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PCI and PTCA Same Day

  1. #1
    Default PCI and PTCA Same Day
    Medical Coding Books
    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

  2. #2
    Default
    Quote Originally Posted by cargo View Post
    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
    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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