Cardiology Coding Alert

Question: What is the correct code for use of a cutting balloon? Some of our cardiologists believe it should be billed as an angioplasty, but others suggest atherectomy codes. Who is correct?

New York Subscriber

Answer: The cutting employs microsurgical blades, called atherotomies, bonded to the balloon surface. When the balloon is inflated at the site of the lesion, the blades expand and incise plaque from the blood vessel.

According to the AMA, the procedure is neither a coronary angioplasty nor an atherectomy (which involves plaque removal), but rather an angiotomy, and recommends billing 93799 (unlisted cardiovascular service or procedure).

Unlisted procedure codes must be backed by thorough documentation, as well as a written explanation of what was performed, says Sandy Fuller, CPC, a coder with Cardiology Consultants, a 13-physician practice in Abilene, Texas. She adds that she would charge more for this procedure than for a percutaneous transluminal coronary angioplasty (92982) but less than for an atherectomy (92995).

Because payers may follow different policies regarding this new procedure, cardiologists should check with their carriers prior to billing to determine if the service is covered and how it should be coded.