Case Study:
Correct Modifiers Ensure Payment When Coding Rescue Stent
Published on Fri Dec 01, 2000
Our November issue featured a case study in which the cardiologist performed a left cardiac catheterization and a percutaneous coronary angioplasty (PTCA) and stent of the right coronary artery (RCA) (Case Study: Documentation is Key to Pay Up for Cardiology Procedures). Six hours later, however, the patient was rushed back into the cath lab for emergency angiography followed by rescue angioplasty and stenting of the RCA.
Because this was the patients second operative session on the same day and many of the same procedures were repeated, modifiers play a critical role in coding the session correctly. The correct coding for the angiography and/or catheterization is further complicated by the repeat nature of the session.
In such instances the clarity of the operative report is especially important. As in the report discussed last month, however, this months operative note lists procedures as performed that are not described in the note itself.
Unlike the first reports omission of the original PTCA and stent which the coder could infer from the rescue nature of the following procedure the discrepancy in this report arises because there is no evidence that one of the procedures listed was performed. To determine this, the skilled coder would have to read the cardiologists procedure notes thoroughly.
Operative Report
Date of Service: 8/17/2000, 4 p.m.
Procedures:
1. Emergency coronary angiography
2. Rescue angioplasty and stenting of distal right coronary artery occlusion
3. Right heart catheterization
4. Intracoronary nitroglycerine thrombolytic
Indications for the procedure:
Patient is status-post PTCA and stenting of right coronary artery a few hours previous. The patient complained of chest pain, and ST changes were noted on the electrocardiogram in the holding room. The patient was rushed back to the lab due to suggested collapse and closure of the stent site.
Procedure notes:
Patient was brought back to the cath lab. ... A #7 French JR-4 catheter was advanced and diagnostic right coronary angiography was taken, which showed complete occlusion distal to the stent into the right coronary artery due to spiral dissection, probably caused by edge dissection to the distal edge of the stent. Thereafter, I changed the diagnostic catheter to a #7 French guide catheter, and 100 mg of intracoronary nitro-glycerine was administered. I was able to access the area of occlusion with a Choice PT wire. Over the wire I advanced a 9-mm balloon, and a couple of 0 percent dilatations were performed. Then the balloon was deflated and angiograms were taken that showed restoration of antegrade flow. The dissection was more [...]
