Cardiology Coding Alert

Identify the vessels involved before you make your coding decision.

CPT's parenthetical notes following 92980-+92981 (Transcatheter placement of an intracoronary stent[s] ...) offer rules for proper reporting that you can't afford to miss. The notes reveal the following key points on what is and isn't included.

Include These Same-Artery Services

CPT states that coronary angioplasty (92982-+92984, Percutaneous transluminal coronary balloon angioplasty ...) and/or atherectomy (92995-+92996, Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty ...) in the same artery as the stent placement is not separately reportable for the same encounter.

Separate Vessel Could Mean Separately Reportable

If your cardiologist performs stenting in one coronary vessel, and angioplasty or atherectomy procedures in a different coronary vessel, the angioplasty or atherectomy is not included in the stent code. So you may report those services separately.

Crucial: "When coding interventions on more than one coronary vessel during the same session, the first code should be for the highest level procedure performed on any vessel," says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder with St. Joseph Heart & Vascular Center in Tacoma, Wash.

The hierarchy is stenting before atherectomy before balloon angioplasty, she adds.

Example: For stenting in the right coronary artery (RCA) and an angioplasty in the left anterior descending (LAD), you should report:

• 92980-RC -- Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel; Right coronary artery
• +92984-LD -- Percutaneous transluminal coronary balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure); Left anterior descending coronary artery.

Bonus tip: Note that proper reporting for the above two-vessel example requires reporting the "single vessel" stent code 92980 with "additional vessel" angioplasty code +92984. Many coders mistakenly use "single vessel" code 92980 with "single vessel" code 92982 because the codes represent two different types of procedures. But CPT guides you to the proper codes by stating under the stent codes: "To report additional vessels treated by angioplasty or atherectomy only during the same session, see 92984, 92996." In addition, CPT Assistant (December 1996) indicates that 92980 with +92984 is proper coding for stent placement in one vessel and angioplasty in another.

Don't Miss Thrombectomy and Other Opportunities CPT lists multiple additional services that you may report separately if the cardiologist performs them in conjunction with stenting, atherectomy, or angioplasty.

Specifically, CPT lists:

• +92973 (Percutaneous transluminal coronary thrombectomy [List separately in addition to code for primary procedure]).
• +92974 (Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy [List separately in addition to code for primary procedure]). The service +92974 describes is fairly uncommon, so you may not see it often.
• +92978-+92979 (Intravascular ultrasound [coronary vessel or graft] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report ...). Note that if the cardiologist performs coronary IVUS for diagnostic purposes and not in conjunction with stenting, atherectomy, or angioplasty, you should report 93799 (Unlisted cardiovascular service or procedure). But each individual payer and proof of medical necessity will determine reimbursement.