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Prahlad Posted Fri 25th of October, 2019 07:03:53 AM
1.Selective coronary angiogram 2.balloon angioplasty and stent placement to the distal LAD with a 2.5*12 mm Onyx 3. Kissing balloon angioplasty and stent placement to both diagonal branch and LAD with a 2.5 * 12 and a 2.5*18 mm onyx with final kissing ballon angioplasty. 4. Modifier 22 for complex intervention. ..... PLS CODE THIS FOR US
SuperCoder Answered Tue 29th of October, 2019 10:23:11 AM


Thanks for your question.

The term "kissing balloon" refers to two balloons that the physician inserts that remain close to each other and are inflated at the same time, hence "kissing." 

For example, a cardiologist may place two balloon catheters for a tandem percutaneous transluminal coronary angioplasty (PTCA): One in the left anterior descending (LAD) artery and the other in the diagonal branch.
As with all coronary interventions, you may report the "kissing" intervention only once because you can bill only one intervention per coronary vessel. You cannot bill multiple interventions in the same vessel (or its branches) separately. Therefore, you would report 92920 (Percutaneous transluminal coronary balloon angioplasty; single major coronary artery or branch) once because the diagonal vessel is a branch of the LAD.


As per the limited documentation we have in the question, it appears that code 92928 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch) to be the code of choice. Kindly check with the complete operative report.


Append modifier LD to a code for procedures on the left anterior descending coronary artery.


In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

–Increased intensity

–Additional time

–Technical difficulty

–Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician


An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.

Hope this helps.


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