Cardiology Coding Alert

Question: What modifiers (if any) allow payment for both an angioplasty and stent performed on the same artery during the same session?

California cardiologist

Answer: Unfortunately, there are none. Although the cardiologist may perform more than one intervention during a single operation, Medicare will only pay for one intervention -- the most complex one -- per coronary artery system. Therefore, adding a modifier would not be appropriate.

For example, Medicare recognizes only the most technically complex intervention, using the following hierarchy: Angioplasty ranks as the least complex procedure, followed by atherectomy, and finally stent placement. Therefore, in your example, you can only use the appropriate single vessel code because stent placement is the most complete intervention.

For coding purposes, only three major coronary systems exist: the right coronary artery (RCA), the left anterior descending (LAD) and the circumflex. Even if the cardiologist defines the intermediate or ramus branch as a major branch arising separately from the aorta, Medicare considers this to replace either the LAD or the circumflex system. Therefore, it will pay for no more than three interventions (on three separate systems) per session.