Q&A Major Coronary Arteries

[Angela U.]

I am Confused with major coronary arteries questions. Can you please give an example of questions with the answer as 92933-RC, 92934-LD.


One of the practice exam question gave example of question with an answer : 92933-RC, 92933-LD.

I need more clarification on how to answer correctly questions from major coronary arteries. Thanks for your help.

Angela U.

 

[Ruth Sheets]

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.

 

[Angela U.]

Thanks for your explanation on major coronary Arteries. That really helped. I took the CPC certification exam last month and failed just by 2 points. I scored 68% and I noticed I didn't do well at all on "Coding Guideline." and I have another exam next week. Do you have suggestions for me on how to go about the coding guideline, any areas you know that can help me prepare for the exam? I will really appreciate your help. Thanks.

Angela U.

 

[Ruth Sheets]

Glad that helped!

Regarding coding guidelines, the Review Blitz videos highlights the coding guidelines. The ICD coding guidelines are mainly in the front of the ICD manual, and you need to read through them to just make yourself aware of the special rules. You should highlight key things or make notes in the margins. That will help you locate the pertinent guidelines during the exam, if you need a quick review on something. For the CPT guidelines; that are in the front of each section. Those are also worth reading and doing some notes in the margins. The whole CPC exam is about following the guidelines; any guideline is fair game for a question on the exam. Hopefully you have done some more practice exams and you make a point of understanding why you get any question wrong. When I was studying for my exam, I kept a list of the rules/ guidelines that I had missed questions on and reviewed the list each day to remind myself of the rules/ guidelines and anything that I had missed because I had been simply too careless when I read the question.

I hope you do really well on the exam when you take it again!

 

[Ruth Sheets]

This topic was discussed by Laureen Jandrop during the July 2015 Q&A Webinar. She also presented a camera view of how she Bubble and Highlights the pages of her manual for the PCI codes. Very helpful!

If you missed the webinar, it is a great idea to sign up for the CCO Club. That way you will get access to the recording of the webinar, conveniently divided into video clips by topic. You also get the transcript, answer sheets, and a chance to earn a CEU for the webinar by passing a 10 question quiz. Not only that, but you can access all the available resources for past webinars, too!

 

[Ruth Sheets]

Just an update...this topic Percutaneous Coronary Intervention (PCI) CPT Coding was revisited by Laureeen Jandroep in the May 2016 Q&A Webinar. Join the CCO Club if you'd like to hear an updated version.