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Ask the expert: It is my understanding that atherosclerosis of bypass grafts is considered a complication/comorbidity (CC). What about vessels that have stents or a stented vessel that restenosed?

HIM Connection, January 15, 2008

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A: It depends on whether the restenosis is due to the progression of the disease or whether the presence of the stent is causing scar tissue to form around the stent site. Coding Clinic, third quarter 2006, discusses how to code restenosis due to a progression of the disease. This is the most common of the two scenarios.

Note that code 414.01 is not a CC or a major CC (MCC) condition.

When the stenosis is due to the presence of the stent, Coding Clinic instructs us to report code 996.74, which is a CC. Given that physicians typically use drug-coated stents, the percentage of patients with the true complications due to the stent insertion is most likely lower. More often, the progression of the disease causes the restenosis.

Refer to the following Coding Clinic references:

• Coding Clinic, Vol. 23, No. 3, third quarter 2006
• Coding Clinic, Vol. 17, No. 1, first quarter 2000

Editor's note: Shannon McCall, RHIA, CCS, CPC, director of coding and HIM for HCPro, Inc., in Chesterfield, VA, answered this question.

This Q&A was adapted from the January 2008 issue of Briefings on Coding Compliance Strategies. For more information, visit www.hcpro.com/content/202988.cfm.

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