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Connie Posted Mon 02nd of May, 2011 16:09:19 PM

Can I bill for 3 or more stents in the same vessel?

SuperCoder Answered Wed 04th of May, 2011 03:58:03 AM

Giving you some examples, hope this helps you.
There are three major coronary arteries: LAD, LCX, and RCA. Each one of these divisions is charged by the vessel. So, LAD, LCX, and RCA can each be charged as initial, and each additional vessel(s). Multiple stents in the same vessel family cannot be charged as separate procedures, but, of course, each stent (supply) can be billed. As long as they are not in the same vessel, you can charge for LAD, CFX. If there are two in the same vessel (LAD, DIAG) charge for the higher one. For example, if you have a non-coated stent in the DIAG, but put a drug-eluting stent in the LAD, charge for the LAD, but if you put DES in both the LAD and CFX, charge for both. Another example, if you stent a mid-LAD and also a diagonal, this is billed as one, but if you stent the mid-LAD and the RCA, this is billed as stent and a stent to an additional vessel.

It is appropriate to bill for extra time spent placing two or more additional stents in the same vessel through the use of modifier -22 (unusual procedural services). It will reimburse the additional time on an individual, paper claim basis on review if the physician spent double the time it would have taken to place one stent in the vessel. If the procedure took only 50 percent more time, perhaps because only one additional stent was placed, no extra reimbursement will be forthcoming and the -22 modifier (unusual procedural services) should not be used.

For three or more vessels, you should attach a -22 modifier to the stent procedure, and include the letter and the op report and code after finding out from the physician involved how much more difficult the job was.

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