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Coronary Intervention & Pericardiocentesis

Oscar Posted Mon 12th of November, 2012 21:08:20 PM

Could you please answer my following coding question.

Two sessions of coronary interventions on same day.
Session1:

LHC/bilateral coronary angiogram showed 80-90% stenosis in anomalous circumflex artery coming from RCA. Successful stent placement in anomalous circumflex artery lesion. Following this a complication raised: At end of procedure doctor noticed minimal amount of perforation coming from one of the small branches of the anomalous circumflex artery.
My coding is 93458-26, 92980.

Session2:

During observation pt developed chest pain and hypotension. Echo showing significant effusion in subcostal view. Brought back to cath lab to look at stents & as well as to drain the pericardial fluid.

Used pericardiocentesis radial and drain under fluoroscopy, drained fluid through needle and then took out syringe and put the J-wire in the pericardial space. Over J-wire placed a pigtail pericardial fluid drainage catheter and aspirated 450ml of bloody pericardial effusion.

Conclusions: Stents are good in coronary angiogram & drainage of pericardial fluid under fluoroscopy about 450ml.

Please suggest the coding for second session.

Thanks & Regards
Oscar M

SuperCoder Answered Tue 13th of November, 2012 03:30:24 AM

Hi,

We are working on this

Thanks

SuperCoder Answered Tue 13th of November, 2012 19:17:25 PM

For session one, you’ll probably need a modifier 59 on 93458 if the payer bundles it into 92980. Also check if the payer requires anatomic modifiers for 92980 (e.g., mod LC).

It’s a bit difficult to tell exactly which services were performed in the second session, so consider the following possibilities depending on the full documentation. There’s also a chance the payer will ask for documentation.

The posting refers to an echo, so see if it qualifies for a code such as 93307-26 or 93308-26 or something similar.

Was there a second coronary angiography, such as 93454-26? Will need to show it’s a diagnostic service from a separate session, so look at mod 59.

For pericardiocentesis, look at 33010 (it doesn’t look like the tube was sutured to the chest wall and left in for prolonged drainage, which would suggest 33015 as more appropriate). This appears to be a procedure performed in the cath lab for a same-day related complication, so look at mod 78. For fluoro, compare the documentation to 77002-26 with mod 59.

It’s not right on point, but there’s an article from ACR that may be useful because it goes into what’s drainage vs. aspiration and coding when the catheter is removed immediately. Some of the codes have since been renumbered, so be on the watch for that: http://gm.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/NovemberDecember2005/ImageGuidedPercutaneousDrainageAspirationAndBiopsyProceduresDefinitionsProceduralDescriptionsA.aspx

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