AAPC - Back to school
Results 1 to 3 of 3

Thread: crossing the lesion

  1. #1
    Join Date
    Apr 2007

    Default crossing the lesion

    AAPC: Back to School
    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?
    Last edited by jtuominen; 09-16-2010 at 11:19 AM.

  2. #2
    Join Date
    Apr 2007
    North Central Florida


    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?

  3. #3

    Default wire crossing the lesion

    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!

Similar Threads

  1. Opinion on crossing over to Home Health & Hospice Coding
    By burgettbd in forum Employment General Discussion
    Replies: 1
    Last Post: 05-15-2015, 12:54 PM
  2. Replies: 0
    Last Post: 11-14-2013, 12:03 PM
  3. crossing a total occlusion
    By rschmautz in forum Interventional Radiology
    Replies: 1
    Last Post: 08-31-2013, 12:03 PM
  4. Hill Sachs Lesion (Bankart Lesion)
    By tmeddaugh@yahoo.com in forum Orthopaedics
    Replies: 1
    Last Post: 02-20-2012, 07:06 AM
  5. lesion excision, lesion not found
    By FLSJarrel in forum General Surgery
    Replies: 1
    Last Post: 07-15-2011, 10:23 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.