# Angioplasty...need help coding



## ammontagano (Oct 20, 2009)

Procedure:  Angioplasty and Placement of Stent into LAD Left heart Catheterization with Coronary Angiography

Procedure:

A #6 French sheath was placed in the right femoral artery.  The pt had been premedicated with 600 mg of Plavix and aspirin, and was given Angiomax.  After a diagnostic angiogram was performed, a #6 French EBU #4 guide advanced to the left coronary artery.  A 0.014 BMW wire was advanced across the total occlusion and dilated to 2.5 15-mmlong voyager balloon.  There seemed to be significant narrowing of the diagonal.  A Pilot 50wire was advanced into that and the lesion dilated with the same 2.5 balloon.  There was slow flow in the LAD.
An Export catheter was placed down the LAD and clot aspirated with marked improvemnet in his flow.  A 3.0 15-mm long Vision stent was placed at 16 atmospheres.  There seemed to be significant narrowing of the diagonals.  A BMW wire was placed into the diagonal and dilated with a 2.5 balloon and then the stent dilated with a 3.0 balloon.  Againm there was narrowing of the diagonal.  Both balloons would not fit through the catheter tp do kissing-balloon technique and therefore the guidewaire was placed back in the diagonal and dilated with a 2.5 balloon.  This markedly improved the narrowing.  The catheters were removed and hemostatis obtianed using Angio-Seal.


CPT 

93510/26
93543
93555/26
93556/26
92980/LD
93545



Does this coding seem correct or does 92982 seem more appropriate?  Any responses are appreciated.


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## rcosta (Oct 20, 2009)

You would always code the hiearchy of the codes which is the stent.


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## bmkardok (Oct 21, 2009)

*bcard*

Looking at the documentation provided I would code this op note like this:
92982
92984
93510/26
93545
Hope this helps.


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## dpeoples (Oct 21, 2009)

ammontagano said:


> Procedure:  Angioplasty and Placement of Stent into LAD Left heart Catheterization with Coronary Angiography
> 
> Procedure:
> 
> ...



I would code only 92980-LD. 
The diagnostic LHC lacks sufficient documentation to bill IMO. I certainly see no interpretation of images taken prior to the balloon being used. With better documentation you might also have a case for a thrombectomy, 92973 but as is I would not include that charge.

HTH


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## Jaden0716 (Oct 23, 2009)

I would agree with the above 92980 LD/Martha Hernandez.CPC


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