Cardiology Coding Alert

Question: The cardiologist placed a stent in the LAD first diagonal through a venous graft. She also performed RCA angioplasty through another graft. How should I report this?

Utah Subscriber

Answer: You should report 92937 (Percutaneous transluminal revascularization of or through coronary artery bypass graft [internal mammary, free arterial, venous], any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel) twice to reflect the work through the different grafts.

Support: The March 2014 CPT^® Assistant indicates that because the cardiologist accessed a separate vein graft for the second intervention, reporting two base codes (92937 and 92937) is correct based on the guideline that “PCI performed during the same session in additional major coronary or in additional coronary artery bypass grafts should be reported using the applicable additional base code(s).”

In other words, because the LAD and RCA are two distinct vessels (one is not a branch of the other), you report two base codes for the two separate vessels. You should not report one base code and one additional branch code, such as +92938 (…each additional branch subtended by the bypass graft [List separately in addition to code for primary procedure]).

Modifiers: Depending on payer preference, you may append modifier 59 (Distinct procedural service) to the second code, or you may need only the anatomic modifiers LD (Left anterior descending coronary artery) and RC (Right coronary artery), appending LD to one code and RC to the other.