Cardiology Coding Alert

To avoid unbundling, be aware of what's contained in the intracoronary stent placement codes 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) and +92981 ( each additional vessel [list separately in addition to code for primary procedure]). A previously scheduled (AKA elective) stenting procedure includes the following components:

<UL><LI> the normal preoperative assessment and sedation

<UL><LI> obtaining vascular access

<UL><LI> placing various guidewires and catheters for use during the procedure

<UL><LI> angiography necessary to guide the procedure

<UL><LI> predilatation of the lesion (such as angioplasty)

<UL><LI> placement of the stent(s) in the targeted coronary vessel

<UL><LI> angiography to confirm the procedure's success

<UL><LI> withdrawal of all equipment, obtaining hemostasis and the normal post-operative course.<LI>

These codes do not include the diagnostic cardiac catheterization that prompted the cardiologist to decide an intervention was necessary. With urgent interventions, however, you may be able to receive reimbursement for the diagnostic procedure, depending on your circumstances.

For example, if angiography is part of a planned intervention, you would not report it (the catheter placement or the radiological supervision and interpretation). But if a cardiologist does the left heart catheterization and determines the patient needs an urgent intervention (which is often the case), you can report both and be paid for both, says Melissa Bedford, CPC, a coding specialist at Austin Heart PA in Texas.

When a diagnostic heart catheterization (93510-26, 93543, 93545, 93555-26 and 93556-26) reveals the need to proceed to the intervention, you can report it and get paid for both the diagnostic heart catheterization and the stent.

Just make sure to attach modifier 59 (Distinct procedural service) to the supervision and interpretation codes (93555, Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography; and 93556, ... pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]), says Heather Stecker, CPC, senior coding and financial analyst at Cardiology Consultants of Philadelphia PC.

Why? Modifier 59 tells the payer that 93555-93556 do not represent the angiographic services that the Correct Coding Initiative (CCI) includes in the stent placement service.

Example: If your cardiologist performs a left heart catheterization (93510, Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous), left ventriculogram (93543 and 93555-26) and coronary angiography (93545 and 93556-26) for diagnostic purposes, you can report these services. Attach modifier 59 to 93555 and 93556 to indicate that the S&I relates to the diagnostic heart catheterization and not to the stent placement.

If your cardiologist places one or more stents per vessel, you should report 92980 or 92981 only once. You will never use modifier 51 (Multiple procedures).

Key coronary arteries: When you're coding interventions, you'll likely use the modifiers for three Medicare-recognized coronary arteries:

• Modifier LC -- Left circumflex, or LCX

• Modifier RC -- Right coronary, or RCA.

Most carriers cover only one intervention per coronary artery (or vessel) -- including the associated branches.

Reason: The relative value units (RVU) for the angioplasty include multiple lesions in multiple branches. Therefore, you can properly code only one intervention for each of these three main arteries.

The only way you can bill for multiple coronary stents is if they are in different vessels. For example, if the cardiologist places a stent in the distal LAD and a stent in the mid RCA, you can report two coronary stents.

Rule of thumb: When your cardiologist performs multiple interventions, the number of coronary vessels he repairs -- not the type or the number of interventions -- determines how you should code this service, Bedford says. See the chart below: