Cardiology Coding Alert

Question: Per CPT® the LAD includes the diagonals as branches. Can you bill separately for the S1 as a branch of the LAD for non-Medicare coronary intervention patients? 

Ohio Subscriber

Answer: Any payer who follows CPT® guidelines will not count the S1, or septal branch, as a reportable branch of the left anterior descending (LAD) artery. If the intervention takes place in only the S1, you should report it as occurring in the LAD. If interventions take place in both the LAD and the S1, you should report a single intervention. 

For instance, regardless of whether the patient had angioplasty in the LAD or in both the LAD and S1, you should report 92920-LD (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch; Left anterior descending coronary artery).

As you mentioned, you could report a service in one of the diagonals separately. So for angioplasty in the LAD and one diagonal, you should report 92920 and +92921 (… each additional branch of a major coronary artery [List separately in addition to code for primary procedure]) with LD appended.

Remember: Medicare bundles payment for +92921 into the primary procedure. Experts advise you to report the code to show the physician performed the service even if you don’t expect payment.