Cardiology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our cardiologist performed a percutaneous transluminal coronary angioplasty (PTCA) with adjunctive stents in the right coronary artery and the left anterior descending artery. Are radiologic supervision and interpretation (S&I) codes 93555 and 93556 bundled with the stents? Should coronary artery modifiers be used for stent placements, or are these modifiers for hospital use only? How should this session be coded? Michigan Subscriber

Answer: Use modifiers -RC (Right coronary artery), -LD (Left anterior descending coronary artery) and -LC (Left circumflex, coronary artery) to report any intervention. Although these Level II HCPCS modifiers are listed in CPT with instructions to hospitals that they should be used with the following codes, these instructions do not mean that only hospitals should use these codes:
92980 Transcatheter placement of an intracoronary stent(s),percutaneous, with or without other therapeutic intervention, anymethod; single vessel
+92981 ... each additional vessel (list separately in addition to code for primary procedure)
92982 Percutaneous transluminal coronary balloon angioplasty; single vessel
+92984 ... each additional vessel (list separately in addition to code for primary procedure)
92995 Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel
+92996 ... each additional vessel (list separately in addition to code for primary procedure). If no diagnostic procedure preceded the stent placement, no S&I code (93555-93556) should be billed because injection and S&I procedures are included in the stent.

If left heart catheterization (93510) or coronary angiography (93508) was performed for diagnostic purposes and is appropriately billed, 93555 and/or 93556 may be reported, but modifier -59 (Distinct procedural service) should be appended to the code that is billed to indicate that the S&I is connected to the heart catheterization and not to the stent. Because there is no mention of diagnostic angiography or left heart catheterization in this case, the session should be billed 92980-RC and 92981-LD. The PTCA is included in the stent procedure and should not be billed separately. Remember that when two coronary artery modifiers are arbitrarily assigned primary and secondary stents, switching the location of the modifiers does not affect payment, because both claims are correct.