Cardiology Coding Alert

Discover how the number of coronary artery repairs affects your claim

Fed up trying to understand what 92980-92981 include, how to report multiple stents in different vessels, and what to do when your cardiologist performs other interventions as well? Let our experts answer your questions.

Step 1: Know What CPT 92980 and CPT 92981 Include

The first step to avoiding coding inaccuracy is to know what's contained in the intracoronary stent placement codes 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) and +92981 (... each additional vessel [list separately in addition to code for primary procedure]). A previously scheduled (AKA elective) stenting procedure includes the following components:

• the normal preoperative assessment and sedation,

• obtaining vascular access,

• placing various guidewires and catheters for use during the procedure,

• angiography necessary to guide the procedure,

• predilatation of the lesion (such as angioplasty),

• placement of the stent(s) in the targeted coronary vessel

• angiography to confirm the procedure's success, and

• withdrawal of all equipment, obtaining hemostasis and the normal postoperative course.

Diagnostic Cardiac Caths Not Included

These codes do not include the diagnostic cardiac catheterization that prompted the cardiologist to decide an intervention was necessary. With urgent interventions, however, you may be able to receive reimbursement for the diagnostic procedure, depending on your circumstances.

For example, if angiography is part of a planned intervention, you would not report it (the catheter placement or the radiological supervision and interpretation). But if a cardiologist does the left heart catheterization and determines the patient needs an urgent intervention (which is often the case), you can report both and be paid for both, says Melissa Bedford, a coding specialist at Austin Heart PA in Texas.

When a diagnostic heart catheterization (93510-26, 93543, 93545, 93555-26 and 93556-26) reveals the need to proceed to the intervention, you can report it and get paid for both the diagnostic heart catheterization and the stent.
 
Just make sure to attach modifier 59 (Distinct procedural service) to the supervision and interpretation codes (93555, Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography; and 93556, ... pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]), says Heather Stecker, CPC, senior coding and financial analyst at the Cardiology Consultants of Philadelphia PC.
 
Appending this modifier will illustrate that these are not the angiographic services which the National Correct Coding Initiative (NCCI) includes in the stent placement service.

Example: If your cardiologist performs a left heart catheterization (93510, Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous), left ventriculogram (93543 and 93555-26) and coronary angiography (93545 and 93556-26) for diagnostic purposes, you can report these services. However, you will need to attach modifier 59 to codes 93555 and 93556 to indicate that the S&I relates to the diagnostic heart catheterization and not to the stent placement.

Step 2: Don't Make the Multiple Mishap

If your cardiologist places one or more stents per vessel, you should report 92980 or 92981 only once. You will never use modifier 51 (Multiple procedures).

Key coronary arteries: When you're coding interventions, you'll likely use the modifiers for three Medicare-recognized coronary arteries:

• Modifier LD--Left anterior descending, or LAD

• Modifier LC--Left circumflex, or LCX

• Modifier RC--Right coronary, or RCA.

Most carriers cover only one intervention per coronary artery (or vessel)--including the associated branches. Reason: The relative value units (RVU) for the angioplasty include multiple lesions in multiple branches. Therefore, you can properly code only one intervention for each of these three main arteries.

"The only way you can bill for multiple coronary stents is if they are in different vessels," says Sylvia Krummer, CPC, CCP, certified coder and internal auditor for CardioVascular Associations in Louisville, Ky. For example, if the cardiologist places a stent in the distal LAD and a stent in the mid RCA, you can report two coronary stents.

Rule of thumb: When your cardiologist performs multiple interventions, the number of coronary vessels he repairs--not the type or the number of interventions--determines how you should code this service, Bedford says. See the chart below:

Vessels                                         Code(s)

One vessel (LC/LD or RC)                92980
Two vessels (LC/LD and/or RC)        92980
                                                     92981 
Three vessels (LC/LD and RC)          92980
                                                     92981 x 2 

Special case: If your cardiologist places stents to the LCX and to the obtuse marginal (OM), Medicare considers these both part of the LCX, meaning you cannot report them separately. Payers will deny your claim, which is "frustrating to cardiologists because they've performed the work," Stecker adds.

Step 3: Code to Highest Complexity

You shouldn't separately report the angioplasty that the cardiologist performs before or as part of the atherectomy/stenting in the same vessel. Best bet: You should report only the more complex procedure (such as the intracoronary stent or atherectomy). 

Here are the highest to the lowest complexity procedures:

• Stenting (92980-92981)

• Atherectomy (92995, Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel; or +92996, ... each additional vessel [list separately in addition to code for primary procedure])

• Percutaneous transluminal coronary balloon angioplasty (PTCA) (92982, Percutaneous transluminal coronary balloon angioplasty; single vessel; or +92984, ... each additional vessel [list separately in addition to code for primary procedure]).

Similarity: You'll discover that using these codes is similar to using atherectomy codes. If a cardiologist performs a percutaneous transluminal coronary angioplasty or other therapeutic modality in the same vessel as the stent placement, you'll include this service in the stent placement code.

Keep in mind: If your cardiologist performs these procedures in different vessels, such as the stenting in RCA and an angioplasty in LAD, you'll report 92980-RC and 92984-LD. If your cardiologist's documentation supports a case that went beyond the norm, you could attach modifier 22 (Unusual procedural services) to the stent code 92980. This will show how your doctor placed two overlapping stents in the RCA, which can increase your revenue anywhere from 20 percent to 30 percent, Bedford says.