92980 and 92982

dbarbagallo

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I work @ and insurance company and wehave many conversations on how to pay the above codes. As they are not in the surgical section of the CPT , some feel it should be a diagnostic test, while other feel this is a surgical procedure. Can someone clarify please?
 

Anna Weaver

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diagnostic vs surgical

I work @ and insurance company and wehave many conversations on how to pay the above codes. As they are not in the surgical section of the CPT , some feel it should be a diagnostic test, while other feel this is a surgical procedure. Can someone clarify please?

This is just my opinion, I want to clarify that from the beginning. These codes are for stent insertion (92980) and balloon angioplasty (92982). I don't feel these would be diagnostic. Diagnostic by definition in medical field is: a device or substance used for the analysis or detection of diseases or other medical conditions. I can't remember what the size of the lesion would have to be in order to place a stent, but I am thinking it's more than 50%.
When they do the heart cath, then they determine whether to do an angioplasty, stent, thrombectomy, etc. Therefore, I think the heart cath should be the diagnostic test, not the intervention itself (stent, angio). Any one else? I'm not explaining this very well I'm afraid, I know what I want to say, but I'm having trouble here.
 

kevbshields

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They are interventional procedures; I wouldn't classify them as surgical, because they do not "fit" that classification. Likewise, they are not diagnostic--a heart cath is an example of a diagnostic service.

I hope this offers some assistance.
 
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I work @ and insurance company and wehave many conversations on how to pay the above codes. As they are not in the surgical section of the CPT , some feel it should be a diagnostic test, while other feel this is a surgical procedure. Can someone clarify please?

dbarbagallo,
Not all services listed in the surgical section are “surgical” Just as there are surgical procedures in other than the surgical section. There are plenty of diagnostic procedures in the surgery section e.g. screening colonoscopy (45378). I always try to identify if the "service" is to diagnose or treat a condition. I hope this is helpful.
 
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