Cardiology Coding Alert

Question: If my cardiologist does a left heart cath, then intervenes with a stent placement, can I append modifier -59 to the 92980 and bill with the left heart cath?


Missouri Subscriber


Answer: Appending modifier -59 (Distinct procedural service) to the 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) is not the way to go in the situation you describe.

Neither 92980 nor the cath codes (93501-93533) are subject to National Correct Coding Initiative edits when billed during the same session. The only codes that would require modifier -59 (assuming you're billing a diagnostic cath w/LV or RV gram and a therapeutic procedure) are 93555 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography) and/or 93556 (...pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]), if the injections these S/I codes pertain to were part of the diagnostic cath and not just "guide shots" for stent placement. 

In other words: If the cardiologist performed a left heart cath and stent on the same day, with RV gram and coronaries, code as 92980, 93510-26, 93543, 93545, 93555-26-59, 93556-26-59. If the stent was placed on a different day, and the physician only cathed and shot (angio) the coronaries identifying where to place the stent, then no, you cannot bill 93555 and 93556. This is what is meant by "guide shots."