Cardiology Coding Alert

Question: How should we code for an intervention in the ramus intermedius?

Kansas Subscriber  
Answer: Most Medicare carriers recognize only three coronary vessels, although some may recognize four, including the left main coronary artery, which branches off into the left anterior descending (LAD) and the left circumflex (LCX) arteries. A few carriers even recognize the ramus intermedius artery, another branch of the left main that is separate from the LAD and LCX, as a fifth coronary vessel.
 
For most carriers, interventions involving the ramus intermedius should be coded as procedures in either the LAD or LCX, according to the American College of Cardiologys Guide to CPT, which also states that if one lesion is treated in the ramus intermedius and a second intervention is performed in either the LAD or LCX, the ramus intermedius should be coded as the other vessel. In such cases, ACC recommends cardiologists submit comprehensive documentation regarding the procedure to maximize the chance of obtaining appropriate reimbursement.
 
For example, if the cardiologist performs two percutaneous transluminal coronary angioplasties, one in the LAD and one in the ramus intermedius, the procedures should be coded as follows:
 
92982-LD percutaneous transluminal coronary balloon angioplasty, initial vessel; LAD.
 
92984-LC each additional vessel; LCX.
 
Note: Some local Medicare carriers recognize the left main and ramus intermedius arteries and have their own modifiers to indicate that interventions have been performed on these vessels.