Cardiology Coding Alert

Applying PTCA Coding Rules Optimizes Payment

- Published on Fri, Sep 01, 2000
When filing claims for percutaneous transluminal coronary angioplasties, commonly referred to as angioplasties or PTCAs, coders need to read the operative report carefully to make sure they know the vessel and branch that received the service because this information directly affects how the procedure(s) should be coded.

PTCAs, like atherectomies and stents two procedures that are associated with PTCAs and often performed at the same time are interventional or therapeutic procedures performed by cardiologists to improve blood flow through coronary vessels. The procedure involves inserting a catheter with a balloon tip to the area of the blocked artery and then inflating the balloon to flatten plaque that is causing the obstruction against the artery wall.

The procedure almost always is preceded by a diagnostic procedure, such as coronary angiography (93508, catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization), with or without left cardiac catheterization (93510, left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous).

Coding the Procedure

Code 92982 (percutaneous transluminal coronary balloon angioplasty; single vessel) should be used when a single angioplasty is performed in one vessel. CPT 2000 also lists the following three modifiers that should be attached to 92982 to indicate which vessel (artery) received the PTCA:

-LC left circumflex, coronary artery, referred to as LCX;
-LD left anterior descending coronary artery, or LAD;
-RC right coronary artery, or RCA.

Note: These modifiers need not be used if only one angioplasty is performed; however, they must be used when two or more PTCAs in separate vessels are claimed.

Each of the three arteries has branches connected to them. If angioplasty is performed on the branches, it is coded the same as an angioplasty performed on the primary artery, says Terry Fletcher, BS, CPC, CCS-P, an independent cardiology coding and reimbursement specialist in Dana Point, Calif.

If two or more PTCAs are performed in the same coronary artery (or its branches), 92982 may be billed only once, according to guidelines published in the American
College of Cardiologys (ACC) Guide to CPT Coding. For example, if the cardiologist uses angioplasty to treat a blockage in the RCA and the posterior descending artery, both angioplasties are coded as one procedure, and 92982 is billed only once. No additional PTCA codes may be charged.

If a third PTCA is performed on a vessel in the same family, however, modifier -22 (unusual procedural service) could be added to the 92982 and additional payment could be claimed, if the documentation provided by the cardiologist indicates the additional time and complexity of the procedures.

Additional PTCAs in a Separate Coronary Artery

If the cardiologist performs a [...]

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