Reader Question: Brachytherapy (March 2001)
Question: Our cardiologists would like to use brachytherapy in association with heart catheters to try to prevent restenosis of stents. Will Medicare pay for this procedure? How should it be coded?
California Subscriber
Answer: Coronary brachytherapy is intended to treat in-stent restenosis, which causes coronary stents to become clogged with new tissue growth or with scar tissue that has formed after stent placement, says Diane Elvidge, CPC, senior reimbursement specialist with Princeton Reimbursement Group in Minneapolis.
The [...]
You Be the Coder: Stress Echo Coding (March 2001)
Question: How should we code when the cardiologist performs a stress echo in the hospital?
Rhode Island Subscriber
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Answer: The stress echo combines two separate services a stress test and an echocardiogram says Martha Gerant, CPC, a coder with Cardiology Services, an 11-physician practice in Shawnee Mission, Kan. Code 93350 (echocardiography, transthoracic, real-time with [...]
CPT 2001 has introduced several new codes, many of which are separately billable, to describe endovascular repair of abdominal aortic aneurysms (AAA) procedures that formerly had to be billed using a single unlisted procedure code (37799, unlisted procedure, vascular surgery). In addition, two new radiology codes may also be billed with the procedures under certain circumstances.
Endovascular repair involves the introduction of a collapsed prosthesis through arteries in the groin (either femoral or iliac). [...]
Reader Question: Use Unlisted Procedure Code for Cutting Balloon (March 2001)
Question: What is the correct code for use of a cutting balloon? Some of our cardiologists believe it should be billed as an angioplasty, but others suggest atherectomy codes. Who is correct?
New York Subscriber
Answer: The cutting employs microsurgical blades, called atherotomies, bonded to the balloon surface. When the balloon is inflated at the site of the lesion, the blades expand and incise plaque from the blood vessel.
According to the AMA, the procedure is neither [...]
Reader Question: Incomplete Procedure (March 2001)
Question: Can we bill an unsuccessful procedure? The operative reports reads,Angioplasty of both the renal arteries was attempted utilizing multiple catheters, guides and wires to cross the lesions. Angioplasty was unsuccessful because of inability to cross the lesions. No complications were experienced. Failed intervention of both renal arteries due to inability to cross the angulated, calcified renal artery lesions. Recommend bypass surgery to the renal arteries.
Oregon Subscriber
Answer: When a procedure is cut short without an [...]
HCFA Suspends CCI Edits; Significant, Separately Identifiable E/M Still Required (February 2001)
HCFA has suspended edits of evaluation and management (E/M) services with diagnostic tests. In a monthly conference call with representatives of specialty societies, HCFA announced the suspension but gave no reason for it.
The edits, published in version 6.3 of the national Correct Coding Initiative, became effective Oct. 30, 2000, and bundled 66 E/M codes with more than 800 diagnostic tests and other services listed in the Medicare fee schedule as having XXX global days. [...]
Breaking News: HCFA Rejects Modifier -60 (February 2001)
HCFA has decided not to recognize modifier -60 (altered surgical field). The new modifier, introduced in CPT 2001, was supposed to be appended in place of modifier -22 (unusual procedural services) if a procedure involved significantly increased operative complexity and/or time due to the effects of prior surgery, marked scarring, adhesions, inflammation or distorted anatomy.
Surgeons had hoped modifier -60 would be recognized because it explains more precisely than modifier -22 why a procedure was more [...]
Reader Question: Heart Cath Performed Prior to Intervention (February 2001)
Question: Our cardiologist performed a percutaneous transluminal coronary angioplasty (PTCA) and stent on the right coronary artery. His procedure description also states he performed a left heart catheterization. But, the body of the report only describes the stent placement and PTCA. The physician believes he shouldnt have to dictate the left heart cath because the stent cannot be placed without it. I dont want to bill for a left heart cath that is not described [...]
Correction: Stent Placement and Modifier -26 (February 2001)
The December and January issues of Cardiology Coding Alert erroneously reported that stent placement code 92980 (transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) should be appended with modifier -26 (professional component) when billed together with a left heart cath (93510, left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) and its associated injection and supervision and interpretation codes (i.e., 93543, [...]
Code Multiple Interventions by Vessel for Best Billing Results (February 2001)
When cardiologists perform multiple interventions, the number of coronary vessels being repaired, not the number or type of interventions, determines how the operative session should be coded. Furthermore, if a different intervention is performed on a separate vessel, the lower-valued intervention should be billed using an add-on, rather than a primary, procedure code.
The three types of coronary interventions (stent placement, percutaneous transluminal coronary angioplasty [PTCA], and atherectomy) are coded as follows:
92980 transcatheter [...]
