Cardiology Coding Alert

Question: The cardiologist placed one stent in the obtuse marginal vessel and one stent in the circumflex. Because these are considered the same vessel, should I append a modifier for prolonged service when billing 92980?

Ohio Subscriber

Answer: The obtuse marginal vessel is a branch of the left circumflex. Any intervention the cardiologist performs in the left circumflex or any of its branches is considered a left circumflex intervention. You should report this service with 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) and append the anatomic modifier -LC (Left circumflex, coronary artery) to indicate the specific procedure location.
 
Indeed, the American College of Cardiology states that when the cardiologist performs two or more interventions in the same vessel or in any of its branches, you can bill only the highest-valued procedure. In this case, the physician placed two stents but you may bill only one. If the cardiologist placed the stent in the left circumflex and performed a percutaneous transluminal coronary angioplasty (PTCA) in the obtuse marginal branch, you would report just the stent.
 
Be aware that you can report 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) only when the cardiologist performs the second intervention in a different coronary vessel, such as the left anterior descending artery or the right coronary artery.
 
Even though you cannot use a modifier when the physician performs two interventions in the same vessel or any of its branches, you could be paid extra if the physician performs three or more interventions. In such cases, you could append modifier -22 (Unusual procedural services) to the intervention code.
 
As with all claims involving modifier -22, you must submit the patient's medical record to the payer. You should write a separate letter to explain in simple terms why the procedure was unusual (three or more lesions) and how much additional work and time were involved. This will generate an additional administrative burden and will tie up reimbursement for much longer than if you submit the claim without modifier -22. 

 - You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.