Cardiology Coding Alert

Question: Our cardiologists would like to use brachytherapy in association with heart catheters to try to prevent restenosis of stents. Will Medicare pay for this procedure? How should it be coded?

California Subscriber

Answer: Coronary brachytherapy is intended to treat in-stent restenosis, which causes coronary stents to become clogged with new tissue growth or with scar tissue that has formed after stent placement, says Diane Elvidge, CPC, senior reimbursement specialist with Princeton Reimbursement Group in Minneapolis.

The procedure should be billed with 93799 (unlisted cardiovascular service or procedure) and the same diagnosis code used for the primary intervention. Unfortunately, most local Medicare carriers dont cover this relatively new service. For example, the local medical review policy for Empire Medicare Services, the local Medicare carrier for New Jersey and 16 counties in southeastern New York state, specifies, A claim for coronary brachytherapy for restenosis will be denied as investigational.