Compliance Question of the Week – Cardiology

How is the following scenario coded? A patient has a 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.

Last week’s answer to pediatric echocardiograms made me wonder what codes would be assigned for the congenital echocardiogram.

We are starting to perform pediatric echocardiograms, and I was wondering if the CPT® codes are the same for children as they are for adults. We use CPT code 93306 for adult echos; is that appropriate for pediatric exams as well?

Can we charge for the catheter placement for insertion of pacemakers?

Can we assign the coronary mechanical thrombectomy code (92973) for an aspiration thrombectomy catheter?

What code should we report for the insertion of a percutaneous ventricular-assist device such as the Impella device?

Is code 93567 to be assigned only for aortic root or ascending aortic imaging? If a true, diagnostic abdominal (75625) or thoracic (75605) aortogram is performed at the same time as a diagnostic cardiac cath study should the radiology S&I CPT® code continue to be submitted in addition to the diagnostic heart cath codes instead of 93567?

Can you provide any information about the new ICD-10 coding guidelines for MI?

What code would I use for the second stent if the doctor’s dictation states “MI in the LAD and RC”? If I can only assign code 92941 one time, what code do I use for the additional artery?

Does Medicare cover leadless pacemakers?

For Medicare hospital billing, if a planned PTCA is attempted but the balloon cannot be advanced across the lesion, can we bill for the attempted angioplasty?

A diagnostic cardiac catheterization is performed demonstrating two-vessel coronary disease. Due to contrast load, the procedure is staged. A lesion in the LAD is treated by a DES at the initial session and the right coronary lesion is treated at a separate encounter. Can the injection of the coronary arteries during the second encounter be coded and billed with code 93454 (coronary angiography only)?