Cardiology Coding Alert

Question: Do I need to use a coronary vessel modifier for angioplasties and stents in the saphenous vein graft? For instance, the documentation shows: “… catheter was used to engage the saphenous vein graft to the ramus … Dilatation of the stenosis was obtained … balloon was inflated …”

New York Subscriber

Answer: If the payer allows or requires use of a coronary modifier on percutaneous coronary intervention codes, it is appropriate to report an anatomic modifier on a graft code like 92937 (Percutaneous transluminal revascularization of or through coronary artery bypass graft [internal mammary, free arterial, venous], any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel).

Example: Part B MAC National Government Services’ local coverage determination L28395 states, “Claims for percutaneous coronary intervention must include the appropriate modifiers to identify which vessel is undergoing a specific procedure. The modifiers are RC: right coronary artery, LC: left circumflex coronary artery, LD: left anterior descending coronary artery, LM: left main coronary artery, and RI: ramus intermedius.”

You should code interventions in bypass vessels according to the coronary artery the bypass vessel connects to. In your case, you would append modifier RI because the documentation states, “saphenous vein graft to the ramus.”

Bypass vessels, such as the saphenous vein graft, are conduits through which blood “bypasses” an area of obstruction in a coronary artery. A surgeon connects the bypass graft proximally to the aortic arch and distally to a diseased coronary artery, downstream from the obstruction. The intent of the bypass vessel is to provide blood flow to heart muscle (myocardium) that the coronary artery obstruction has deprived of blood flow.