Codapedia is now a division of Find-A-Code

Cardiology Coding Unmasked - Part 2 Therapeutic Cardiology Procedures, CPT Codes (92980-92982; 92984; 92995-92996), Medical Necessity Issues (ICD-9-CM)

December 29th, 2015 - Nancy Maguire
0 Votes - Sign in to vote or comment.

92980 Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
92981 Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessels
92982 Percutaneous transluminal coronary balloon angioplasty, single vessel
92984 Percutaneous transluminal coronary balloon angioplasty, each additional vessel
92995 Percutaneous transluminal coronary atherectomy, with or without balloon angioplasty, initial vessel
92996 Percutaneous transluminal coronary atherectomy, each additional vessel

Correct reporting of interventional cardiology services requires knowledge of cardiac anatomy as well as an understanding of CPT coding conventions.

Facts: Only the most highly valued procedure (stent code in above listed codes) would be reported with the initial vessel code in the first vessel. Any other therapeutic coronary artery procedures (ex, angioplasty or athrectomy) in different vessels are reported using the "each additional vessel" code for the same procedure, which is reimbursed significantly less than the initial vessel code.
If a single intervention is utilized in more than one of these three vessels, the first vessel is to be identified using the respective "single vessel" code. Each additional major coronary artery treated is identified by using the "each additional vessel" code.

Interventions in the branch vessels are considered a part of the intervention in the major vessel and are not reported separately. Anatomic variants should be reported as closely as possible to a corresponding major vessel and not separately coded.

The Medicare Correct Coding Initiative (CCI) defines a hierarchical schema in technical complexity that exists when multiple coronary interventions are performed in a single session. This means that certain services supersede other services and the other services are not reported separately. Generally, stent placement supersedes atherectomy, which supersedes angioplasty. Stent placement, angioplasty, and/or atherectomy may not be paid on the same vessel.

Many payors, including Medicare, recognize only three major coronary arteries. (The left main coronary artery is not recognized as a separate major coronary artery.)  The description below shows the three major coronary arteries recognized by Medicare.

Artery Branches:

(RC) Right Coronary includes: Posterior Ventricular and Posterior Descending
(LC) Left Circumflex includes: Obtuse Marginal 1 and Obtuse Marginal 2, Left main
(LD) Left Anterior Descending includes: Diagonal Branch 1 and Diagonal Branch 2, and Septal branches
Note that if multiple stents were placed side by side in a single vessel, the stent code would be reported only once.

If a diagnostic cardiac catheterization was performed prior to intervention, it is coded secondary with the appropriate catheterization code and modifiers -59 and -26. Example: 92980-RC, 93458-59-26.

Only one of the three most commonly performed therapeutic coronary techniques (stenting, atherectomy, and angioplasty) can be reported in each major coronary artery (and its branches), even if more than one technique is performed.  Stenting includes any angioplasty or atherectomy that is performed in the same coronary artery, and atherectomy includes any angioplasty that is performed in the same coronary artery.

Add-on codes: Codes +92973 (percutaneous transluminal coronary thrombectomy), +92974 (coronary brachytherapy), +92978, and +92979 (intravascular ultrasound) are add-on codes for reporting procedures performed in addition to coronary stenting, atherectomy, and angioplasty, and are not included in the therapeutic interventions.

FFR: Flow reserve measurement: "Intravascular distal coronary blood flow velocity measurement, CPT codes +93571 and +93572, is an invasive procedure employing a miniaturized Doppler transducer mounted at the tip of a specialized guide wire to record intravascular coronary blood flow velocity measurement distal to a coronary lesion (prior and subsequent to pharmacologic stress)....... Codes 93571 and 93572, designated as add-on codes, should be reported in addition to the primary procedure (eg, angiography, angioplasty) without appending modifier -51.... Intravascular distal coronary blood flow velocity is performed during a cardiac catheterization procedure for coronary angiography or other therapeutic intervention." (CPT Assistant). Assign modifier -26 for physician billing.

