Health Information Management

Q&A: Reporting stent placement with other procedures

APCs Insider, December 28, 2012

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Q: When the AMA created all the new codes for the combination procedures, such as stent placement and atherectomy, they deleted the codes for the individual procedures. So how do we report the drug eluting stent procedures when we have only two codes, G0290 (transcatheter placement of a drug eluting intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) and G0291 (transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel), but no CPT codes for the other components if performed with other procedures? How in the world are we going to set up the chargemaster (CDM) to compensate for all these options?

A: There are two parts to your question – the first about the codes to be reported, and the second about CDM maintenance. Let’s look at each of these.
 
First, similar to how CMS handled the reporting of echocardiograms with contrast, CMS has created a set of HCPCS Level II codes that mimic the Level I codes created by the AMA, but are specific to the use of the drug-eluting stents.
 
These HCPCS codes are C9600 – C9608. For example, C9600 is defined as “Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch” and C9601 “Percutaneous transcatheter placement of drug eluting 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)”.
 
These HCPCS Level II codes correspond to CPT codes 92928 (percutaneous transcatheter placement of intracoronary stent[s], with coronary angioplasty when performed; single major coronary artery or branch) and 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].) respectively.
 
So, if the physician uses a drug-eluting stent, then coders would report C9600; if the physician uses a bare metal stent, then coders report CPT 92928.
 
When you perform your CDM maintenance, be sure that the total charges for the component procedures from the past are incorporated into the one line item charge to ensure you capture and report the total cost for performing the procedure. Just because one code represents a combination of procedures performed, it doesn’t mean that the cost to perform the procedure has changed. Review these items very carefully to ensure that you have all components accounted for in the price setting methodology used by your facility.
 
Keep in mind that these changes are related to reporting the procedures ONLY; the C code for the stent must still be reported in order to satisfy the device to procedure/procedure to device edits.
 
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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