Cardiology Coding Alert

Question: What is CPT's logic in omitting 92995 (Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel)as a conjunction code for billing +92974(Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy [list separately in addition to code for primary procedure])? Wisconsin Subscriber Answer: The reason for the omission is that CMS has approved brachytherapy for treating in-stent restenosis, which is re-narrowing of the arteries following the placement of a stent during angioplasty. Most restenosis occurs because scar tissue forms in response to the injury created when the cardiologist implanted the stent. In some cases, the scar tissue recloses the artery, which means that the re-narrowed site is radiated using brachytherapy. This procedure involves concurrent percutaneous transluminal angioplasty (PTCA), and the code for this is 92982 (Percutaneous transluminal coronary balloon angioplasty; single vessel). You should include 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) because restenosis sometimes extends beyond the previously stented segment. Cardiac physicians generally would not use atherectomy in these situations.