Health Information Management

Q/A: Coding for incomplete stent placement

APCs Weekly Monitor, August 21, 2009

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Q: How should we code the following scenario: A patient arrives at the catheterization laboratory for placement of a noncoronary stent and the physician performs an angioplasty to prepare for the stent. The physician places the stent in the vessel but cannot cross the lesion, so the physician removes the stent. Should we report a stent placement with CPT code 37205 (transcatheter placement of an intravascular stent(s) [except coronary, carotid, and vertebral vessel], percutaneous, initial vessel) and modifier -74 (discontinued outpatient procedure after anesthesia administration)? Or should we just report an angioplasty?
 
A: We would not code the angioplasty as it was integral to the stent insertion. Although the stent insertion was incomplete, it was attempted and we would code it with modifier 74 (outpatient coding rules and modifier -74 allows this). Exercise caution from a charging perspective with this scenario. Some stent companies don’t charge for the stent when this occurs. Ensure that your facility does not charge/bill for a stent when you will receive reimbursement. Hospitals should not charge for stents when manufacturers give them some type of price break (free, rebate, etc.). Some Medicare modifiers may be applicable to indicate when a device is supplied at no cost or at a discounted price. However, hospitals that incur the cost of the device should bill it as well.



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