Cardiology Coding Alert

Question: When my physician performs an angioplasty to LAD and a stent to RCA how should I correctly bill this? Our HCFA carrier told us via telephone to use 92982 for the angioplasty (LAD), while the American College of Cardiology (ACC) says 92984. Both groups say use 92980 for the stent (RC).

Nicole Branstetter
Certified Medical Assistant
Montana Heart Institute

Answer: Heres an example of a common coding dilemma. The coder worries that, although she has verbally received the carriers go-ahead for billing at the higher rate (using both codes - 92982 and 92980), she may be setting herself up for future audits.

What should she do?

Our sources advise playing it safe and going with the ACCs recommendation. Their rationale is as follows: You cant do a stent without doing an angioplasty, so the RCA is considered your first vessel and should be coded 92980. The angioplasty performed on the additional vessel (LAD) would be coded 92984.

TIP: A written coding policy is always preferable to verbal instructions -- especially when youre receiving conflicting opinions. Ask the carrier representative who is giving you the information to direct you to their state policy, either in the carriers newsletter or on the Web. Youll also want to check national HCFA policy as well, since it can override state regulations. At the very least, make a note of the representatives response, along with his or her name and title, and the date and time you spoke. And for some added protection, try and get something in writing from the carrier.