Cardiology Coding Alert

Question: The patient has a diagnostic left heart cath, coronary angiogram, left ventriculogram and percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending (LAD) artery with stent and PTCA of the first diagonal. How should I code this?

California Subscriber

Answer: Because the first diagonal artery is a branch of the left anterior descending artery, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding educator and specialist in North Augusta, S.C., and because all three interventions (two PTCAs and one stent) were performed in the same arterial family, only the intervention with the most relative value units the stent can be billed. According to Callaway-Stradley, the session should be coded as follows:

92980-26 transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel-professional component;

93510-26 left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous-professional component;

93543 injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography;

93545 ... for selective coronary angiography (injection of radiopaque material may be by hand);

93555-26-59 imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography-professional component-distinct procedural services, and;

93556-26-59 ... pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits (whether native or used in bypass)-professional component-distinct procedural service.

Because stent procedures include supervision and interpretation (S&I), both 93555 and 93556 should be appended with modifier -59 to indicate the S&I is linked to the left heart cath, not the stent.

If the session took place in the hospital, modifier -26 should be attached to 93510, 93555 and 93556 to indicate that the cardiologist or his or her practice does not own the equipment used.