Cardiology Coding Alert

When cardiologists perform multiple interventions, the number of coronary vessels being repaired, not the number or type of interventions, determines how the operative session should be coded. Furthermore, if a different intervention is performed on a separate vessel, the lower-valued intervention should be billed using an add-on, rather than a primary, procedure code.

The three types of coronary interventions (stent placement, percutaneous transluminal coronary angioplasty [PTCA], and atherectomy) are coded as follows:

CPT 92980 transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel;

CPT 92981 each additional vessel (list separately in addition to code for primary procedure);

CPT 92982 percutaneous transluminal coronary balloon angioplasty; single vessel;

CPT 92984 each additional vessel (list separately in addition to code for primary procedure);

92985 percutaneous transluminal acoronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel; and

CPT 92996 each additional vessel (list separately in addition to code for primary procedure).

Of the three interventions, stents are the highest-valued procedures, followed by atherectomies and, lastly, PTCAs.

Often, cardiologists must perform more than one intervention in different vessels. For example, a stent may be placed in the left anterior descending (LAD) artery and a PTCA performed in the right coronary (RCA) artery. In such cases, billing for two initial interventions (92980 and 92982) is incorrect, says Terry Fletcher, BS, CPC, CCS-P, an independent cardiology coding and reimbursement specialist in Laguna Niguel, Calif.

Only the initial vessel code for the stent (the highest-valued procedure) should be billed. The PTCA would be coded using 92984 (the PTCA add-on code for a second or third, etc., intervention on a different vessel).

An add-on code like 92984 isnt used only when the first procedure was a PTCA. Regardless of what the first intervention was, if the second intervention on a different vessel was a PTCA, 92984 should be used, Fletcher says. The same principle applies to a second stent or atherectomy performed on a separate vessel.

Modifiers Indicate Branches

To inform the carrier that the interventions are performed on separate vessels, modifiers that indicate which vessel receives the intervention should be attached to the appropriate code. In the example above, for instance, 92980 should be appended with modifier -LD to indicate that the stent was placed in the left anterior descending artery. Code 92984 should be appended with modifier -RC to let the carrier know that the PTCA was performed on the right coronary artery.

If three separate interventions are performed in the three coronary vessels designated by Medicare, only the first is coded with an initial vessel code. For example, if the cardiologist performs a PTCA in the LAD and an atherectomy in [...]