Cardiology Coding Alert

When reporting intracoronary brachytherapy codes, make sure you have documentation supporting the specific coronary artery catheterized, angioplasty details, and radiation procedure data, or you'll see rejected claims. Typically, interventional cardiologists perform intracoronary brachytherapy on patients with scar tissue in a coronary stent or saphenous vein graft, resulting in the renarrowing (restenosis) of the coronary artery.

During the procedure, the physician places a brachytherapy catheter across the lesion and delivers radioactive material within the artery to decrease the scar tissue causing the restenosis. Know Who Documents What Brachytherapy, which usually takes place in a hospital's heart catheterization lab, requires the expertise of an interventional cardiologist and a radiation oncologist. Consequently, the cardiologist's procedure notes should clearly indicate the service components he actually provided.

The interventional cardiologist's documentation normally describes the angioplasty or stent for the restenotic lesion and mentions the radiation procedure. The radiation oncologist prepares a detailed report of the radiation procedure and bills separately for the radiation portion. Even so, interventional cardiologists should include in their operative reports
a description of radioactive material inserted with specific information about the insertion site, and the "dwell time" or length of time the radioactive material remains in the artery. If the notes reference such details as the radiation dwell time, for instance, this helps confirm for carriers that the cardiologist actually performed the catheter radiation procedure, says Sheldrian Wayne, CPC, a cardiology coding specialist with Coding Strategies Inc. of Powder Springs, Ga. Pair Brachytherapy with Angioplasty Usually, cardiologists perform left heart catheterizations before brachytherapy to diagnose restenosis. When this occurs, report 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) for the left heart catheterization. If the physician performs a left heart catheterization with bypass graft angiography, report 93540 (Injection procedure during cardiac catheterization; for selective opacification of aortocoronary venous bypass grafts, one or more coronary arteries). Once the physician identifies the restenotic site, he will likely perform an angioplasty to reopen the site and then administer brachytherapy, says Happiness Miller, RN, an auditor with the cardiac catheterization lab in Central Baptist Hospital in Lexington, Ky. If this is the case, report 92982 (Percutaneous transluminal coronary balloon angioplasty [PTCA]; single vessel) for a single vessel PTCAand add +92984 ( each additional vessel [list separately in addition to code for primary procedure]) for each additional vessel. Next, add +92974 (Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy [list separately in addition to code for primary procedure]) for the brachytherapy. For instance, a 56-year-old male with a previously placed coronary stent comes in because of chest pain (786.50). The cardiologist first performs a left heart catheterization (93510) and detects restenosis in the stent. He [...]