Cardiology Coding Alert

You must meet certain conditions to bill angioplasty and stent placement of same lesion Suppose your cardiologist intends to perform angioplasty or atherectomy, but the intervention fails and he places a stent. Should you report the stent code only, or should you include the angioplasty or atherectomy code as well? If you meet three simple criteria, you may be able to collect for each. According to Jim Collins, ACS-CA, CHCC, CPC, president of Compliant MD Inc. in Matthews, N.C., the physician's note must clearly illustrate each of these three criteria:

1. the doctor's intention to perform angioplasty as a primary intervention
2. failed/suboptimal results from the angioplasty (based on your carrier's definition of "failed")
3. Subsequent stent deployment. If you do not document each of these three factors, angioplasty would be considered predilatation of the lesion, and atherectomy would be considered debulking of the lesion and not separately billable, Collins says. Angioplasty or Atherectomy Must Be Primary Intention The first hurdle your doctor's medical record must clear to bill multiple interventions of the same vessel in this fashion is to establish angioplasty (or atherectomy) as the physician's primary intention during the particular intervention. You will typically not be able to meet this criterion if the physician addresses lesions located at the origin of the renal arteries, industry experts say. One reason for this is that clinical studies have shown that the majority of percutaneous transluminal angioplasties (PTA) that physicians perform in the ostium of the renal arteries fail due to the lesions'pronounced elasticity. Most interventional radiology coding experts agree that when physicians perform peripheral interventions in the renal arteries, the only time when they are justified in performing primary stenting is when they treat orificial lesions (the most common lesions involving the renal arteries). If, before the physician even performs the procedure, he intends to stent for treatment of orificial lesions, you should report only the stent codes, not PTA.

"If a renal artery lesion (particularly one involving the renal artery ostium) is treated by angioplasty alone, re-stenosis is likely to occur," says Jackie Miller, RHIA, CPC, senior consultant for Coding Strategies Inc. in Powder Springs, Ga. "Stenting significantly reduces the likelihood of reoccurrence." Therefore, your cardiologist may perform primary stenting.

"You should report stenting of the renal artery with codes 37205 (Transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel) and 75960 (Transcatheter introduction of intravascular stent[s], [non-coronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel)," Miller says. Because the cardiologist knows from the start that he will be stenting for treatment of orificial lesions, you should report only these codes. "Make sure to also report the appropriate code(s) for any preceding diagnostic study as [...]