Cardiology Coding Alert

Reader Question:

Cath Now, PTCA/Stent Later

Question: If a cardiologist performs a left heart cath on the 25th of one month and comes back on the 11th of the next month and does a PTCA/stent, how do I bill for the later service? In addition to the 92980-LC (transcatheter placement of an intracoronary stent), should I code 36215 (selective catheter placement, arterial system) plus 76000 (fluoroscopy, separate procedure)?

CCA Subscriber

Answer: No, all you can bill for is the stent (92980). You cannot bill for any placement codes, such as 36215, since the stents RVU already includes this work.

Usually if a cath is done and then the cardiologist has to come back and do a PTCA, there is no need to repeat the angiogram; however, if, because of an extended time frame, the cardiologist needs to repeat it, he or she should be paid, says Sueanne Bicknell, RRA, CCS-P, reimbursement and compliance specialist at Cardiovascular Provider Resources-Heart Place in Dallas, TX. In that case, append modifiers -59 (distinct procedural service) and -26 (professional component) to 93555 or 93556.

You cannot charge for the fluoroscopy because it is included in the PTCA and you cant charge for a PTCA because as soon as the stent is placed (92980) you lose the right to bill for the PTCA.

Modifiers -58 (related procedure or service by same physician during the postoperative period) or -78 (return to the operating room for a related procedure during the postoperative period) should not be appended to the cath because they were designed to tell payers that a procedure was performed outside the global period and as such be reimbursed. The global period for a cath is 0 days.

This situation is similar to a stent that follows an angioplasty: The RVU of the stent (34.50) also includes the work of a PTCA (25.04); therefore, 92982 becomes a 92980 when a PTCA is followed by a stent.

However, if the cardiologist had performed a diagnostic cath that was immediately followed by a PTCA/stent, the American College Cardiologys coding convention says you can bill for the cath as well. (Medicare will pay for the stent at 100 percent and for the cath at 50 percent.) Check with your payers for how to combine diagnostic procedures followed by therapeutic ones. For example, youll need to append modifier -51 (multiple procedures) on the diagnostic cath.