# Can someone read this PCI?



## brandyleigh23 (Mar 14, 2011)

I have been doing quite a few of these and I fear I am billing them incorrectly. This is long but I would appreciate anyone that could give me some input.  I know the CPT states angioplasty within the same vessel is part of the stenting procedure, 92980. Sometimes they do the balloon procedure and sometimes they dont.  I coded this report as 92980/LC.  


We have transluminal balloon angioplasty, Revascularizations, , Transcatheter placements, Transcatheter introductions, etc...  I feel as if I really need to read in between the lines with this coding.  I am so confused right now.. Cardiology is tough!





PERCUTANEOUS CORONARY INTERVENTION:

PROCEDURES PERFORMED:
1.    Selective left coronary angiogram.
2.    Balloon angioplasty of the obtuse marginal branch.
3.    Percutaneous coronary intervention with drug-eluting stents placement (obtuse marginal branch as well as the mid left circumflex branch).
4.    Postdilation of the drug-eluting stents using a noncompliant balloon. 
5.    Selective right peripheral arteriogram.



REASON FOR PERCUTANEOUS CORONARY INTERVENTION:

Ms. Dickens is a 57-year-old Caucasian female with past medical history of chronic pain syndrome with a spinal cord stimulater, COPD, acid reflux disease, hypothyroidism, who was admitted to the hosptial with new onset of atrial fibrillation. The patient was undergoing a stress test a tht he Boice-Willis Clinic Cardiology office and developed tightness in the cest and palpttations and was found to be in rapid a-fib. She was subsequently admitted to the hosptial where she converted back to sinus rhythm spontaneously. She however continued to have significant discomfort  in her chest which prompted invasive workup in the form of cardiac catheterization. 


PROCEDURE:

An SV 3.5 5 French guide was used to cannulate the left main coronary artery. Angio max  (bolus of 13 mL per hour followed by continuous infusion of 30 mL per hour)  was used for anticoagulation. The patient was bolused with Plavix 600 mg orally on the table. A run-through coronary NS guidewire was then used to cross the proximal left circumflex into the obtuse marginal branch. The crossing of the wire required some manipulation, but we were able to cross the wire without any complications. 

We then used a complliant balloon (mini-trek 2.0 x 8 mm)  and this was used to pre-dilate the OM lesion. After pre-dilation of the OM lesion, there was some resolution of the OM occlusion. We than gave 200 mcg of intracoronary nitroglycerin and took an angiogram to size the vessel. We then used a drug-eluting stent (Xience V 2.5 x 15 mm) which was postitioned in the mid part of the obtuse marginal branch at the tightest stenosis. The stent was deployed at 8atmospheres. 

We then took another long stent  (Xience V 2.5 x 23 mm)  and overlapped this with the previously placed stent distally and postitioned it proximally to cover the proximal and mid left circumflex stenosis. This was revealed minimal residual stenosis within the stents. We then used a noncompliant balloon (Voyager NC 2.5 x 12 mm)  and did multiple inflations within the two stents. After removal of the noncompliant balloon, the final angiogram revealed patent vessel with TIMI-3 flow, no residual dissections as well as complete filling of all the branches of the previously subtotally occluded distatl left circumflex and the other obtuse marginal branches. 

We then did a limited peripheral angiogram of the right femoral artery to confirm the postition of the femoral sheath. The femoral sheath was in the common femoral artery above the bifurcation of the profunda femoris and the superficial femoral arter. the sheat was removed and hemostasis was achieved using a Perclose closure device. 

IMPRESSION:
1.    Successful percutaneous coronary intervention with drug-eluting stents placement in a subtotally occluded obtuse marginal branch and a critical mid left circumflex branch using drug-eluting stents (2.5 x 15 mm and 2.5 x 23 mm) with no residual dissections and TIMI-3 flow.



Thank you to anyone who can help me

Brandy Edmondson, CPC


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## dgarri (Mar 14, 2011)

I would use 92980-59-lc, what other codes are you using for this procedure?


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## brandyleigh23 (Mar 14, 2011)

This is the only procedure performed, so I have it coded as 92980/LC.  I just wanted to make sure I am doing this correctly. My doc is questioning the angioplasties that I am charging. 

All the procedures I have found that he is questioning me about are all with stents.  However, now that I am being questioned I have been digging further and finding other codes that are confusing me with the "transcatheter" and  "transluminal" and also some of the radiology codes.

75960,35471,37205,37220, are some of the codes I have come across that keep me crosseyed!  

Thank you so much for reviewing the report and responding to my question



Brandy Edmondson, CPC


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## Jim Pawloski (Mar 15, 2011)

brandyleigh23@hotmail.com said:


> This is the only procedure performed, so I have it coded as 92980/LC.  I just wanted to make sure I am doing this correctly. My doc is questioning the angioplasties that I am charging.
> 
> All the procedures I have found that he is questioning me about are all with stents.  However, now that I am being questioned I have been digging further and finding other codes that are confusing me with the "transcatheter" and  "transluminal" and also some of the radiology codes.
> 
> ...




My reading of this report is to just bill for the stent placement, 92980-LC for the physician, G0290 for the drug eluting stent for the hospital if patient has Medicare, 92980 if not a Medicare patient.  Stent placement supercedes atherectomy which supercedes angioplasty, so you cannot bill for angioplasty, and you cannot use radiology for heart procedures.

Hope this helps you,
Jim Pawloski, CIRCC


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## theresa.dix@tennova.com (Mar 15, 2011)

Jim Pawloski said:


> My reading of this report is to just bill for the stent placement, 92980-LC for the physician, G0290 for the drug eluting stent for the hospital if patient has Medicare, 92980 if not a Medicare patient.  Stent placement supercedes atherectomy which supercedes angioplasty, so you cannot bill for angioplasty, and you cannot use radiology for heart procedures.
> 
> Hope this helps you,
> Jim Pawloski, CIRCC




I agree with Jim. He is right on


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## brandyleigh23 (Mar 15, 2011)

Thank you so much, you all have been a big help.  I have read about the hierarchy of the interventions with the stenting being the greatest. It just eases my mind for someone to agree with me since I am always second guessing!  Thanks again

Brandy Edmondson, CPC


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