Ask Dr. Z

92941, Acute MI

My physician stented the right coronary and the left circumflex when the patient presented with an MI. Can I bill code 92941 for each vessel, or do I bill codes 92941 and 92928 (for the second intervention)? Thank you so much!

92941

Dr Z. Per documentation pt presents with a non-stemi acute MI. SCA shows total occlusion of the proximal RC. PTCA done. Procedure ended. We are questioning how to bill this as 92941 states ANY combination of stent, atherectomy and angioplasty. Does this mean that more that one intervention must be done on the lesion in order to bill with 92941? Would 92920 be the correct code to use? Thanks for your assistance. JD

92941 and 92928 in the same vessel.

Patient presents with STEMI involving both left anterior descending and left circumflex coronary arteries. Provider places drug-eluting stent in proximal LAD, mid LAD, second diagonal, and 3rd marginal branches. Based on being allowed to bill 92941 once during the procedure, would appropriate coding be 92941-LD, 92928-LD-51, 92929-LD (as hb charge), and 92928-LC-51? Or would the second stent in the LAD be considered part of the 92941 and should we only bill 92928-LD as a facility charge in the diagonal branch?

92941

Dr.Z For CPT code 92941, would that cover all AMI's even if the %blockage was say 80% and not a total/subtotal occlusion. Thanks

92941 and NSTEMI

I have been told that you shouldn't use code 92941 for non-ST MIs. Is this correct?

C9606

Hello Dr. Z. I have a question for you regarding the new CPT Code 92941. I believe there is much confusion regarding the use of this code. While I though I understood the concept of CPT 92941 (patient with MI and having a combination of BMS/DES Stenting, Angioplasty or Atherectomy), I'm not sure I do. If I have a patient who presents with an MI but we only insert a BMS or DES stent, am I to charge CPT Code 92928 or C9600 since CPT 92941 requires a combination of stenting, angioplasty or atherectomy? If this is the case, why have CPT 92941 when CPT Code 92928 & C9600 includes angioplasty. This seems to me to be the most common procedure performed as a combination. Thank you in advance for your help. Candy

Clarification on CPT Code 92941

Can we bill code 92941 if patients are diagnosed with NSTEMIs but are stable and not taken to the cath lab until the next day and an intervention is performed?

92941 Multiple Times?

Is it ever okay to bill 92941 twice in one day? Examples: If the MD states co-culprit lesions for the STEMI? Or if the patient has two different STEMIs noted on the same day with different culprit lesions and different MDs intervening (different practices)?

92941

I have a doctor who feels that he does not need to use the word emergent for when he performs a PCI during an acute MI (92941). Do you know of any documentation per CMS that provides that clarification that I can reference for him to see that understanding? Any references would be greatly appreciated or documentation or articles that I can use to help him understand this reference.

CPT 92941 Acute MI

Does a provider need to state urgent or emergent for acute MI to use 92941 for acute MI?

92941 vs. 92943

I need help determining the different documentation needs of codes 92941 and 9294.. Providers are clearly documenting the total occlusion when doing the stents, but not that the occlusion is chronic or acute. Sometimes there is an MI within the previous 4 weeks, and sometimes no MI is involved. I want to give appropriate feedback to providers of documentation needs to appropriately code these procedures.

92941 Revascularization of Acute/Subtotal Occlusion during Acute MI

Would you recommend using code 92941 if the MD chooses the dx 410.XX (acute MI) diagnosis code, or does it have to specifically say "acute MI" or "AMI" in dictation? Most of our docs call it a STEMI or NSTEMI, but fail to mention the word "acute". I am assuming the most of them are acute?

AMI with Thrombectomy Only

Patient presents with AMI. Culprit lesion treated with aspiration thrombectomy followed by AngioJet thrombectomy (92973). The physician tried to wire lesion past occlusion but could not make it across. Can I charge 92941 for the aspiration thrombectomy if it's the only intervention performed in the list of included components for 92941?

92941 dictation?

