Cardiology Coding Alert

Question: If my cardiologist does a left heart cath, and then intervenes with a stent placement, can I append modifier 59 to 92980 and bill with the left heart cath?

Missouri Subscriber

Answer: Appending modifier 59 (Distinct procedural service) to 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) is not the way to go in the situation you describe. Neither 92980 nor the catheterization codes (93501-93533) are subject to Correct Coding Initiative (CCI) edits when billed during the same session.

The only codes that would require modifier 59 (assuming you're billing a diagnostic cath with left ventricular [LV] or right ventricular [RV] gram and a therapeutic procedure) are 93555 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography) and/or 93556 (... pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]), if the injections these supervision and interpretation codes pertain to were part of the diagnostic catheterization and not just "guide shots" for stent placement.-

In a nutshell: If the cardiologist performed a left heart cath and stent on the same day, with LV gram and coronaries, you'll code this with:

• 92980

• 93510-26 -- Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous; professional component

• 93543 -- Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography

• 93545 -- ... for selective coronary angiography (injection of radiopaque material may be by hand)

• 93555-26-59

• 93556-26-59.

If the stent was placed on a different day, and the physician only cathed and shot (angio) the coronaries identifying where to place the stent, you cannot bill 93555 and 93556. This is what is meant by "guide shots."

-- You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition 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.