Cardiology Coding Alert

Question: We have a coronary intervention operative report indicating that the physician performed a percutaneous transluminal coronary angioplasty (PTCA) in the LIMA graft to the first diagonal and placed a stent in the proximal left circumflex coronary artery. He next performed a cutting balloon angioplasty in the left anterior descending coronary artery. Which codes should I report?

Ohio Subscriber

Answer: You should report CPT 92980-LC (Transcatheter placement of intracoronary stent[s] ...; single vessel; left circumflex) for the stenting in the left circumflex coronary artery and +92984-LD (... each additional vessel [list separately in addition to code for primary procedure]; left anterior descending) for the PTCA in the left anterior descending coronary artery.

Even though the physician treated three coronary lesions (PTCA to the left internal mammary bypass that feeds the first diagonal, stent to the left circumflex, and PTCA to the left anterior descending), you would report only the stent to the left circumflex (92980-LC) and the PTCA to the left anterior descending (92984-LD).

You should list coronary interventions as being performed in one of the recognized coronary arteries (left anterior descending, left circumflex or the right coronary). And, you can report only the most intensive intervention the physician performed in each of these three recognized vessels.

You should report the PTCA in the LIMA bypass to the first diagonal as an intervention in the left anterior descending coronary artery, because the first diagonal is a branch of this recognized coronary artery. Since the physician performed a more intensive procedure in the left circumflex (that is, placement of a stent), you would not report this PTCA separately.  

Report the cutting balloon angioplasty as a PTCA rather than an atherectomy. The definition of atherectomy is the removal of atherosclerotic material (such as plaque). A cutting balloon is a PTCA balloon outfitted with three tiny blades. When the physician inflates the balloon, the blades score the inside of the plaque ring creating three incisions. These incisions allow the physician to dilate the ring of hardened plaque with much less force than if he made no incisions.       

The only modifiers you would report are the anatomic modifiers, which indicate the coronary artery in which the physician performed the interventions. There are no professional or technical component modifiers for these coronary interventions.