What supports the MI stent? Does the dictation have to say they were taken emergently? Does emergently mean it's an MI? Doesn't the hospital coding have to match the physicians? For example, 92941, C9606 in same setting, is it possible to code 92928, C9606 in same setting? I'm very confused now after an audit. Where can I get the rules in black and white hard copy paper?

Acute MI 92941

Pt. came in as a stemi. Pt. had previous grafts and the physician stented the native circumflex,not going through svg.In the final impression he stated that the svg to the om was the culprit lesion. I'm assuming, due to years working in the cath lab, and not what the physician stated in his dictation that he opened the native circumflex to get flow to the om. If the pt. comes in infarcting but he doesn't do the culprit lesion, can we still charge AMI-92941?

IS IT 92941?

I have an unusual case and need your help. Patient presented with NSTEMI in the middle of the night. He was responsive to nitro, and it was decided to defer consult until the morning. Throughout the night the pain waxed and waned, and he was responsive to increased nitro each time. When the cardiologist consulted in the morning, the patient stated he was having difficulty breathing.

"Impression: NSTEMI: Patient is having post-infarction angina and is developing heart failure. Emergent heart catherization recommended."

Stent was placed in the circumflex with resolution of symptoms. I'm having difficulty deciding whether to bill 92941 vs. 92928. It is documented the patient had an acute MI of the circumflex; however, with the initial deferral and the mention of POST- infarction angina, does the emergent status still allow for the stent to be reported using 92941?

Acute MI that is too unstable to go directly to cath lab

A provider wants to bill a 92941 for a patient with an acute MI who was too unstable to go directly to the cath lab. The patient was stabilized and sent for a cath and intervention later. Would this be coded with a 92941?

92941 after tPA

If a patient presents to a small, rural facility with an NSTEMI/STEMI, and then the patient is given tPA or other thrombolytic therapy and then emergently transferred to a larger facility for an emergent coronary angiography/interventional procedure, can the larger facility still charge code 92941? Also, would there be a time limit from the diagnosis of NSTEMI/STEMI at the rural facility to transfer/treatment at the larger facility?

92941 Clarification

Does the following documentation/example support the use of code 92941? Indications listed in the procedure note include known history of CAD, status post prior stenting of LC, typical chest pain, EKG suggestive of inferior wall ischemia, and cardiac enzymes that became positive. Because of her increase in enzymes and her acute EKG change, she was taken emergently to cardiac catheterization laboratory. Findings consist of 70% hazy lesion of the LC as the culprit lesion and is type A or low risk. Procedure performed was angioplasty of the circumflex artery. 

Vasodilator or catheter placement for acute mi treatment

Our doctor is wanting to charge an acute MI intervention (92941), but the following text is from the report and this was all that was performed. "Placement of Pronto catheter intracoronary in the ramus intermedius with direct delivery of vasodilators including nitroglycerin, veramil, and nipride with improvement of vasospasm. Intervention on the ramus intermedius was performed as detailed above with no balloon angioplasty or stent placement." Would any of this warrant the billing of 92941?

Code 92941

If a physician documents "recent non-ST evelvation myocardial infarction" as the indication, but the patient is not brought to the cath lab acutely, would code 92941 be appropriate for DES/BMS placement? Or would code 92928 be better? Several of our physician are documenting non-ST elevation myocardial infarction for indication for the procedure, but patients are not being brought to the cath lab for several days. I have been using codes 92928, 92920, 92937, etc., because the description reads "during acute MI". Is my thinking correct?

Acute MI in a Branch

The CPT description for 92941 only states coronary artery or coronary artery bypass graft, but it does not mention coronary artery branch like the description for 92943. Does this mean that if the patient has an acute occlusion in the branch of a coronary artery during an acute MI we cannot report 92941? Report states: "99% lesion in the proximal portion of the 2nd diagonal; successfully stented with a 2.25 x 15 mm XIENCE drug-eluting stent, followed by post dilatation using 2.25 high pressure balloon. Excellent opening and TIMI 3 flow. Patent LM, LAD, circumflex, and dominant RCA."

