Question

CLINICAL SUMMARY: The patient is a 55 year-old female with known coronary disease and previous left anterior descending and diagonal artery intervention, with recent recurrent chest pain. Cardiac catheterization demonstrated continued patency of the stented segment, but diffuse borderline changes in the ostial/proximal portion of the right coronary artery.

PROCEDURE: With informed consent obtained, the patient was prepped and draped in the usual sterile fashion. With the right groin area infiltrated with 2percent Xylocaine and the patient given 2 mg of Versed and 50 mcg of fentanyl intravenously for conscious sedation and pain control, the 6 French catheter sheath from the diagnostic study was exchanged for a 6 French sheath and a 6 French JR4 catheter with side holes utilized. The patient initially received 3000 units of IV heparin, and then IVUS interrogation was carried out using an Atlantis Boston Scientific probe. After it had been determined that there was significant stenosis in the ostial/proximal segment of the right coronary artery, the patient received an additional 3000 units of IV heparin, as well as Integrilin per double bolus injection. A 3.0 16-mm-long Taxus stent was then deployed in the ostium and proximal segment of the right coronary artery in a primary stenting procedure with inflation pressure up to 12 atmospheres applied. Final angiographic documentation was carried out, and then the guiding catheter pulled, the sheath upgraded to a 7 French system, because of some diffuse oozing around the 6 French sized sheath, and the patient is now being transferred to telemetry for post-coronary intervention observation and care.
RESULTS: The initial guiding picture of the right coronary artery demonstrates the right coronary artery to be dominant in distribution, with luminal irregularities in its proximal and mid-third with up to 50 percent stenosis in the ostial/proximal segment per angiographic criteria although some additional increased radiolucency observed in that segment.
IVUS interrogation confirms severe, concentric plaque formation in this ostial/proximal portion of the right coronary artery with over 80 percent area stenosis demonstrated. The mid, distal lesions are not significant, with less than 40 percent stenosis per IVUS evaluation.
Following the coronary intervention with stent placement, there is marked increase in the ostial/proximal right coronary artery size, with no evidence for intimal disruption, no intraluminal filling defect, and TIMI III flow preserved.
CONCLUSION: Successful coronary intervention with drug eluting Taxus stent placement to the ostial/proximal right coronary artery. What CPT® coding is reported?

Answer 1

The CPT coding reported for this coronary intervention with drug-eluting stent placement and IVUS interrogation would be 92928 for the stent placement and 92978 for the IVUS.

Step-by-step explanation:

The CPT (Current Procedural Terminology) coding that should be reported for the clinical summary described is as follows:

The correct CPT code for a percutaneous coronary intervention (PCI) with stent placement in the ostial/proximal segment of the right coronary artery is 92928. This code represents the procedure of coronary artery stenting including angioplasty, when necessary, for a patient who has a stenosis in a coronary artery. The CPT code for intravascular ultrasound (IVUS) is 92978, which is used when this imaging technique is performed in conjunction with PCI in the coronary arteries.

Therefore, for the professional component (the work done by the physician), the codes to be reported are 92928 for the stent placement and 92978 for the IVUS if the physician is billing separately for the imaging service provided during the intervention.