hello,
> I thought I had these new PTCI codes down, but now I'm confused.- please HELP!
> 
> This patient had CTO of the LAD with multiple stents placed.
> ...




Elizabeth, I am not sure I understand but here are a couple of my thoughts:

1) Your codes seem correct to me. 92944 would apply if the branch of the RC(PDA) had a CTO.
2) The list under the add on codes is in numerical order, not hierarchial order. 

HTH


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## theresa.dix@tennova.com (Jan 11, 2013)

dpeoples said:


> Elizabeth, I am not sure I understand but here are a couple of my thoughts:
> 
> 1) Your codes seem correct to me. 92944 would apply if the branch of the RC(PDA) had a CTO.
> 2) The list under the add on codes is in numerical order, not hierarchial order.
> ...



Elizabeth,
You have Collins crosswalk. Look at how he has listed when two major chronic occluded vessels are stented or one major chronic and one branch chronic are stented.(they are coded the same way)  Then get your 2013 CPT and read the description of 92944(add on code). the description says "each additional coronary artery,coronary artery vessel BRANCH, or bypass graft( list separately in addition to primary procedure).

So code your first chronic occlusion with 92943 and your second chronic occlusion( if you have one) with 92944.Whether major vessel or branch. Because 92944 ISNT just for the chronic BRANCH. Its for any vessel that is occluded after the first occlusion. You see?

The confusion seems to be that the"other"  new PCI codes have major vessel codes and branch codes specifically. CTO are more like our old codes where you have primary code and additonal code.


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## mabar1571 (Jan 16, 2013)

I think the problem is (just as the ami code 92941) whether additional vessels are occluded or not.  If an additional vessel is occluded (either cto or ami) then using the 92944 for cto (or an addtl.92941 for ami) isn't an issue, the problem is when a secondary vessel (whether major or branch) isn't occluded.  Do we still use the 92944 (for cto) or 92941 (for ami) for these addtl.vessels or code using the other intervention codes?  My thought is that if the addtl.vessel isn't clearly documented as occluded we would have to code using the other intervention codes.


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## theresa.dix@tennova.com (Jan 17, 2013)

mabar1571 said:


> I think the problem is (just as the ami code 92941) whether additional vessels are occluded or not.  If an additional vessel is occluded (either cto or ami) then using the 92944 for cto (or an addtl.92941 for ami) isn't an issue, the problem is when a secondary vessel (whether major or branch) isn't occluded.  Do we still use the 92944 (for cto) or 92941 (for ami) for these addtl.vessels or code using the other intervention codes?  My thought is that if the addtl.vessel isn't clearly documented as occluded we would have to code using the other intervention codes.



Its confusing. If the first vessel is chronic occlusion use CTO code and if the additonal vessel isnt chronic occlusion go back to using the "regular" PCI codes. Yes your right.


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