Wiki Case #19 Winner, Answer Key, & Rationale

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alex.mckinley@aapc.com

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Abi L. wins again. The grand prize is going to come down to case #20, which is now live. See case #19 answers and rationale below.

ANSWER
CPT: 92928, 92928
CPT Modifiers: LD, RC
ICD-9: 414.01

RATIONALE
The provider performs stent placement in the LAD and the RCA. Angioplasty is included when performed in the same vessel(s) as stent placement. Because the LAD and RCA are both major coronary arteries, report 92928 twice with the anatomic modifiers LD and RC. It is not appropriate to report the cardiac catheterization because it is included with the procedure unless it is diagnostic and meets the criteria stated in CPT?. It is not appropriate to report 92929 because it is an add on code reported for an additional branch which is not the case, both vessels are major coronary arteries. Because there is no mention of a previous CABG, CAD is reported with 414.01

CPT?: 92928-LD, 92928-RC

Steps to look up: Stent/Placement/Transcatether/Intracoronary

ICD-9-CM: 414.01

Steps to look up: Arteriosclerosis/coronary/native
 
2015 AAPC Coding Challenge

In the ICD-9-CM coding book, the is a note that states, "Use additional code, if applicable, to identify chronic total occlusion of coronary artery (414.2).

Is the reason this procedure codes was not used because it states "near-total occlusion."
 
why is there no modifier -59

I looked in the CPT Assistant and used this example they gave (different codes, but same principle). I got everything correct except I used modifiere -59 also.

Coding Example

Percutaneous transluminal coronary angioplasty (PTCA) is performed in a patient's LD and RC arteries. Report code 92920 (coronary angioplasty-single major vessel) for the LD artery PTCA. Code 92920, with modifier 59, Distinct procedural service, appended, (coronary angioplasty?single major vessel) should be additionally reported to represent PTCA of the RC artery. Based on payer requirements, it may also be necessary to append the HCPCS Level II -LD and -RC modifiers for these vessels or denote frequency in the "units" field. Add-on code 92921 is for "branch" vessels. Neither the LD nor the RC is a branch of the other. Therefore, in this specific example, it would not be appropriate to report add-on code 92921 in addition to code 92920.
 
i should have 2 correct answers

Hi I answered #19 correctly so I should have 2 on the leadership board but there is still only 1 next to my name.
Joann Pitman
 
Case # 19 clinical added to Answer key & Rationale

Case # 19 clinical added to Answer key & Rationale
Since the clinical info wasn't included in posting of answer & rationale; and the link to case clinical info given now is not accessible (error page shows up) .... I thought it wise to include the missing clinical info.

See case #19 answers and rationale below.

ANSWER
CPT: 92928, 92928
CPT Modifiers: LD, RC
ICD-9: 414.01

RATIONALE
The provider performs stent placement in the LAD and the RCA. Angioplasty is included when performed in the same vessel(s) as stent placement. Because the LAD and RCA are both major coronary arteries, report 92928 twice with the anatomic modifiers LD and RC. It is not appropriate to report the cardiac catheterization because it is included with the procedure unless it is diagnostic and meets the criteria stated in CPT?. It is not appropriate to report 92929 because it is an add on code reported for an additional branch which is not the case, both vessels are major coronary arteries. Because there is no mention of a previous CABG, CAD is reported with 414.01

CPT?: 92928-LD, 92928-RC

Steps to look up: Stent/Placement/Transcatether/Intracoronary

ICD-9-CM: 414.01

Steps to look up: Arteriosclerosis/coronary/native



Hint: The summary for Case 19 indicates this was a successful angioplasty and stent placement confirmed by follow-up angiography in the LAD and RCA with bare metal stents. Extensive knowledge of guidelines for ICD-9-CM will be most helpful here.


Case #19

Indications: Two-vessel CAD identified on heart catheterization yesterday.

Procedures Performed:
1. Stenting of proximal left anterior descending coronary artery lesion
2. Stenting of mid-right coronary artery

Procedural Description: 1 mg of IV Versed, 1 mg of Dilaudid was administered. With the usual, sterile approach, a 6-French sheath was placed in the left common femoral artery. A guide catheter was advanced into the LAD. The LAD lesion was pre-dilated with a balloon up to 18 atmospheres. The lesion was subsequently stented with a 3.0 x 30 bare metal stent. Post-dilatation with the same 3.0 x 15 balloon at 18 atmospheres created an excellent, final result based on follow-up, selective angiography of the LAD. I then advanced a BMW guide wire through the near-total occlusion of the mid-right coronary artery. A 3.0 x 30 stent was then placed into the vessel and deployed to 6 atmospheres and post dilated with the same 3.0 x 15 balloon to 16 atmospheres. Follow up angiography confirmed an excellent post-interventional result.

Summary: Successful angioplasty and stent placement confirmed by follow-up angiography in the LAD and RCA with bare metal stents.

https://www.aapc.com/code/aapc-coding-challenge/cases.aspx
 
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