Look for Clues When Coding Myocardial Infarction Interventions

Look for Clues When Coding Myocardial Infarction Interventions

Compliant reporting of myocardial infarction revascularization procedures is all in the timing.

Does your staff know the coding guidelines for interventions performed on a patient’s coronary artery during a myocardial infarction (MI)? Proper code selection requires very specific documentation. Coders need to know what to look for, and query if it isn’t there. Let’s see how you do.

Test Your Coding Skills

A patient presents to the emergency department (ED) with chest pain and is diagnosed with a non-ST-elevation myocardial infarction (NSTEMI). The patient later goes to the cardiac catheterization lab for a diagnostic coronary angiogram and possibly an intervention.

If the cardiologist inserts a stent in this situation, should you report CPT® code 92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel?

The CPT® descriptor holds the key: This is an intervention for an “acute total/subtotal occlusion during acute myocardial infarction.”

Typically, NSTEMI patients go from the ED to the intensive care unit (ICU) for stabilization before going to the cardiac cath lab. In these cases, the coder should not report 92941.

Is It Emergent?

An American College of Cardiology (ACC) guideline states that if a patient has an electrocardiogram (EKG) indicating an ST-elevation myocardial infarction (STEMI) and meets other STEMI criteria, the patient should go emergently to the cardiac cath lab for a cardiac angiogram and potential coronary artery intervention.

If a stent is inserted, you will report 92941 since the patient was sent directly to the cath lab while experiencing an acute MI.

Is It a STEMI or NSTEMI?

When coding from a cardiac cath report, the report may not specify whether the patient was sent directly to the cath lab or stabilized first. Clinicians should use the key terms “STEMI” and “NSTEMI” to alert the coder to check the ED records to see whether the patient came emergently to the cath lab for the procedure.

In most cases, STEMI patients go directly to the cath lab, and NSTEMI patients go to the ICU. It is not compliant coding to report 92941 when a stent is inserted after the patient stabilizes from the acute MI.

If the NSTEMI patient does not have a bypass or a chronic total occlusion, you will report the insertion of a coronary artery stent with CPT® code 92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch.

About Has 4 Posts

Karen D. Chappell, EJD, MBA, CHC, CCS, CIRCC, CPMM, LPN Ms. Chappell has 25 years of outpatient compliance audit experience, CDM maintenance review, and Revenue Integrity operations experience. She is a leading subject-matter expert in CMS and OIG regulations. Ms. Chappell is a coding education and curriculum writing consultant.

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