Topic Under Discussion:

How do you charge for two stent lesions?
My understanding is that you cannot charge for an additional vessel if lesions are in the same vessel or if it is in the same system. For example, we do not charge for additional lesions even if one is in the LAD and the other one is in the CFX. However, if the additional lesion is in the RCA, then we do charge. I ask because APC™s Weekly Monitor on June 18th makes it sound like we can charge for additional lesions.

Thank you,
Larry Sneed, BS, RCP
Coordinator, Cath Lab
Alamance Regional Medical Center
sneelarr@armc.com

Group Members™ Responses to ¦
How do you charge for additional stented lesions?

From the U.K.
You should be able to charge for the extra stents used, regardless of the number of vessels stented.
Annie Ollivierre-Smith, The London Independent Hospital Cath Lab
London, England
annieollivierre@yahoo.co.uk

Different vessels, yes
We do charge for vessels (i.e., we would charge for a stent in the LAD and one in the CX because these are two different vessels.) We do not charge for more than one lesion that is in the same vessel.
carletta@weirtonmedical.com

Check appropriate sources
As I see it, both the LAD and CX are two different second order vessels. We currently do not do cardiac intervention, but we do peripheral. You can only charge to the highest level of service, i.e. PTCA, then x2 for each second order vessel entered. You would also charge for two stents. Your facility should have a company that does chargemaster review annually. Contact them for final clarification and/or your coding department. Some items are chargemaster-driven and some are coded in Abstract Coding. Check with your Business Office Manager.
Steve Gressmire RT(R)(CV) ARRT, ACCA Cardiology Services Manager, Northwest Mississippi Regional Medical Center
Steve.Gressmire@nwmrmc.hma-corp.com

Don™t charge if branch
We charge for stents in the LAD, Circ and RCA. We do not charge for additional stenting if the lesion is in a branch of one of those already stented. For example, if the LAD is stented, and the OM is stented, then that is 2 stent charges. If the Circ is stented and the Diagonal is stented, then that is two charges. If the RCA and the PDA are stented, then that is one charge.
Todd Ginapp
tginapp@houston.rr.com

We do the same as Todd Ginapp (see above).
Charles Williams, RPA, RT(R)(CV)(CI), RCIS
Emory University Hospital, Atlanta, GA
CharlesWilliams@mail.weber.edu

Know vessel families
As I see it, the ACC recognizes 3 major coronary arteries: LAD, LCX, and RCA. Each one of these divisions is charged by the VESSEL, not the number of lesions treated. Thusly, LAD, LCX, and RCA can each be charged as Initial, and each additional vessel(s). Multiple stents in the same vessel family cannot be charged as separate procedures, but, of course, each stent(supply) can be billed...By the way, this pertains to peripheral procedures, also, utilizing the family approach...
Hope this helps!
Alex
Alex.Holmes@tenethealth.com

Charge for higher one
As long as they are not in the same vessel. You can charge for LAD, CFX. If there are two in the same vessel (LAD, DIAG) charge for the higher one...for example, if you have a non-coated stent in the Diag, but put a drug-eluting stent in the LAD, charge for the LAD, but if you put DES in both the LAD and CFX, charge for both!
Kevin Rich, BS, RN, RCIS
ldrich3@comcast.net

Additional devices ok, just not procedure
The vessels are broken down into 4: Left main, LCA (includes septals and all diagonals), LCX (includes all marginals) and RCA (includes PL and PDA). So if you do an intervention on the LAD and LCX, that is a primary and secondary lesion charge. But if it is the LAD and Diag, it is only primary vessel. You can charge for the additional devices, just not procedure. That comes from our outside contracted coder.
LTracijo Capua, RT(R), Cath Lab Coordinator
Flagler Hospital, Inc.
Tracy.Capua@flaglerhospital.org

Only if more than one of 3 vessels
We charge for PTCA/stent multi-vessel if it is in more than one of the 3 vessels (RCA, CX, LAD). When we do multi-lesions in one vessel, I charge for the procedure and then the number of stents, balloons and etc. used. Also the physicians do not get credit for more than one procedure unless they enter more than one of the 3 vessels.
JudithF@mcgh.org

Only for LAD, Circ and RCA
For billing purposes, we can only bill for stents placed in LAD, Circ and RCA. For example, if you stent a mid-LAD and also a diagonal, this is billed as one, but if you stent the mid-LAD and the RCA, this is billed as stent and a stent to an additional vessel.
Annie Ruppert RN
Annie.Ruppert@sharp.com

Range of examples
It's my understanding that the LAD/ Diagonals are considered one system, and if the graft to the LAD/Diag is being stented, that is also part of the LAD unit.

The same holds true for the LCX/OM vessels. The RCA and vessels stented in the PDA/PLA system are all part of the RCA. So if you stent the LAD and LCX system, and use two or more drug-eluting stents, you charge for DES stenting of LD; and then DES stenting for the additional vessel (LC) up to 3 systems if they are all stented.

If using bare metal stents and DES stents, the primary lesion is the DES stenting code, and the additional vessel is the code for stenting the additional vessel.

When multiple stents are in one vessel, one procedural stent charge is done and the supply charge is done for what's used. Remember to utilize the 59 for coronary and LV imaging charges when starting with the LHC and continuing on to the intervention.
Chris Reoch RCIS
reochris2000@comcast.net

Next month¦The Email Discussion Group takes on two topics:

1. How does your hospital policy on defibrillation address non-nursing personnel in the cath lab? Are your Rad Techs or Resp Therapists allowed to defibrillate if they are ACLS-certified? Is that a department policy or covered under a hospital policy?

2. Other than an acute MI, what are considered emergency cases after normal operating hours? Do you have specific criteria? Do your interventionalists follow them?

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