Cardiology Question for the Week of July 11, 2016



A left heart catheterization (LHC) was performed on a Medicare patient, then a drug-eluting stent (DES) was placed in the left anterior descending (LAD) artery, and an angioplasty of the diagonal branch was performed.

What can the hospital charge here? I am assuming that it would be as follows and would like to know if this is correct

For the LHC:


Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed

For the DES to the LAD: 


Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch

For the percutaneous transluminal coronary angioplasty (PTCA) of the diagonal branch:


Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)



If a diagnostic LHC with coronary angiography is performed with DES in the LAD and PTCA in a diagonal, assign the above codes. Be sure to append modifier -59 to code 93458. Since the diagonal is a branch of the LAD, you report an “additional branch” code.