On-Demand: Diagnostic Cardiac Cath and PCI Case Coding-Questions & Answers

Questions & Answers
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This document is a Q&A session on Diagnostic Cardiac Cath and PCI Case Coding. The questions cover various topics related to coding and documentation for cardiac catheterization and percutaneous coronary intervention (PCI) procedures. Here are some key points from the Q&A:<br /><br />- Billing for unsuccessful stent placement: The appropriate modifier (52 or 53) depends on the provider's progress and the reason for stopping the procedure.<br />- Documentation for Left Heart Catheterization (LHC): Crossing the aortic valve, performing LV gram, and documenting LV pressures are sufficient for coding LHC. Consult the provider if in doubt.<br />- No specific CPT code for Instantaneous Wave-Free Ratio (IFR): As of now, CPT has not listed any updates or changes regarding reporting IFR.<br />- Unlisted code for IFR or FFR: If reporting is required, use code 93799. Most carriers will pay with modifier 52 since no medication is administered.<br />- Vessel modifiers for stent and angioplasty: Vessel modifiers may not be adequate to bypass coding edits. Modifier 59 or X may be required for angioplasty code.<br />- Coding for PCI in different branches: Only two branches in the left circumflex (LC), left descending (LD), and right coronary (RC) arteries can be coded.<br />- Multiple PCI codes per coronary branch: Up to 2 PCI codes can be reported for each of the three major coronary arteries (LD, LC, RC).<br />- Challenges with coding wasted stents and unsuccessful attempts: Coding depends on the equipment used and how far the provider progressed in the intervention.<br />- Emergent requirement for AMI cases: Documentation should clearly state the case was performed emergent for NSTEMI cases.<br />- Lithoplasty in major coronary arteries: No specific guidance on coding for multiple vessels. It is recommended to code for each primary vessel supported.<br />- Kissing stents and coding: If two vessels are involved, code for both stents. If two in one vessel, only one stent should be coded.<br />- Modifier 59 with add-on codes: Modifier 59 or X can be applied to add-on codes, but modifier 51 should not be used.<br />- 3D FFRct code (0523T): This is a Carrier Priced CAT III code, and reimbursement depends on individual MACs.<br />- Stent insertion and removal on the same day: Report only the insertion, not the removal, if performed on the same day.<br />- Adding main artery modifiers for branch interventions: Yes, main artery modifiers can be added if only the branch lesion was intervened.<br />- Door to balloon time and 90-minute guideline: Door to balloon time and 90-minute guideline may vary depending on MAC requirements.<br />- Aortogram during catheterization and medical necessity: All procedures require medical necessity; specific carrier requirements may vary.<br />- Diagnosis coding for stenosis: The percentage of stenosis to qualify for a diagnosis code depends on the provider's documentation and definition of CAD.<br />- Coding Impella without covered diagnosis code: The coverage and reimbursement for Impella may depend on the specific MAC's guidance and LCD.<br />- Coding "mild" conditions: Whether to code "mild" conditions, such as mitral regurgitation, depends on the specific provider's clinical judgment and documentation.<br />- Using STEMI CPT code with non-STEMI diagnosis: Generally, it is possible to use a STEMI CPT code with a non-STEMI diagnosis if the requirements for ongoing symptoms and emergent activation of the cath lab are met. Check the carrier's LCD for specific requirements.
Keywords
Diagnostic Cardiac Cath
PCI Case Coding
billing
stent placement
documentation
Left Heart Catheterization
CPT code
vessel modifiers
coronary branches
AMI cases