Health Information Management

Two stents in the same vessel

APCs Insider, February 23, 2004

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QUESTION: This question pertains to Medicare HCPCS code G0290, for insertion of a drug-eluting stent. When a drug-eluting stent is inserted in a coronary vessel (RC or LC or LD) and a bare-metal stent is also inserted in the same vessel, can you code both? Or are you limited to use of one stent code per coronary vessel, which would have to be the G code for the drug-eluting stent?

ANSWER:One code, G0290, should be reported with the appropriate modifier to indicate the artery (LC, LD, RC). G0290 represents the work of inserting the eluting stent. The description of the code states "stent(s)," so, according to this CPT directive, it would not matter how many stent(s) are inserted in the same vessel.

The HCPCS code structure allows for additional coding only if the additional stent is in an additional vessel. If we ignore for the moment that one stent is drug-eluting and one is not, the question becomes can you code two stents for the same vessel? The answer is no. Therefore, by extension, the answer to this question is "one code."

If you code both G0290 and 92980 for this situation, you get OCE edit 20; Column1/Column 2 CCI edit "not mitigated by modifier." Also, the provider would charge for both stents, which means a possible outlier trigger. Do not use 92981 either because it's an add-on code indicating that a non-drug-eluting coronary stent was placed in an additional vessel.

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