Wiki 92941 vs 92943

[jessica1974]

I am confused as to which code would be the best when a pt has a NSTEMI and it's discovered that they have a 100% blockage. Which is the correct CPT code to use?

Pt has non-st elevation myocardial infarct is the reason the intervention is done. Then the physician states angiogram confirms a total occlusion of the RCA. Thrombectomy is performed and a total of 3 stents were place in the RCA.

I usually look to see if a thrombectomy was done and to see if the verbage says 100% occlusion or chronic total occlusion. If that exact wording isn't used then I chose the MI CPT code.

Would anyone agree or disagree that this correct? Sometimes I over anaylize. Thanks

 

[econnolly]

Hi Jessica,
To apply the correct CPT code you should refer to the description of the consistency of the total occlusion in your procedure report.
In this case, you have a 100% occlusion, but the blockage is Acute (new), due to thrombus (hence thrombectomy performed), with a diagnosis of NSTEMI. However in order to apply CPT code 92941, you must have clear documentation that this is an ACUTE MI which required an emergent procedure (92941).
If the 100% occlusion was described as Chronic, it is an established lesion/blockage (often calcified) that has occurred over a period of time. In this scenario you would code 92943 for a "Chronic Total Occlusion".
**Medicare is now down-coding CPT code 92941, with a diagnosis of NSTEMI , to 92928 or 92920. See CPT Assistant, January 2014 for additional information.

I hope this information is helpful.
Elizabeth

 

[jessica1974]

Thank you Elizabeth. I guess I am still a little confused. So if the MI isn't ACUTE but they have a 100% blockage do you refer back to code 92928? I would think because you did a thrombectomy (even though it is a nstemi) that would qualify for the 92941. I understand the 92943 is used when the blockage is 100% and no flow is established. Am I understanding this correctly?