Cardiology Coding Alert

Question: How do you code an emergency PTCA with coronary stent? Can you code the PTCA separately from the stent and also for a left heart cath?

Linda Remala
Michigan City, Ind.

Answer: When a diagnostic cardiac catheterization and a therapeutic coronary artery procedure(s) are performed at the same session by the same physician, most Medicare carriers will reimburse the therapeutic procedure(s) at 100 percent of the Medicare-allowed charge and the diagnostic procedure at 50 percent, says Wanda Oplinger, CPC, a cardiology coding and reimbursement specialist in Belleville, Ill.

Oplinger recommends billing for the left heart catheterization with code 93510 (left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous), appending modifier -26 (professional component), and any appropriate injection codes.

Billing codes 93555 and 93556 when performing the cardiac catheterization at the same session as the PTCA and stent warrants appending modifier -59 (distinct procedural service) because these supervision and interpretation codes are bundled with 92984 (PTCA) and 92980 (stent).

When performing a stent and a PTCA in the same vessel, you may bill only for the more comprehensive procedure; in this case, the stent. You may bill only one treatment method per vessel. As in all cases, you will want to be sure you have documentation to support all of these services, Oplinger says.

Third-party payers may have a specific policy regarding the reporting of procedures combining diagnostic and therapeutic services. Call the carrier to review their policy.