INDICATION: Angina pectoris, coronary artery disease
HPI: pt 64 history of coronary disease, hypertension, dyslipidemia, previous stenting to LAD, circumflex and right coronary artery 4/11, presenting w/escalating angina and highrisk stress test. Pt had diagnostic angiography earlier in the day for which he was determined to have 99% in-stent restenosis of the ostium of his LAD as well as high grade disease in it's proximal LAD and intermediate disease in his ostium of the CIRC. Coronary artery bypass grafting was recommended. The patient was taken off the table and brought to the holding area for futher discussion. After a long discussion with thepatient and his wife, it was determined that he elected to proceed with a percutaneous approach. Risks, benefits were explained and full detail as far as benefits of bypass surgery of the left main versus balloon angioplasty and stenting and the pt elected to proceed with percutaneous intervention.
PROCEDURE: An 8 French system was placed using modified seldinger technique, and an EBU 3.5 guide catheter was used to intubate the left main coronary artery.
INTERVENTION: Angiomax was used for effective anticoagulation & a runthrough wire was placed to the distal circumflex. A second runthrough wire was placed across the 99% diffuse type C lesion in the LAD. A 2.5 balloon was used to predilate the ostial lesion with sequential inflations. This was done in a simultaneous fasion with 3.0x15 balloon in the ostium of the circumflex. It was determined that there was a significant lesion within the previously placed bare-metal stent in 2002 in the proximal LAD and a 3.0x18 Endeavor drug-eluting stent was then deployed across the 70% stenosis seen in the proximal LAD. Next, a 3.0x24 Endeavor stent was deployed across the ostial lesion and was deployed with sequential inflation with circumflex balloon at the same ostial region. Next a 3.5x15 noncompliant balloon was used to postdilate the lesion in the proximal LAD, and then subsequently in the ostium of the LAD in tandem with the deployment of the 3.0 balloon at the ostium of the circumflex. With sequential balloon inflation, TIMI-III flow was established with an excellent angiographic result.
SUMMARY: Successful percutaneous intervention of the distal left main and ostial LAD and circumflex disease as well as proximal LAD with placement of sequential Endeavor drug-eluding stents as well as balloon angioplasty of the ostium of the left circumflex.
Now I billed it as
92980
92982 and the 92982 was denied as redundent. The insurance this pt has you do not put the LD and such on as modifiers. I usually send in the procedure report with the claim. s
So can this be billed seperatly and if so do I need a 59 on the 92982? Thanks