Cardiology Coding Alert

While performing cardiac catheterizations or coronary interventions (i.e., angioplasty, stent and atherectomy), cardiologists must deal with the possibility of coronary thrombi blood clots in the coronary arteries that could cause a myocardial infarction (MI).

To minimize the chance of coronary blood clots, the cardiologist may inject the patient with one of several kinds of drugs. The method of delivery can vary, depending on whether the injection is preventive (to inhibit clot formation) or is administered to dissolve an existing clot.

Coding these services can be difficult, because thrombolysis may be bundled with other procedures that could be performed at the same time, such as left heart catheterizations and coronary interventions.

For example, if the cardiologist performs intracoronary thrombolysis during a cardiac catheterization or a percutaneous transluminal coronary angioplasty (PTCA), the thrombolysis is separately billable using 92975 (thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography), says Sueanne Bicknell, RRA, CPC, CCS-P, compliance administrator for CPR/Heart Place, an 80-physician practice in Dallas that includes 60 cardiologists and five electrophysiologists. The correct diagnosis to justify the thrombolysis is 411.81 (coronary occlusion without myocardial infarction).

If a stent (92980, transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) is inserted, however, 92975 cannot be coded because it is bundled with 92980 in the national Correct Coding Initiative (CCI).

Note: Code 92980 should not be used if the occlusion is the result of atherosclerosis without associated thrombus.

According to the American College of Cardiologys (ACCs) Guide to CPT, 92975 includes selective coronary angiography. Many coders have taken this to mean that if intracoronary thrombolysis is performed during a heart catheterization, the injection portion of the catheterization (for example, 93545, injection procedure during cardiac catheterization; for selective coronary angiography [injection of radiopaque material may be by hand]) would not be separately billable.

Bicknell disagrees: The diagnostic injection 93545 is performed to identify the blockage, which is then treated by thrombolysis (92975). Therefore, 92975 should be separately payable. She adds, however, that if the blockage had been diagnosed and identified during a previous catheterization or other procedure, 92975 should not be coded, because it is part of the procedure (i.e., the catheterization) being performed to correct or treat an already identified problem.

Intravenous or Intracoronary Injection?

Although some cardiologists continue to use intracoronary injections to deliver clot-dissolving medication to the site of the thrombus, other drugs may be injected intravenously, either as a preventive measure or because the medication is able to seek out the clot and therefore does not need to be targeted.

According to the ACC, however, intravenous coronary thrombolysis (92977) although a covered service for Medicare beneficiaries has been assigned zero physician work units [...]