Coding Interventional Radiology

Vol. 14 •Issue 20 • Page 15
Coding Corner

Coding Interventional Radiology

By Jeff Majchrzak, BA, (RT)(R)NMTCB, RCC

Case Study

To help you arrive at the appropriate CPT code(s) for the case study below, key phrases from the documentation appear in boldface type. Boldface underline type indicates key phrases that will help you arrive at the appropriate ICD-9 code(s) for the study performed. Finally, italic type indicates key phrases that will help you arrive at the overlapping CPT code(s) and ICD-9 code(s).

Procedure

1.Percutaneous transluminal coronary angioplasty (PTCA) and stent deployment to the proximal right coronary artery with a 3.0 x 30 mm Cypher stent.

2.PTCA and stent deployment, times two, to the left superficial femoral artery with a 5 x 150 Viabahn stent, times two.

3.AngioJet of the left superficial femoral artery, post stent deployment.

Details of Procedure

After obtaining informed consent, the patient was brought to the cardiac catheterization laboratory in a non-sedated, fasting, post-absorptive state and given Versed for conscious sedation. The area over the right inguinal region was appropriately prepped and draped in the usual sterile fashion. This area was anesthetized with 1% lidocaine.

A 6 French sheath had been inserted in the right femoral artery (RFA).

A prior coronary angiogram and left superficial femoral artery angiogram re-vealed anatomy requiring percutaneous intervention, and it was scheduled for today.

First we inserted a 6 French Judkins right 4 coronary guide catheter into the right coronary ostium, where a coronary arterial tree was visualized in single projection. We then passed a 0.014 BMW guidewire across the lesion in the mid portion of the vessel. We submitted the mid-vessel artery to angioplasty with a 2.5 x 21 mm NC Stormer balloon, inflated to burst pressures of 18 mmHg. The proximal lesion was then stented with a 3.0 x 30 mm cypher stent and inflated to 10 atmospheres. A repeat cineangiography showed excellent resolution of the 80% stenosis in the proximal right coronary artery, and the guidewire and guide catheter were removed.

Next we used a 6 French IMA catheter to advance a 0.035 stiff angle guidewire to the distal left popliteal artery. This guidewire and sheath were then removed. We exchanged it for a 7 French by 45 cm sheath. We then advanced a 5 x 40 open diamond, and inflated this to six atmospheres in the popliteal area and then a distal superficial femoral area. We then performed an injection that showed a large spiral dissection, significantly outside the parameters of our balloon inflations. We then elected to place two 5 x 150 Viabahn stents, covering these non-bridging lesions.

The first Viabahn stent was successfully deployed. We could not advance the second Viabahn stent into the first to get appropriate overlaps, so we had to perform post dilatation of the first Viabahn stent with a 5 x 40 Fox PTA balloon, inflated to seven atmospheres for 15 seconds, multiple times along the entire length of the first stent.

We then pulled past the second Viabahn stent, 5 x 150, and successfully deployed and post dilated the second Viabahn stent with the same 5 x 40 Fox PTA balloon, inflated to seven atmospheres for 15 seconds, at multiple positions along the stent covering the entire length of the second stent.

Repeat cineangiography then showed no flow into stents. We then brought in the AngioJet, used an Expedior AngioJet over the 0.035 stiff angled guidewire and made multiple passes with complete resolution of the thrombus. A normal flow was documented on completion of the procedure. Guidewire and guiding sheath were re-moved. The right femoral arterial sheath was removed, and we attempted to close with a Perclose device. This was unsuccessful. We had to apply a FemStop.

The patient was returned to her room in apparent satisfactory condition without any evidence of obvious complications.

Summary

1.An 80% stenosis of the proximal right coronary artery, stented with 0% residual stenosis, with a 3.0 x 30 mm Driver cobalt-chromium stent.

2.A 99% stenosis of the mid left superficial femoral artery and 80% stenosis of the proximal left popliteal artery, and 99% stenosis of the mid left popiteal artery. All lesions stented to 0% residual stenosis, with two Viabahn stents measuring 5 x 150 in length.

CPT Code Assignments

92980-RC Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel (Assign modifier ÐRC to indicate right coronary.)

For hospital Medicare billing, see G0290-RC (Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel [Use modifier RC to indicate right coronary.]

36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family

75962 Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation

ICD-9-CM Code Assignments

414.01 Of native coronary artery

447.1 Stricture of artery

Jeff Majchrzak is vice president of radiology services and a senior health care consultant for Medical Learning Inc. (MedLearn^®), St. Paul, MN.