Cardiology Coding Alert

Question: Occasionally, we see the words "cutting balloon" used in our physician's cardiac cath notes. One of our coders thinks that this is referring to a directional atherectomy catheter that "scrapes plaque away from the inside of the coronary artery." Another coder read that it should be billed as a regular angioplasty. Which is proper coding for the procedure?

Michigan Subscriber

Answer: The first coder you mention is partially correct in that a directional atherectomy device scrapes away plaque from inside the artery. A cutting balloon and a directional atherectomy catheter, however, are two separate devices.

When buildup inside an artery hardens, it becomes difficult to reshape. This hardened material can be scraped away with a directional atherectomy or other device such as a rotoblade (a high-speed drill bit that chips away the plaque). Hardened plaque can also be reshaped with the use of a cutting balloon.

A cutting balloon is similar to a traditional angioplasty catheter tip, but it has the addition of razor-sharp edges that, when the balloon is expanded, pierce through the hardened plaque. This piercing action allows the balloon to dilate the artery farther than if the cardiologist used no cutting balloon. This procedure differs from atherectomy because the physician removes no actual plaque. It is just scored and reshaped.

A few carriers have published guidelines to report cutting-balloon procedures with the regular percutaneous transluminal coronary angioplasty (PTCA) codes 92982 and 92984 with the addition of modifier -22 (Unusual procedural services) to reflect that it was an unusual procedure.

Billing in this fashion, however, requires that you submit the claim on paper with a copy of the note. This could substantially prolong the amount of time necessary to receive reimbursement. In addition to the prolonged wait time for payment, many cardiologists see minimal, if any, additional reimbursement for 92982-22 when compared to 92982 without modifier -22 attached.

If your carrier has not indicated that modifier -22 is necessary, you should consider all of the factors and choose the coding path that is right for you. Many providers feel that a cutting balloon is not sufficiently different from a traditional balloon to justify billing for it differently.

Answers to You Be the Coder and Reader Questions were provided by Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups across the country.