Avoid Confusing Atherectomy Codes With Other Similar Procedures
Published on Sat Sep 01, 2001
Of the three coronary interventions performed by cardiologists, atherectomy is the least-often performed, the most poorly understood and, as a result, one of the more difficult procedures to code correctly.
"Coding and documentation errors can arise when atherectomy procedure codes are used incorrectly to describe other services that have some similarity to atherectomies but are not the same procedure," says Nikki M. Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.
Atherectomies are also subject to the same guidelines that apply to percutaneous transluminal coronary interventions (PTCAs) and stents, with which they are frequently combined, she adds.
When filing claims for PTCAs, coders need to read the operative report carefully to ensure they know the vessel and branch that received the service, because this information has a direct impact on how the procedure(s) should be coded. The cardiologist's documentation must clearly indicate the vessel that received the intervention, as well as the type and number of atherectomies, PTCAs and/or stents performed.
Note: See box on page 67 for a definition of the procedure.
Code Accurately for Atherectomies: Single and Multiple
CPT Codes 2001 includes the following coronary atherectomy codes:
CPT 92995 -- percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel; and
CPT 92996 -- ... each additional vessel.
Code 92995 should be reported for an atherectomy (with or without PTCA) of a single vessel. If atherectomies are performed on more than one coronary artery, 92996 should be used to report the additional procedure.
If the cardiologist performs two atherectomies in the same vessel or within one of its branches, only 92995 should be billed. For example, if the cardiologist performs atherectomies on the distal and proximal portion of the left anterior descending artery, report 92995 only.
Similarly, because branch vessels are considered part of the major artery that they are associated with, a second atherectomy performed in a branch of a major artery that received an atherectomy should not be billed separately as well. For instance, if the cardiologist performs an atherectomy in the left anterior descending artery and another in diagonal side branch, bill 92995 only.
Most Medicare carriers recognize only three coronary arteries. These are identified by appending the following modifiers to the appropriate atherectomy code:
LD -- left anterior descending, or LAD;
LC -- left circumflex, or LCX; and
RC -- right coronary, or RCA.
Most carriers cover only one intervention per coronary artery, including its associated branches. If more than one procedure is done on an artery, list only the most complex procedure.
Coronary interventions are organized in a hierarchy that reflects the relative values of the three procedures, with stents at the top, atherectomies in the middle and PTCAs at the bottom:
92980 -- transcatheter [...]
