Cardiology Coding Alert

Peripheral interventions in the renal arteries are justified only in one instance
Suppose your cardiologist intends to perform angioplasty or atherectomy, but the intervention fails and he places a stent. Should you report the stent code only, or should you include the angioplasty or atherectomy code as well? If you meet three simple criteria, you may be able to collect for each.According to Jim Collins, CCC, CPC-CARDIO, CHCC, president of CardiologyCoder.com in Saratoga Springs, N.Y., the physician's note must clearly illustrate each of these three items:1. The doctor's intention to perform angioplasty as a primary intervention. In other words, "this is the procedure that is planned to be the ultimate solution to address the lesion," Collins says.
2. The angioplasty as a failed procedure or that it produced a suboptimal result. Note: Payers define what is suboptimal differently. However, a "30-percent residual stenosis or a flow-limiting dissection are very common standards," Collins says.
3. The decision to proceed with the stent placement after the cardiologist identified the suboptimal angioplasty result.Keep in mind: The lesion must be of the type that is a viable candidate for primary angioplasty.
If you do not document each of these three factors, your payer will consider the angioplasty a predilatation of the lesion and the atherectomy a debulking of the lesion. In that case, both these services are not separately billable, Collins says.Angioplasty or Atherectomy Must Be Primary IntentionThe first hurdle your doctor's medical record must clear to bill multiple interventions of the same vessel in this fashion is to establish angioplasty (or atherectomy) as the physician's primary intention during the particular intervention. You will typically not be able to meet this criterion if the physician addresses lesions located at the origin of the renal arteries, industry experts say.Why: One reason for this is that clinical studies have shown that the majority of percutaneous transluminal angioplasties (PTA) that physicians perform in the ostium of the renal arteries fail due to the lesions' pronounced elasticity.Most interventional radiology coding experts agree that when physicians perform peripheral interventions in the renal arteries, the only time they are justified in performing primary stenting is when they treat orificial lesions (the most common lesions involving the renal arteries). If, before the physician even performs the procedure, he intends to stent for treatment of orificial lesions, you should report only the stent codes, not PTA."If a renal artery lesion (particularly one involving the renal artery ostium) is treated by angioplasty alone, re-stenosis is likely to occur," says Jackie Miller, RHIA, CPC, coding expert and senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. "Stenting significantly reduces the likelihood of reoccurrence." Therefore, your cardiologist may perform primary stenting."You should report stenting of the renal [...]