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5 Stents in RC at one session.

Tammy Posted Mon 06th of April, 2015 10:05:42 AM

I have a patient that my physician put 5 stents in the right coronary artery at the same session when the patient was having a non-ST elevation myocardial infarction. He also used atherectomy to remove much of the total occlusion. He is billing a 92941RC, 9297826, 947582659. I researched and Medicare LCD L34139 states that "However, if four or more stents are placed in a single vessel, then it would be considered an "unusual procedural service" and eligible for additional reimbursement equivalent to that of an additional treated vessel - I feel that the additional code should be 92928. Any input would be greatly appreciated.

SuperCoder Answered Tue 07th of April, 2015 03:46:42 AM

No, CPT code 92928 can only be billed with CPT code 92941 when stenting done on 2 different vessel, which is not the case here. As per the mentioned LCD L34139, you should bill CPT code 92941 with -RC and -22 modifier for unusual procedural service. Do not forget to include
an operative report and a concise statement specifying how the service
differs from the usual procedure.
CPT code 92978 -26 should be use if Intravascular ultrasound was also used.

CPT code 94758 is a invalid code.

Tammy Posted Tue 07th of April, 2015 08:23:34 AM

I meant 934582659. Typo!! Thanks I will process as you suggested.

SuperCoder Answered Wed 08th of April, 2015 00:37:39 AM

Thanks!

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