Health Information Management

More multiple-stent guidance

APCs Insider, June 17, 2004

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QUESTION: In the February 20, 2004, edition of APCs Weekly Monitor, information was provided regarding coding for two stents in the same vessel. How would one code for placement of a drug-eluting stent (DES) in one vessel/branch and placement of non-DES in a different vessel/branch? Would it be appropriate to code G0290/92981 or 92980/G0291 depending on which stent was placed first?

ANSWER: You are correct. The HCPCS Level II code is specific to drug-eluting stents and is effectively a subset of 92980/92981. The HCPCS Level II 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" are specific to drug-eluting stents (DES).

G0290 and G0291 are effectively a subset of 92980, "Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel" and 92981, "Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel" (listed separately in addition to code for primary procedure) representing non-DES stent placement.

With the April 2004 Outpatient Code Editor (OCE), codes G0290/G0291 with 92980 evoke OCE edit 20, "column 2 of a column 1/column 2 CCI edit in which no modifier will be allowed." Therefore, if a non-DES is placed in one vessel and a DES in another, appropriate coding is G0290 and 92981 with modifier LC (left circumflex coronary artery), LD (left anterior descending coronary artery), or RC (right coronary artery).

Note that CMS assumed an average of 1.5 stents per case. We recommend that you track this figure for your hospital and comment to CMS on whether this assumption continues to be valid.



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