Unsuccessful Attempt at Crossing Coronary Lesion with Guidewire

mcauffman86

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Saint Joseph, MI
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My provider documented:
"Using a 6 Voda 4 guiding catheter, we were able to engage the left main coronary artery. Through a flexible guidewire we were unable to cross the 100% OMB stenosis. Further attempt is aborted."

Can I code for the attempt at crossing the lesion with the guidewire or is it only appropriate to code when the provider is attempting to cross the lesion with a balloon?
 

cpc2007

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To my understanding, this is a bit of a gray zone and payers may vary in policy. The main concern is making sure you can defend the coding of the attempted intervention with the insurance company.

I haven't seen anything authoritative (from CMS, AMA) that addresses this particular scenario. There are some well-respected consultants in the field though (Dr. Z of Z Health Publishing being one of them) who has indicated that if the patient had a recent diagnostic heart cath and is in the cath lab for a planned intervention, and after attempting to cross with a wire, the physician is unsuccessful, he would support coding the attempted intervention with a modifier 53 for physician coding or a modifier 74 for facility coding. If, on the other hand, the patient is in the cath lab for an initial diagnostic study, the physician inserts a wire to confirm the presence of a lesion and decides that there is no possibility of doing an intervention through the catheter, and he stops there, he would consider that "probing with the wire" part of the diagnostic heart cath and would not additionally code an attempted intervention since significant additional work outside of that required for the heart cath would not be performed. I would lean in this same direction (I tend to lean conservatively when determining whether or not insertion of the guidewire is enough to code an attempted intervention).

I hope that helps :)

Kim
www.codingmastery.com
 

mcauffman86

Contributor
Messages
18
Location
Saint Joseph, MI
Best answers
0
To my understanding, this is a bit of a gray zone and payers may vary in policy. The main concern is making sure you can defend the coding of the attempted intervention with the insurance company.

I haven't seen anything authoritative (from CMS, AMA) that addresses this particular scenario. There are some well-respected consultants in the field though (Dr. Z of Z Health Publishing being one of them) who has indicated that if the patient had a recent diagnostic heart cath and is in the cath lab for a planned intervention, and after attempting to cross with a wire, the physician is unsuccessful, he would support coding the attempted intervention with a modifier 53 for physician coding or a modifier 74 for facility coding. If, on the other hand, the patient is in the cath lab for an initial diagnostic study, the physician inserts a wire to confirm the presence of a lesion and decides that there is no possibility of doing an intervention through the catheter, and he stops there, he would consider that "probing with the wire" part of the diagnostic heart cath and would not additionally code an attempted intervention since significant additional work outside of that required for the heart cath would not be performed. I would lean in this same direction (I tend to lean conservatively when determining whether or not insertion of the guidewire is enough to code an attempted intervention).

I hope that helps :)

Kim
www.codingmastery.com

So what if the provider is doing a planned peripheral intervention and cannot cross the lesion with the guide wire after multiple attempts, but states that he plans for the patient to come back for a staged retrograde approach? Would I code the initial attempt or wait to see if he is able to complete a successful intervention on the second attempt?
 
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