Wiki PCI and PTCA Same Day

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cargo

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Patient had cardiac cath followed by PCI & thrombectomy of LC.

92980/LC
92973
93548/26/59

Later that day, severe chest pain and EKG changes occurred & patient went back to cath lab for acute stent thrombosis. Doc performed coronary angiography that demonstrated thrombotic occlusion within the stented segment. He performed mechanical thrombectomy, PTCA & IVUS of the stented segment.

I'm looking for input on coding the 2nd procedure. I can't modify the 92982 for the PTCA even though it's a separate session, so he just loses that? And would/should I bill the coronary angiography - 93454/26/59 since new symptoms developed? Otherwise, I'm just left with the IVUS and 2nd thrombectomy maybe with a 78?

TIA,
Carol Wright, CPC
 
cargo said:
Patient had cardiac cath followed by PCI & thrombectomy of LC.

92980/LC
92973
93548/26/59

Later that day, severe chest pain and EKG changes occurred & patient went back to cath lab for acute stent thrombosis. Doc performed coronary angiography that demonstrated thrombotic occlusion within the stented segment. He performed mechanical thrombectomy, PTCA & IVUS of the stented segment.

I'm looking for input on coding the 2nd procedure. I can't modify the 92982 for the PTCA even though it's a separate session, so he just loses that? And would/should I bill the coronary angiography - 93454/26/59 since new symptoms developed? Otherwise, I'm just left with the IVUS and 2nd thrombectomy maybe with a 78?

TIA,
Carol Wright, CPC
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Yes, you can bill for everything that was done in the 2nd procedure. You can bill for a PTCA as this was a different session. Yes, bill the 93454.26.59 as the patient's condition had changed since his last study. Bill for IVUS.

I'd be careful about the thrombectomy, though. I don't know what kind of thrombectomy was done but if it was an aspiration thrombectomy this will be included in the intervention. The 92973 is intended for a mechanical thrombectomy. (Only catheter approved for this code would be an Angiojet I believe)

Jessica CPC, CCC
 
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