Cardiology Coding Alert

Question: We have recently added cardiology services to our facility, and no one seems to know if we are billing correctly to Medicare and the commercial payers. Do we submit both 92928 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch) and C9600 (Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch) to both Medicare and commercial payers? My interpretation is that we bill both codes to Medicare but would only bill 92928 to the commercial. Another opinion is to bill only C9600 to Medicare and leave off 92928. However, I have a remit where Medicare paid on 92928, and C9600 wasn’t even submitted, which is also incorrect.

Wisconsin Subscriber

Answer: For Medicare, and payers that accept the Medicare codes, your facility should use C9600 for drug-eluting stents and 92928 for other coronary artery stents. The two procedures are mutually exclusive and bundled, so you would not use both unless your documentation supports the use of a modifier to unbundle them.