Cardiology Coding Alert

Question: The cardiologists in our practice are using PercuSurge in the cath lab. I have heard this is similar to AngioJet. Should I use +92973 (Percutaneous transluminal coronary thrombectomy [list separately in addition to code for primary procedure]) for this service?

Nebraska Subscriber

Answer: There is no specific code that describes "distal embolic protection," the generic term for the service. Medtronic AVE, the Santa Rosa, Calif.-based manufacturer of the PercuSurge Guardwire Plus Temporary Occlusion and Aspiration System, recommends using 93799 (Unlisted cardiovascular service or procedure). Although nobody has suggested that 92973 should not be used, it may be inappropriate, particularly because PercuSurge does not always involve removing a thrombus.

The FDA approval applies only to the use of this system on saphenous vein coronary bypass grafts that require stenting (92980) or balloon angioplasty (92982). This does not mean that the service cannot be reported by cardiologists who use it when performing interventions on native coronary vessels.

As with most services reported with unlisted-procedure codes, PercuSurge coverage is determined by individual carriers. The service should be considered separate from the primary intervention by most carriers, but some cardiologists have reported that some consider PercuSurge performed with stents as inclusive.

The PercuSurge system involves several steps. First, the standard angioplasty guidewire is replaced by a special guidewire with a balloon at its distal tip that is inflated to temporarily occlude the vessel and provide distal protection from any particles that may break free. Next, the cardiologist uses the special guidewire to advance an angioplasty balloon and/or a stent to the lesion. Any embolic particles generated during the PTCA or stent placement remain suspended in the occluded vessel. Once the intervention is completed, an aspiration catheter is advanced, and any atherosclerotic particles or clots are aspirated.

The last step may be confused with percutaneous thrombectomy code 92973 because, in effect, that is what the PercuSurge system does when a thrombus is present. The service is performed more for prophylactic reasons than to remove a particular thrombus, which may be why 92973 is not recommended.

If the PercuSurge system is used for peripheral vessels, Medtronic recommends using 37799 (Unlisted procedure, vascular surgery).

Mitch Sugarman, reimbursement manager with Medtronic AVE in Santa Rosa, Calif., provided information for this answer.