Cardiology Coding Alert

You Be the Coder:

Decide Which Coronary Codes Belong Together

Published on Tue Apr 15, 2014

Question: In a patient with AMI who has diagnostic LHC with coronary angiography followed by angioplasty and stenting of the right coronary artery, should I report 92941-RC, 92920-59-RC, and 93458-26-59?

Codify Subscriber

Answer: Based on the information provided, you should not report 92920-59-RC (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch; Distinct procedural service; Right coronary artery).

Here’s why: The angioplasty represented by 92920 is included within 92941-RC (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel).

Note that 92941’s definition states, “any combination of intracoronary stent, atherectomy and angioplasty” performed in a single vessel.

CPT® guidelines indicate you may report a diagnostic angiogram with a percutaneous coronary intervention (PCI) code in specific circumstances, such as having no prior study available or the patient’s condition changing. So for a truly diagnostic angiogram with left heart catheterization (LHC), you may report 93458-26-59 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection[s] for left ventriculography, when performed).

Tip: The January 2014 CPT® Assistant explained that “during myocardial infarction” in 92941 requires these three elements:

ECG changes indicate acute myocardial infarction (AMI), including when nonspecific ECG changes are in conjunction with AMI symptoms
The coronary angiography and PCI are treated in the cath lab as an emergency
The target coronary lesion causes total or subtotal occlusion.

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