Wiki crossing the lesion

[jtuominen]

Does anyone have any sources of information on billing rules regarding the following situation? Ive been looking around and haven't found anything concrete yet:

Patient presents for coronary angiogram (93510/93543/93545/93555/93556) and decision is made to move to intervention. The MD attempts to wire the lesion so that he can perform a PTCA, but he can never get the wire to cross the lesion. He tries for about a half hour.

I thought for sure there was some rule out there that stated if the wire does not cross the lesion, that the PTCA should not be billed for.
or would it be more appropriate to bill 92982-53 profee / 74 for hospital?

 

[hannahgasser]

I have a similar dilemma. Physician attempted a Common Iliac PTA but was unable to cross the lesion. I have not been able to find any guidance in writing about these particular situations are to be coded. I was thinking 35473 with modifier 52 could also be appropriate.

Per Encoder Pro "Modifier 52 is used for surgical procedures and certain diagnostic procedures for which anesthesia was not planned. Report this modifier when the procedure was discontinued after the patient was prepared and brought to the room where the procedure was to be performed only."

Modifer 53 definition: "Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued..."

My patient isn't critical but would his 100% occlusion be considered an extenuating circumstance?

 

[theresa.dix@tennova.com]

wire crossing the lesion

HI,
There is not rule about the wire crossing the lesion. No clear cut guidelines for this. ITs a matter of your own confort zone.A few ways you could do this is

1) bill for the cath only
2) bill for the cath and add 22
3) bill for the ptca and reduce it

THe primary difference between mod 52 and 53 is the stability of the patient at the time the physician decides to stop the procedure. Use 52 if the patient is stable. Use 53 is patients instablity was a part of the decision to stop.

Other than that this is what I know!