Code 92995 is reported for atherectomy of a single coronary artery.  Code +92996 is an add-on code that is reported for atherectomy of each additional coronary artery.  Like other add-on codes, code 92996 is exempt from modifier 51 (Multiple procedures). Both of these codes are assigned per vessel; therefore, if multiple lesions are treated in the same vessel (or its branches), only one atherectomy is coded.

There are different types of athrectomy catheters, each is a different method for removing plaque.

Examples:
Treatment of strictures with a cutting balloon catheter is an angioplasty rather than an atherectomy.
Intra-Aortic Balloon Pump is a device used to improve cardiovascular function. CPT code 33967 describes a percutaneous insertion of IABP. Modifier -26 is not required on codes 33967-33968 (Removal IABP).

Medical Necessity

It has never been more important for health care organizations to be proactive with respect to assurance of medical necessity.

Examples:

410.12 410.20 410.21 410.22 410.30
410.31 410.32 410.40 410.41 410.42
410.50 410.51 410.52 410.60 410.61
410.62 410.70 410.71 410.72 410.80
410.81 410.82 410.90 410.91 410.92
411.0 411.1 411.81 411.89 413.0
413.1 413.9 414.01 414.02 414.03
414.04 414.05 414.06 414.07 414.10
414.11 414.12 414.19 414.2 414.3
414.4 414.8 414.9 996.72
 

According to the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), the most common Medicare reimbursement violation is the failure to comply with the medical necessity requirements, especially for certain costly diagnoses involving interventional cardiology procedures (for example, angioplasty and pacemaker implantation).

Document what was done and medically necessary and assign codes to reflect the medical record documentation.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Transparency and Fees
August 15th, 2017 - Christine Taxin
More than any other industry, healthcare is almost notorious for its lack of price transparency. While patients generally know how much their copay will be and certainly how much their final bill turns out to be, few hospitals and practices publish the actual costs of their services prior to those ...
United HealthCare Ending Consultation Reimbursements: Effective October 1st, 2017
August 15th, 2017 - NAMAS
While Medicare discontinued payment allowance for consultation services (ranges 99241-99245 and 99251-99255) in January 2010, many commercial carriers have continued to cover these services. United Healthcare is now joining Medicare's opinion on consultation services. In the June 2017 edition of the United HealthCare Bulletin, United Healthcare has announced that effective October ...
Collect More Cash from Patients
August 11th, 2017 - Christine Taxin
One of the easiest things a practice can do to increase collections makes it easier for patients to pay by whatever method they have available at the time of the visit, says Christine Taxin Adjunct Professor at NYU Dental School and Owner of Links2Success.biz.
Cybersecurity - Are you sure you are secure?
August 4th, 2017 - Wyn Staheli
An article by Medical Economics highlights the June report of the Health Care Industry Cybersecurity Task Force. Their report confirmed once again that healthcare providers are not adequately addressing cybersecurity as part of the compliance programs. The threat of hackers is very real and providers need to ensure that they have taken ...
Proposed Telehealth Changes for 2018
August 4th, 2017 - Wyn Staheli
Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements...
Veterans Choice Program
August 4th, 2017 - Wyn Staheli
In 2017, President Trump signed into law changes to the Veteran's Choice program, which allows veterans to seek care from a civilian (privately contracted) healthcare provider, closer to home, when obtaining care through the VA has become burdensome to the veteran or requires the veteran to wait too long for an appointment.
Case Law Update: Just Because HIPAA Does Not Provide a Private Right of Action, Doesn't Mean that Other Avenues Exist
August 4th, 2017 - NAMAS
Simply stated, the Health Information Portability and Accountability Act (HIPAA) does not provide a private cause of action[1]. And, prior to the 2009 passage of the Health Information Technology for Economic and Clinical Health Act (HITECH Act)[2] and the more robust chain of liability (e.g. covered entities, business associates and ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2017 Find A Code, LLC - CPT® copyright American Medical Association