Cardiology Coding Alert

Have you mastered when to report a diagnostic cath?

Coding for coronary stents can be a minefield, where you have to watch out for varying rules depending on the circumstances of the procedure, the use of multiple stents, and more. Conquer your next stent report by applying these tips.

Conquer the Physician vs. Facility Code Question

The following codes describe percutaneous placement of intracoronary stents:

In addition, according to CPT Assistant (August 2000), 92980 "includes the introduction, positioning, and any repositioning of the catheter within the vessel. Any injection of dye and related imaging to determine the catheter/balloon/stent placement and post-procedural effectiveness are also included and should not be coded separately."

Facilities: Remember that facilities reporting to payers that accept G codes should code based on the type of stent(s) administered. For a bare metal stent(s), facilities should report 92980 for the first vessel. In contrast, for a drug eluting stent(s), the facility should report G0290 (Transcatheter placement of a drug eluting intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel). For each additional vessel, facilities use +92981 for a bare metal stent(s) and G0291 (... each additional vessel) for drug eluting stent(s).

And experts advise that if the physician administers both bare metal and drug eluting stents in the same vessel, the facility should report the appropriate G code rather than 92980 or +92981.

Capture Chances to Report Diagnostic Cath

You may see stent procedures performed under different circumstances. In many cases -- perhaps the majority of cases -- the cardiologist will perform a diagnostic heart catheterization, determine the patient requires a stent, and provide the stent immediately.

In other cases, the cardiologist may perform the diagnostic service on one date and perform the therapeutic procedure on another date. You may see this staging occur "if there is concern over dye overload, equipment unavailability, patient instability, or the need to evaluate the course of the next treatment with a surgeon or other interventionalist," explains Anne C. Karl, RHIA, CCS-P, CPC, CCC, coding and compliance specialist with St. Paul Heart Clinic in Minnesota.

Key point: When a diagnostic service reveals the need for the intervention and the cardiologist performs the stent procedure immediately, you may report both the diagnostic service and the therapeutic procedure. Or if the patient had a previous diagnostic exam and new indications occur prior to the staged procedure requiring a new diagnostic, you may report both the diagnostic and interventional procedures.

In contrast, if the patient had the diagnostic service on a previous date and returns for the stent procedure at a later date without the need for an additional diagnostic, you should not report catheter placement or imaging supervision/interpretation on the stent procedure date. Remember that 92980 includes catheter introduction and placement as well as any imaging required for the stent placement.

In other words: Only report the diagnostic service codes if the services are truly diagnostic.

Example: The cardiologist performs the following diagnostic services:

Based on the above services, the cardiologist determines the patient requires a stent (92980), and performs the procedure immediately. You may report the diagnostic services in addition to 92980 when coding for the physician (remember, facilities would report G0290 for this single vessel stent service).

Modifier must: The Correct Coding Initiative edits bundle 93555 and 93556 into 92980, so for any payers who apply these edits, you will also need to append modifier 59 (Distinct procedural service) to the imaging codes to indicate that they relate to the diagnostic heart catheterization and not to the stent placement. Some payers also may request modifier 51 (Multiple procedures) appended to the diagnostic procedure (left heart catheterization, 93510-26). This modifier will identify multiple services were provided at the same session by the same physician.

Stay tuned: Next month, continue your stent coding education with crucial information about the artery-identifying modifiers required for your stent claims.