Question:

How is the following scenario coded? A patient has an SVG anastomosed to the LC obtuse marginal (OM). Next, this graft “jumps” to the RC posterolateral branch. Through the vein graft, the OM lesion is treated with angioplasty and bare-metal stenting, and a second lesion in the posterolateral branch of the RC is treated with angioplasty and bare-metal stenting.

Answer:

Report code 92937 to describe angioplasty and bare-metal stenting of the OM lesion through the graft and assign 92938 for the angioplasty and bare-metal stenting within the RCA. Even though the procedure was performed through one vein graft ostium and blockages in two major coronary arteries were dilated, the vein graft is analogous to a single major coronary artery and each artery is coded separately. The OM and RCA are “branches.” To delineate the vessels for the payer, add HCPCS modifiers LC and RC to each code.

92937 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
92938 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure)

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