Wiki Attempted PCI of CTO

[sandya]

Hi,
pt had a cath, which showed a CTO of the OM, doctor attempted to insert/guide many wires, however, none of them were successful crossing into the distal portion of the vessel beyond the stenosis. At which time, the procedure was terminated. Does this give me enough to bill 92943-LC-53? thank you Sandy

 

[nellt]

It is my understanding that the doctor has to cross the lesion in order to bill for the PCI. I am thinking you might be able to bill increased procedural services for the coronary angiogram (modifier 22).

 

[jtuominen]

If this is a staged patient, where the diagnostic portion of the study was performed on an earlier date, and today there was a considerable attempt to cross the CTO (you can see this via documentation, ie. they tried for a prolonged period of time, tried multiple wires and catheters and this is vigorously stated) I would be inclined to code this as an attempted CTO treatment (92943-LC/53 for prof or 92943-LC/74 for hospital billing) instead of a dx study.

However in other non-staged/non CTO lesion case types, I would be agree with previous commentor to defer to appropriate angiogram charges only, when the lesion cannot be crossed with any equipment. IMHO.