First some key ideas:
To do this type of coding (PCI) you must pay attention to the difference between a major artery and a branch of a major artery. Here are the 5 major arteries and their modifiers.
left main -LM
left anterior descending -LD
left circumflex -LC
right coronary -RC
ramus intermedius -RI
If you are coding for a
branch of a coronary major artery, the modifier you use will be the same as the modifier for the major artery.
You need to realize which coronary artery branches are recognized. According to the guidelines, the following branches are recognized:
Up to two coronary artery branches of the left anterior descending.(These are called diagonals.)
Up to two branches of the left circumflex. (These are called marginals.)
Up to two branches of the right coronary. (These are called posterior descending and posterolaterals).
The left main and ramus intermedius coronary arteries do not have recognized branches for reporting purposes.
Also note that the base codes - 92920, 92924, 92928, and 92933 - can be coded for
a single major artery OR a
branch, but the add-on codes - 92921, 92925, 92929, 92934 - can only be coded for
branches when some base code was applied to the same major artery or another one of its recognized branches. (This last idea comes from the guideline: "PCI performed during the same session in additional recognized branches of the target vessel should be reported using the applicable add-on codes(s)."
Also, note that the add-on codes for PCI have parenthetical notes stating which base codes they can be used with.
Now, to get to your question... you wanted an example of a question with the answer as 92933-RC, 92934-LD, but this pair of codes (with no other base code for LD would violate the guidelines because you have to code for PCI in the main
target vessel or
branch ( of LD) using a base code before you can possibly code any of the add-on codes for a
branch of the LD. So I can't provide any question to be coded just with just the 2 codes: 92933-RC, 92934-LD because we also need a base code used for LD to be a realistic "codable" situation.
However, let's code the following, all done in the same operative session.
Percutaneous transluminal coronary atherectomy, with intracoronary stent for right coronary artery. (92933-RC)
Percutaneous transluminal coronary atherectomy, with intracoronary stent for diagonal branch, D1, of the left anterior descending artery. (92933-LD)
Percutaneous transluminal coronary atherectomy, with intracoronary stent for diagonal branch, D2, of the left anterior descending artery (92934-LD).
Do you see? We used a base code - 92933 for the first branch of LD, and the add-on code 92934 for the same type of procedure for the second branch of LD.
NOW, if it had been a less involved type of procedure in D2, we would have used another add-on code for that type of work. This would be okay, because we have a base code which applies to LD. For example:
Percutaneous transluminal coronary atherectomy, with intracoronary stent for right coronary artery. (92933-RC)
Percutaneous transluminal coronary atherectomy, with intracoronary stent for diagonal branch, D1, of the left anterior descending artery. (92933-LD)
Percutaneous transluminal coronary angioplasty for diagonal branch, D2, of the left anterior descending artery (92921-LD).
Note that 92921 can be used in conjunction with 92933 - for the same target vessel (which is the left anterior descending artery, because both D1 and D2 are branches of LAD.)
This PCI coding is a little complex, not that easy to understand - at first. And believe me, it has been challenging for me to break it down, but I like a challenge... and I hope this helps!
I suggest that you read the guidelines over, highlight the key notes I've mentioned here, and Bubble and Highlight (TM) the codes. That should help you keep it all straight in your head when you go to use these PCI codes.