Cardiology Coding Alert

Question: Is there a modifier I can use to report both angioplasty and stent placement in the same coronary artery at the same session?

Oregon Subscriber

Answer: No, there is no modifier that allows you to report more than one intervention in a single coronary vessel. CPT® designed the codes so that you need only a single code per vessel.

Example: Note how 92933 (Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch) covers atherectomy and stent placement as well as any angioplasty performed within a single artery.

To report services in a different artery, you should use the appropriate add-on code, such as +92934 (Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery [List separately in addition to code for primary procedure]).

Remember: CPT® now recognizes five major arteries, and you have a different modifier for each:

• LD, Left anterior descending coronary artery
• LC, Left circumflex coronary artery
• RC, Right coronary artery
• LM, Left main coronary artery
  
• RI, Ramus intermedius coronary artery.

CPT® also recognizes branches of three of these vessels for reporting purposes. The LD branches are the diagonals. The LC branches are called marginals. The RC branches are the posterolaterals and posterior descending. Note that a minority of patients are left dominant, and for them the posterior descending is an LC branch.

In other words: Use add-on codes (such as +92934) for each additional branch of a major coronary artery only when the branch is from one of these three major arteries: LD, LC, and RC.