Coding for when a percutaneous transluminal coronary angioplasty (PTCA) is performed, a drug-eluting stent (DES) is attempted, but provider is unable to cross lesion

Q.

If a percutaneous transluminal coronary angioplasty (PTCA) is performed, then a drug-eluting stent (DES) is attempted, but the provider is unable to cross lesion do you charge this using Level ll HCPCS code C9600-74. I am performing coding and billing for a hospital and this patient is a Medicare outpatient.

A.

You code for the completed procedure, so you would code this as an angioplasty and not a stent placement. When modifiers 73 and 74 were introduced, Medicare said the following about billing when there were multiple planned procedures. 

“When one or more of the procedures planned is completed, the completed procedures are reported as usual. The other(s) that were planned, and not started, are not reported. When none of the procedures that were planned are completed, and the patient has been prepared and taken to the procedure room, the first procedure that was planned, but not completed is reported with modifier -73. If the first procedure has been started (scope inserted, intubation started, incision made, etc.) and/or the patient has received anesthesia, modifier -74 is used. The other procedures are not reported.

If the first procedure is terminated prior to the induction of anesthesia and before the patient is wheeled into the procedure room, the procedure should not be reported. The patient has to be taken to the room where the procedure is to be performed in order to report modifier -73 or -74.”

If you could not get the wire or stent across the lesion, then you could not start the stent placement, so it is not coded. 

Remember, Level ll C-codes are only to be used for coding and billing Medicare for Outpatient Prospective Payment System (OPPS) billing of hospital services. Do not submit these C-codes for other payers unless clearly instructed by the payor to use them instead of CPT codes.