Cardiology Coding Alert

You Be the Coder:

Brachytherapy After Angioplasty

Published on Thu May 01, 2003

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: How should we code the following brachytherapy procedure: The physician performed angiography on the left anterior descending artery. The two stents noted in the proximal and mid vessel were found to be widely patent. Angiography of the right coronary artery disclosed 90 percent in-stent restenosis of the distal right coronary artery.

His attempt to insert a cutting balloon was not successful. The balloon would not cross the lesion, and a Maverick balloon was inflated twice and removed. The Barath cutting balloon was then reinserted and positioned to the stenosed area. He inflated the balloon at 1 atmosphere every 15 seconds for a total of 14 atmospheres and then deflated in a similar fashion. He performed two more inflations in this same manner and then removed the cutting balloon. Angiography showed the lesion completely reduced.

With the assistance of the radiation oncologist, the cardiologist inserted the beta seeds into the catheter for a total dwell time of 3 minutes and 10 seconds. He performed periodic fluoroscopy during the dwell time to ensure catheter placement.

Georgia Subscriber

Answer: This coding scenario describes three separate procedures: the catheter placement in the coronary arteries; the injection procedure for selective coronary angiography; and the imaging supervision, interpretation and reporting for injection procedures during selective coronary angiography.

You should code these procedures respectively as 93508-26, 93545 (Injection procedure during cardiac catheterization ...) and 93556-26-59. Report 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) for catheterization of the coronary arteries and 93556 (Imaging supervision ...; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]) for the imaging supervision and interpretation (S&I). Append modifier -26 to 93508 and 93556 to demonstrate the professional component if the physician performed the procedure in the hospital. If the cardiologist performed the procedure in his or her freestanding catheterization lab, you would not append modifier -26 because the physician is performing both the technical and professional component of the procedure. In addition, you should append modifier -59 (Distinct procedural service) to 93556 to indicate that the imaging, supervision and reporting for selective coronary angiography is a separate, distinct procedure and should not be bundled into the coronary intervention code.

Report the cutting-balloon inflations with 92982 (Percutaneous transluminal coronary balloon angioplasty; single vessel) and append HCPCS modifier -RC to demonstrate that the physician performed the procedure in the right coronary artery.

Your report indicates that the physician administered brachytherapy by inserting beta seeds into the catheter for a total dwell time of 3 minutes and 10 seconds. Use +92974 (Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy [list separately in addition to code for primary procedure]) for the brachytherapy, and append modifier -RC to signify that the seed placement occurred in the right coronary artery.