Use Noted 3 for Interventions In Other Coronaries
Published on Mon Mar 22, 2004
Let carrier LCDs steer you in the right direction
When your cardiologist performs interventions in certain coronary conduits, such as saphenous vein bypass grafts, mammary conduits or arterial conduits, report the procedures as taking place in one of the three recognized coronary arteries. You should also append the appropriate HCPCS anatomic modifier (-LC, -LD and -RC) to the procedure code to avoid denials.
The problem: HCPCS provides unique modifiers to report procedures in the three main arteries (left circumflex, left anterior descending, and right coronary) but not for interventions in "other" coronary conduits, such as saphenous vein grafts.
The solution: CMS, carriers and specialty societies have issued guidance on these common procedural scenarios, coding experts say.
Best strategy: Before you report "other" coronary conduit procedures, make sure the note is complete. Specifically, the physician's documentation should include a description of the coronary anatomy and any major anatomic variants, says Cynthia Swanson, RN, CPC, a cardiology coding specialist with Seim, Johnson, Sestak and Quist LLP in Omaha, Neb.
To bill these procedures correctly, Swanson advises that coders check the procedure note for the following:
The highest-level procedure the physician performed in each major coronary artery and/or its branches should be clearly identifiable.
The cardiologist must identify the anatomic variant for interventions in other coronary arteries and the rationale for considering that vessel as a major vessel equivalent. For instance, a physician may treat a stenosis in a large diagonal branch of a diminutive left anterior descending artery.
Documentation must clearly identify the number of ostia the cardiologist cannulated at the approach to each lesion.
You should ensure that your practitioners are informed of the carrier local coverage determinations (LCDs) and provide ongoing education and feedback when medical record documentation is lacking, Swanson says. Carriers Emphasize Parent Vessels Take a look at the following lesser coronary categories and the sampling of Medicare carrier guidelines to help you report interventions in these "other" coronaries:
Downstream branches: Noridian Medicare, the provider for a number of Western states, including Arizona, Colorado and Nevada, says that "branch vessels are considered a part of and included with intervention in the named parent vessel."
Therefore, when the report says "PTCA to the first septal perforator," you should identify which of the three recognized coronary arteries the first septal perforator branches from. In this case, the first septal perforator is a branch of the left anterior descending artery. For this procedure, you would report 92982-LD (Percutaneous transluminal coronary balloon angioplasty; single vessel; left anterior descending coronary artery), if this was the only intervention the physician performed during the procedure.
Tip: If your physician does not identify which coronary artery the vessel branches from, you may need to research the branch on-line or in [...]
