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Coronary stent in different vessel, 5 months post prior stent in other vessel

Carl Posted Tue 19th of January, 2016 00:04:08 AM

Dx: I20.9

The patient has documented CAD with previous (2015/06) coronary stent in the RCA and residual disease in Ramus.
Her clinical condition had changed since the prior study 5 months prior (2015/06).
She underwent (2015/11) left heart catheterization, selective coronary angiography but no left ventriculography.
Previous stented segment in RCA looked fine. Progression of CAD in Ramus branch.
Decision was made during the procedure to proceed with coronary angioplasty and 2 drug eluting stents in the Ramus branch. Right radial vascular access.

Which codes are adequate?
Is the left heart cath (93458) with LV end diastolic pressure measurement done but without left ventriculogram demands a different modifier?
Can we add the diagnostic study (93458) to the intervention (92928)?

93458 92928

SuperCoder Answered Wed 20th of January, 2016 07:18:39 AM

According to CCI edits, CPT code 93458-59 can be billed with CPT 92928, if Left Heart Catheterization with or without LV is medically reasonable and diagnostically necessary. and it precedes the percutaneous coronary artery intervention.

Carl Posted Mon 01st of February, 2016 02:36:31 AM

Is this sequence of CPT codes correct?
93458-59, 92928-RI or is the modifier 59 be associated with 92928 instead?

SuperCoder Answered Tue 02nd of February, 2016 04:51:17 AM

92928 is a primary code, therefore modifier 59 would be appended with CPT code 93458.

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