Cardiology Coding Alert

Question: The cardiologist attempted 92928 (PCI) twice using a balloon catheter on the left descending artery, but the patient started experiencing hypertensive crisis, so the cardiologist had to discontinue the procedure to protect the patient’s wellbeing. Since the provider attempted the procedure but it was unsuccessful, can I still code for the attempt?

Pennsylvania Subscriber

Answer: Yes. You can code according to what the physician attempted before discontinuing the procedure by appending modifier 53 (Discontinued procedure). You would append modifier 74 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia) for a facility.

You would report 92920-53-LD (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch) (Left anterior descending coronary artery) since a “balloon catheter” was inserted into the body. If a stent was inserted into the body, then you would report 92928-53-LD (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch).

Remember: When a combination code is intended, only code what the physician provides even if the final coding results with an individual component procedure code of the intended combination code. This guidance does not include intervention procedures attempted on a bypass graft, acute myocardial infarction (AMI) artery, or planned chronic total occlusion (CTO) artery.

You can report codes 92937 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel) through +92944 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure)) or C9602 (Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch) through C9608 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)) in facilities for a single technique or a combination of techniques.

Codes 92937 through 92944 and C9602 through C9608 include coronary angioplasty, atherectomy and/or stent placement to achieve revascularization.

Don’t miss: You would append modifier 53 (Discontinued procedure) to indicate that discontinuing the 92920 was necessary to protect the patient’s health.

“Due to extenuating circumstances or those that threaten the wellbeing of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued,” according to Appendix A in the CPT^® manual. “This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure.”

Always submit documentation: Submitting modifier 53 alone does not provide the payer with enough information to know how to correctly reimburse the provider. So, make sure you submit the supporting documentation for appending modifier 53. The documentation must state that the physician actually started the procedure, why it was medically necessary for him to discontinue the procedure, and what percentage of the procedure he did perform.