Cardiology Coding Alert

Question: To code a particular vessel when the physician performs an angioplasty or stent in the left circumflex coronary, left anterior descending, or the right coronary, we append the corresponding modifiers (LC, LD and RC). How should we code and modify angioplasties and stents in the saphenous vein graft?


Minnesota Subscriber

Answer: You should code interventions in bypass vessels according to the recognized coronary artery with the distal anastomosis (the artery the bypass vessel is connected to).

Bypass vessels, such as the saphenous vein graft, are conduits through which blood "bypasses" an area of obstruction in a coronary artery. Most commonly, bypass grafts are proximally connected to the aortic arch and distally connected to a diseased coronary artery downstream from the obstruction. This bypass vessel will provide blood flow to heart muscle (myocardium) that has been deprived of blood flow due to the obstruction.
 
To select the correct code, you should identify which coronary artery the saphenous vein graft connects to and bill the intervention as being performed in that vessel. For example, if the physician performs an angioplasty in a saphenous vein graft to the right coronary artery, you would report this as an intervention to the right coronary artery.