Cardiology Coding Alert

For some extra help coding brachytherapy procedures, take a look at the following intracoronary brachytherapy coding guidelines adapted from the National Heritage Insurance Company (NHIC), a Medicare Part B carrier in four northeastern states, including Massachusetts.

Although you should consult your carriers for specific instructions, these pointers could come in handy if you're stuck or if you'd like to make suggestions for revisions to your state's guidelines. (For code descriptions, please see "Keep Tabs on Stent Injuries in Brachytherapy Coding to Avoid Denials" in page article 1.)

1. Use 92974 to describe the interventional cardiologist's role in placing a catheter for the brachytherapy.

2. Use 92980 to report stenting. Add 92981 to 92980 to indicate stenting in each additional vessel.

3. Report 92982 for percutaneous transluminal coronary balloon angioplasty (PTCA) in a single vessel. If the physician inserts a stent, you would not report the PTCAseparately.

4. Use code 92978 to report intravascular ultrasound, if necessary.

5. Codes 92974 and 92978 are add-on codes, and you should report them with 92980, 92981, 92982 and 92984.

6. Code 92979 is an add-on code for intravascular ultrasound on additional vessels. Report it with 92978, plus codes 92980 or 92982.

7. Code 92984 is an add-on code for PTCA, each additional vessel, and you should report it with 92980, 92982 and 92995. You may use 92984 with these codes only if the cardiologist performed a PTCAin an additional vessel and performed no other intervention in that vessel.

8. You should use HCPCS vessel modifiers to identify which artery the cardiologist treats for all of the interventional, ultrasound and brachytherapy codes listed above. The modifiers are -RC for right coronary artery, -LC for left circumflex coronary artery, and -LD for left anterior descending coronary artery

Note: For more information on NHIC's policies, see http://www.lmrp.net/lmrp/carrier/1/31143/intracoronary-brachytherapy.htm.