Cardiology Question for the Week of May 16, 2022

Question:

Our cardiologist first performed a diagnostic left heart catheterization, followed by selective injections into the left ventricle and coronary arteries. Next, separate and discrete PCI was performed on the following vessels: Right coronary artery DES, Diagonal PTCA, Branch 1 of diagonal PTCA, and Branch 2 of diagonal PTCA. Do you know how we would code for this?

Answer:

For a physician setting, code 93458-59, 92928-RC, 92920-LD, 92921-LD, 92921-LD, and for a hospital setting, code 93458-59, C9600-RC, 92920-LD, 92921-LD, 92921-LD From the initial diagnostic procedure involving injections and imaging of the LV and coronary vasculature (93458), clinical data was acquired that demonstrated the diseased vasculature that needed to be treated. From a CPT perspective, two separate coronary arteries were treated: the LAD and the right coronary. DES placement is defined by code 92928 for physician billing or C9600 for outpatient hospital Medicare billing. CPT® states that within the LAD, left circumflex, or right coronary artery, one may code for an intervention in a “single major coronary artery or branch” and then up to 2 “each additional branch of a major coronary artery.” As the diagonal is a branch of the LAD, this now becomes the vessel that gives rise to the branches. The branch 1 and branch 2 are separate vessels off of the diagonal. Since all 3 vessels are discrete and each was treated separately, it is appropriate to code separately for each structure. As all were treated by PTCA, one would be assigned code 92920-LD and the other two would be coded as 92921-LD (x2).

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