Wiki MI PCI codes 2013

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econnolly

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Hello List,
It seems there is a lot of confusion about which code(s) to apply when a patient has an intervention/stent during an MI (92941) when additional branches or vessels are treated during the same procedure.
The "crosswalk" we received in January from Jim Collins/Cardiology Coder.com, instructs us to use 92941 for the infarct vessel, AND 92941 for each additional branch and/or major coronary vessel treated.

Another expert, Dr. Zielske, instructs us to code 92941 for the initial, major vessel with 92929 for branch vessels and/or 92928 for additional major vessels.

Both of these coding sources are excellent and usually very reliable, but in this case they contradict each other.

From what I've read, most of you are going with Dr. Zielske's interpretation of the codes.

Has anyone found specific information from the AMA/CPT or ACC that clarifies how to apply the PCI codes, during an MI , when multiple vessels/branches are also treated?

Thanks!
Elizabeth
 
CPT directs us, "for additional vessels use 92920-92938, 92943, 92944" but it is confusing since inevitably we'll encounter situations that will challenge what we thought we knew.

Maybe CPT only meant for 92941 to be used once per encounter. I've never actually had a physician document multiple MI's in different major coronary arteries - but mabe my thought process is wrong here.

Here is an example from AMA:

A guidewire is passed through total occlusion in the proximal LAD, initial balloon angioplasty reveals large thrombus burden with recurrent occlusion, mechanical thrombectomy is performed followed by angioplasty & stent to the proximal LAD. An additional stent placed to mid-LAD, and balloon angioplasty of large second diagonal is performed.

Answer: 92941 (MI—LAD), 92973 (mechanical thrombectomy, +92921 (angioplasty of LADD); stent in mid-LAD not separately reported

This can be found @ http://www.ama-assn.org/resources/doc/cpt/17-cardiology-brin.pdf

So, it seems that the direction of CPT to use, 92920-92938, 92943, 92944, seems correct - based on our situation above. I think if the physician documents MI of other major coronary vessels, then you could consider 92941-59. But the verbiage says, 'single vessel' and all other PCI have add-on for additional vessels.

Sticky, sticky here.
 
If you google CPT 92941 you will see a few different posts on this via AAPC. It seems some are going to bill 92941 for each vessel, when documented with AMI and took the direction from CPT regarding additional vessels to mean ones NOT involving AMI.

Just FYI. We don't have a real solid answer yet.
 
POBA on RI during MI

I am having a difficult time fiding a definitive answer to:

POBA was performed within the RI during MI. I initially thought 92920, but then thought92941, but now I'm not so sure. I have read and re-read the definition to 92941 and while it says "any combination of..." I have found several Cardiology websites that have implied that 92941 is for ANY and ALL services to the vessel during an MI.

Can anyone clarify this for me please.
 
I just pulled off the symposium that Julie referenced.. It states, "ANY PCI of acute/subacute occulssion during acute MI, single vessel" This is only my interpretation, if the physician does a stent, balloon, or thrombectomy in more than one vessel during the MI he/she should be able to bill this code more than once with the 59 modifier and a differentiation of the vessels...
 
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