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Code This!

Scenario Week of January 03, 2013:
View Current Scenario

Assign the Correct ICD-9-CM and ICD-10-CM Diagnosis and CPT 2013 Procedure Codes for the Following Outpatient Coding Scenario.

Preoperative Diagnosis: CAD

Postoperative Diagnosis: Same

Operation: Stent placement — RCA & LAD native artery

Anesthesia: Local anesthesia

Informed Consent: The risks and benefits of the procedure were explained to the patient. The patient elected to proceed with the procedure(s).

Component Information: 8 French long sheath, FR4 guiding catheter with side holes, FL4 guiding catheter with side holes, 0.14 extra support wire x 2, 2.5 mm, Photon balloon, 3.5 mm x 18 mm. Crossflex intracoronary stent (RCA), 3.5 mm x 13 mm Crossflex stent (LAD proximal), 2.5 mm x 16 mm AVE S540 stent (distal LAD).

Procedure: After local anesthesia in the femoral area, appropriate catheters were placed. After systemic heparinization with ACT greater than 300, the guiding catheter was advanced into the ostium of the right coronary artery.

Utilizing fluoroscopic guidance and after confirming the lesion, the 3.5 mm x 18 mm Crossflex stent system was advanced and positioned. The stent was inflated using the stent balloon. After confirming full stent displacement, the balloon was deflated and withdrawn. Attention was then diverted toward the LAD system. The distal lesion was predilated with a balloon. The AVE stent was placed in a standard manner. The proximal lesion was dilated with a balloon and another 3.5 mm x 13 mm Crossflex stent was placed in the artery in a similar manner.

At the completion of the procedure, the patient was transferred to the floor in stable condition without complaints of chest pain.

Results:
Pre-PTCA/stent distal LAD — 95%
Post-PTCA/stent — no residual
Pre-PTCA/stent proximal LAD — 90%
Post-PTCA/stent — no residual
Pre-stent RCA — 95%
Post-stent — no residual

Code This! Assign the correct ICD-9-CM and ICD-10-CM Diagnosis and CPT 2013 Procedure Codes.


ICD-9-CM Diagnosis Code
414.01 Coronary atherosclerosis of native coronary artery

Rationale: The pre- and postoperative diagnosis presented in the operative note is coronary artery disease. When searching in the ICD-9-CM index for the main term “disease,” subterms “artery” and then “coronary” direct the coder to “see Arteriosclerosis, coronary.” Upon reviewing the “Arteriosclerosis, coronary” entry, there are several options. Further in the operative note, it is stated this is a native artery as opposed to a previous graft. This leads us to ICD-9-CM code 414.01, listing the native artery specifically. A quick check of the tabular list verifies our choice as the appropriate one in this situation.

ICD-10-CM Diagnosis Code
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris

Rationale: As above, the pre- and postoperative diagnosis presented in the operative note is coronary artery disease. When searching in the ICD-10-CM index for the main term “disease,” subterms “artery” and then “coronary” lead coders to I25.10. Verifying code selection in the tabular list reveals that a different code would have been used if the patient had angina pectoris. As that is not mentioned in the patient’s history, the appropriate code selection in this instance is I25.10.

CPT Procedure Codes
92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
92929 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)

Rationale: In 2013, the previously existing stenting codes (92980 and 92981) were deleted. New codes 92928 and 92929 were created to describe percutaneous transcatheter placement of an intercoronary stent, including angioplasty when it is performed. Code 92929 is an add-on code so no modifier is needed for the second procedure. Note that the codes indicate that they are for an artery or branch. A second code is not reported for multiple sites of the same artery or branch.

Resources:
CPT 2013
ICD-9-CM 2013
ICD-10-CM 2013

 

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