# 2013 Cardiology changes



## Cathy Casey (Nov 13, 2012)

In reviewing 2013 changes, it appears that 92920-92944, will need LM,LD,RC,LC and RI modifiers for each code?? Is this now you understand it??

And with the carotid angiography codes, each one will need RT or LT modifiers?


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## Jim Pawloski (Nov 13, 2012)

Cathy Casey said:


> In reviewing 2013 changes, it appears that 92920-92944, will need LM,LD,RC,LC and RI modifiers for each code?? Is this now you understand it??
> 
> And with the carotid angiography codes, each one will need RT or LT modifiers?



Yes, and no.  I think you still can't bill the Left Main and Ramus vessle with a separate charge.  If you stent the LM with the LD or LC as one intervention, then your O.K.  But if you have separate lesions on the LD or LC, and Diagonal branch or OM branch. Say a stent is placed in the proximal LD, and a diagnoal is angioplastied, then you use 92928 for the stent, then 92925 fofr the PTCA.  Cerebrals will be RT and LT.
HTH,
Jim Pawloski, CIRCC


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## Cathy Casey (Nov 14, 2012)

Jim, Thank you for the response.  I was thinking since HCPCS notified of the LM and RI modifiers, then they were considered a single major vessel with of course no branches.  I do have one more question, yesterday we received information on 2013 updates from Boston Scientific and included were the procedure intervention codes 92920-92944.  These codes include angioplasty, atherectomy and stent procedures.  It was stated in there there were also C codes for the DES procedures which take the place of the previous G codes of 2012.  With of course pairing with the C device code.  Do you think you would use the 929XX cpt code with the procedure C code or just use the procedure C code in place of the CPT for drug eluting stents?


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## Jim Pawloski (Nov 14, 2012)

Cathy Casey said:


> Jim, Thank you for the response.  I was thinking since HCPCS notified of the LM and RI modifiers, then they were considered a single major vessel with of course no branches.  I do have one more question, yesterday we received information on 2013 updates from Boston Scientific and included were the procedure intervention codes 92920-92944.  These codes include angioplasty, atherectomy and stent procedures.  It was stated in there there were also C codes for the DES procedures which take the place of the previous G codes of 2012.  With of course pairing with the C device code.  Do you think you would use the 929XX cpt code with the procedure C code or just use the procedure C code in place of the CPT for drug eluting stents?



I am also wondering about the drug eluting stents.  First, if you are billing for the hospital, the patient must have Medicare insurance as a primary insurer to use the G0290 and 91.  If you are billing for the doctor, you bill for the stent placement code 92980 and 81.  For the c-code, most interventional codes have to have a piece of equipment billed to match the procedure code.  Example, PTCA must have a angioplasty catheter billed.  Stent placements must have an stent C-code in the bill.  I haven't recieved the newest HCPCS book to see if there are any changes, but I hope this helps you.  
Thanks,
Jim Pawloski R.T. (CV) CIRCC


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## Jim Pawloski (Nov 14, 2012)

Cathy Casey said:


> Jim, Thank you for the response.  I was thinking since HCPCS notified of the LM and RI modifiers, then they were considered a single major vessel with of course no branches.  I do have one more question, yesterday we received information on 2013 updates from Boston Scientific and included were the procedure intervention codes 92920-92944.  These codes include angioplasty, atherectomy and stent procedures.  It was stated in there there were also C codes for the DES procedures which take the place of the previous G codes of 2012.  With of course pairing with the C device code.  Do you think you would use the 929XX cpt code with the procedure C code or just use the procedure C code in place of the CPT for drug eluting stents?



Hi Cathy,
I want to thank you for asking about the drug eluting stents.  Since I haven't recieved my HCPCS book, I checked the G0290 with CodeCorrect.com.  They state that G0290 and G0291 expire on 12/31/12, but don't state what the new codes are for drug eluting stent.  So I have to take what Boston Scientific states.  Now I have to change my billing sheet for the  new codes.  
Thanks again,
Jim Pawloski


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## jewlz0879 (Nov 15, 2012)

Jim Pawloski said:


> Hi Cathy,
> I want to thank you for asking about the drug eluting stents.  Since I haven't recieved my HCPCS book, I checked the G0290 with CodeCorrect.com.  They state that G0290 and G0291 expire on 12/31/12, but don't state what the new codes are for drug eluting stent.  So I have to take what Boston Scientific states.  Now I have to change my billing sheet for the  new codes.
> Thanks again,
> Jim Pawloski



In the 2013 CPT book under the new guidelines for "Coronary Theapuetic Services and Procedures," pg. 500, states: These codes include...and stenting (e.g. balloon expandable, self-expanding, bare metal, _drug eluting_, covered). 

Does that help?


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## Cathy Casey (Nov 15, 2012)

There has been a change on the 92920-92944.  I watched a MedAssets Code Correct Webinar and there are now C96xx codes for drug eluting stents.  The G codes are gone as of 12-31-12.  The C96xx series of codes are PROCEDURE codes that correlate with the 92920-92944 series which are bare metal.  And yes, you still need a C device code to pair with either the C procedure code (DES) or 92920-92944 code for BMS.  Seems like it would have been easier just to keep the G codes!  In hopes this new information will help you.  Each code will have to have duplicates for the modifiers LM, RI, LD, LC and RC.  Our charge sheet is developing into a small BOOK!


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## jewlz0879 (Nov 15, 2012)

It's my understanding you would only bill G codes if you were billing for the hospital, I bill for the physician so I've never had to worry about G codes.


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## staceybrennert (Nov 16, 2012)

I did a bit of research and found that once G0290 and G0291 are deleted, the following C codes will take their place.  

● HCPCS code C9600 (Percutaneous transcatheter placement of drug eluting
intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch);
● HCPCS code C9601 (Percutaneous transcatheter placement of drug-eluting
intracoronary stent(s), with coronary angioplasty when performed; each additional
branch of a major coronary artery (List separately in addition to code for primary
procedure));
● HCPCS code C9602 (Percutaneous transluminal coronary atherectomy, with
drug eluting intracoronary stent, with coronary angioplasty when performed; single major
coronary artery or branch);
● HCPCS code C9603 (Percutaneous transluminal coronary atherectomy, with
drug-eluting intracoronary stent, with coronary angioplasty when performed; each
additional branch of a major coronary artery (List separately in addition to code for
primary procedure));
● HCPCS code C9604 (Percutaneous transluminal revascularization of or
through coronary artery bypass graft (internal mammary, free arterial, venous), any
combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including
distal protection when performed; single vessel);
● HCPCS code C9605 (Percutaneous transluminal revascularization of or
through coronary artery bypass graft (internal mammary, free arterial, venous), any
combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including
distal protection when performed; each additional branch subtended by the bypass graft
(List separately in addition to code for primary procedure));
● HCPCS code C9606 (Percutaneous transluminal revascularization of acute
total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary
artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and
angioplasty, including aspiration thrombectomy when performed, single vessel);
● HCPCS code C9607 (Percutaneous transluminal revascularization of chronic
total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft,
any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single
vessel); and
● HCPCS code C9608 (Percutaneous transluminal revascularization of chronic
total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft,
any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each
additional coronary artery, coronary artery branch, or bypass graft (List separately in
addition to code for primary procedure)).


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