Cardiology Coding Alert

Reader Question:

Modifier -58 Indicates Stent is Staged Procedure

Question: A right and left catheter (93526), coronary angiography (93545), stent (92980) with angioplasty (92982) on the left anterior descending artery (LD) was done on a patient with CAD. Do I bill this as 93526-26; 93545; 93526-26-59; 92980-58-LD? Do I need modifier -58 on 92980, or can I code this procedure without any modifier besides the vessel modifier LD?

Cecilia Lindsey
Medical College of Virginia, VA

Answer: The use of modifier -58 (staged or related procedure or service by the same physician during the postoperative period) is correct because the diagnostic cardiac catheter procedure (93526-26, combined right heart catheterization and retrograde left heart catheterization; professional component) led to the interventional stenting (92980-58-LD, transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel), which by definition is a staged procedure. The key to coding this scenario correctly and obtaining reimbursement is that the cardiologist must document that the catheterization led to the stent.