Cardiology Coding Alert

Question: If the cardiologist uses retrograde access, such as advancing a wire through the left anterior descending to stent the right coronary, to treat a chronic total occlusion, is there a specific code to use?

Illinois Subscriber

Answer: There is no code specific to a retrograde approach, so you should use 92943 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel).

If the procedure takes considerably more time and effort than usual, you can consider appending modifier 22 (Increased procedural services) and submitting documentation to support additional reimbursement. But keep in mind that reimbursement for the code already takes into account a wide range of possible scenarios, so you want to be sure documentation provides strong support for work outside the norm before you ask for extra compensation.

Tip: The December 2014 issue of CPT^® Assistant defined coronary chronic total occlusion (CTO) as being “present when there is no antegrade flow through the true lumen, accompanied by suggestive angiographic and clinical criteria (i.e., antegrade bridging collaterals present, calcification at the occlusion site, no current presentation with ST elevation or Q-wave acute myocardial infarction attributable to the occluded target lesion).”

But watch out: “Current presentation with ST elevation or Q-wave acute myocardial infarction attributable to the occluded target lesion, subtotal occlusion, and occlusion with dye staining at the site consistent with fresh thrombus are not considered chronic total occlusion,” the article states.