atherectomy/angioplasty same vessel

vkratzer

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If a patient has an atherectomy and angioplasty of the same vessel, can I code both procedures? How about angio and stent of same vessel?

Thanks

Vicky
 

mikereyland

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If an atherectomy and an angioplasty are done on the same vessel you can only code the one that works. You can however code a angioplasty and a stent on the same vessel or an atherectomy and a stent on the same vessel.

Mike Reyland, CPC, CIRCC
 

deeva456

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You didnt say if this is for coronary vessels or peripheral vessels? If you are doing a angioplasty and stent placement in a coronary vessel (LC,LD or RC) you can only bill for the stent placement. If an atherectomy and angioplasty are in the same coronary vessel bill only the atherectomy.

Peripheral vessels: you can bill as mentioned in the previous message.
 

dhuston

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I believe that CMS has rescinded their previous instruction to only code the successful procedure and you can bill all the procedures if they were all provided to treat the condition.

Diane Huston, CPC,RCC
 

deeva456

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Do you have documentation that supports this? The National Correct Coding Initiative Policy Manual for Medicare Services, Chap 11 states to report "only one intervention, the most complex regardless of the number of stent placements, atherectomies, or balloon angioplasties performed in that coronary vessel" Just need clarification so I can inform my doctors.

Thank you!
Dolores, CPC, CCC
 

kkamps

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For peripheral interventions you can bill atherectomy prior to angioplasty in the same vessel. NCCI does have a rule that does not allow atherectomy due to a failed angioplasty. Angioplasty and stent placement in the same vessel can only be reported if the angioplasty was planned and results were sub-optimal or for post-stent complications (i.e. dissection). If used for pre-dilation or to further deply a stent it would be inapprpriate to report.:)

Kelly, CPC
 

cmblocher

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My surgeon routinely performs the atherectomy first, and if has does not get the results he wanted.... then he will do a ballon angioplasty. He says he does this to prevent the vessel from tearing do to the laser getting to close to walls.

I feel as though this is personal preference because typically the order is PTA, Atherectomy, and Stent.

The NCCI policy manual states we can't bill for the atherectomy if it follows an unsuccessful angioplasty. But what if the angioplasty follows an atherectomy?

So confused right now.
 
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