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Cardiology Coding Alert

Reader Question:

Multiple Stent Placement

Published on Tue Jan 01, 2002

Question: The cardiologist placed one stent in the obtuse marginal vessel and one stent in the circumflex. As these are considered the same vessel, would it be prudent to add a modifier for prolonged service for payment under 92980? 

Florida Subscriber

Answer: The obtuse marginal vessel is a branch of the left circumflex. Any intervention that is performed in the left circumflex or any of its branches is considered a left circumflex intervention and should be reported as 92980 (transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) with modifier -LC (left circumflex, coronary artery) appended.
 
The American College of Cardiology states that when two or more interventions are performed in the same vessel or in any of its branches, only the highest-valued procedure may be billed. In this case, two stents were performed but only one may be billed. If the stent was placed in the left circumflex and a percutaneous transluminal coronary angioplasty (PTCA) was performed in the obtuse marginal branch, only the stent could be billed.
 
Although no modifier should be used when two interventions in the same vessel or any of its branches are performed, it may be possible to obtain reimbursement if three or more interventions are performed. In such cases, modifier -22 (unusual procedural services) should be appended to the intervention code.
 
As with all claims involving modifier -22, the patient's medical record must be submitted. In addition, a separate letter should explain in simple terms why the procedure was unusual (three or more lesions) and how much additional work and time were involved.
 
Modifier -21 (prolonged evaluation and management services) should not be used. This modifier (not recognized by many payers) is appropriately appended to E/M codes only.
 
Note: The "additional vessel" codes for stents (92981, transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; each additional vessel [list separately in addition to code for primary procedure]), PTCAs (92984, percutaneous transluminal coronary balloon angioplasty; each additional vessel [list separately in addition to code for primary procedure]) and atherectomies (92997, percutaneous transluminal pulmonary artery balloon angioplasty; single vessel) may be used only when the second intervention is performed in a different coronary vessel, i.e., the left anterior descending artery or the right coronary artery.

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