92941 with Other Vessel Interventions

Patient admitted with an acute myocardial infarction. Procedure note documents that a stent was placed in the diagonal vessel of the left main which was presumed to be the culprit vasculature. They then redirected the wire down the left anterior descending artery and in the proximal left anterior descending artery, stented an eccentric lesion that was 85% stenosed. The wire was redirected down the circumflex system and a stent was deployed across the circumflex marginal vessel. The physician is billing 92941, 92938 and 92944. I don't agree with this code selection.

X modifiers in the coronary arteries

When using multiple PCI codes (92920-92944), is it necessary to add an -X modifier in addition to the vessel modifier (LC, LD, LM, RC, RI)? Procedure performed included angioplasty and stenting of the proximal and distal vein graft to the PDA with two drug-eluting stents as well as angioplasty and stenting of the proximal vein graft to the obtuse marginal artery using one drug-eluting stent. This was done in the setting of an AMI with the PDA being the culprit vessel. Would you code 92941-RC and 92937-LC? Or would you code 92941-RC and 92937-XS-LC? Would -XS ever be appropriate to use when coding the coronary arteries?

AMI in More than One Vessel

We had a patient present to the cath lab with AMI. Doctor documented that the "culprit" lesions were in both the LC and LD. Can we bill code 92941 more than once?

Physician documentation of acute MI

In the Case of the Month for May 2018 an acute MI was not documented. The EKG showed ST elevations, and patient was taken to the cath lab emergently, but neither of these proves an acute MI. Under “3.) LAD” it states that lesions of the LAD “seem to be the culprit for current presentation” (substernal chest discomfort and dyspnea only). Also, there was no thrombus in the LAD, which is often present in an acute MI. Although the case does meet the three criteria for use of 92941 as described in CPT Assistant Jan 2014, that article warns that conditions such as non-cardiac chest pain or unstable angina “do not fulfill the designation requirement of ‘during acute myocardial infarction,’ even if there is emergent activation of the catheterization laboratory.” Under these circumstances I question whether code I21.02 or the acute MI procedure code 92941/C9606 are appropriate. Is it okay to code an acute MI in the absence of physician documentation of an acute MI when the three criteria are met?

I21.4, Non-ST elevation (NSTEMI) myocardial infarction

Should code 92941 be used for NSTEMI?

93454 with 92941

Is it appropriate to report both codes in this scenario? Complaining of epigastric/chest pain. ECG showed ST elevations and Q waves V2-V4. Patient was taken urgently to cath lab for LHC and possible PCI. The report indicates, "Mid LAD lesion and decision for PCI."

Failed Acute PCI

Would a failed attempt at treating an acute MI require a -53 modifier on 92941? There was no stent placed, and the angioplasty failed to restore flow.

IVUS Study

Two interventionists performed separate interventions during the same case; one did 92941-RC and the other 92928-LD. Each performed IVUS on the artery they intervened on. Can each bill for an initial vessel IVUS for professional billing? 

coronary IVL - 0715T

Can code 0715T for coronary IVL (Shockwave) be reported with C9600-C9608 for coronary interventions performed with the use of drug-eluting stents? Or is its use limited to 92920, 92924, 92928, 92933, 92937, 92941, 92943, and 92975?

93458 with return for 93454

Left heart cath documented along with 92941 and 75630 with verified PAD, later same day return due to chest pain and did 93454 to make sure nothing else was wrong. Can we charge both 93458 and 93454-59 same day for separate sessions? 

0715T Facility vs Professional

I am coding for a hospital, and we are being told that 0715T is for use for physicians only and not valid for facility billing. Can you confirm whether or not 0715T should be coded for facility when performed in conjunction with the codes listed in the CPT book 92920, 92924, 92928,92933,92937, 92941, 92943, 92975?

92943 vs. 92941 vs. 92928

If the physician just states that the RCA is totally occluded without saying "chronic total occlusion", can we report code 92943, or should we report code 92928 instead?

Is an "evolving STEMI considered acute?

Patient presented to ER with CP @ 21:19PM; first troponins were negative. Patient left AMI before second troponin results came back. ER staff called patient to return to the hospital. Patient returned next morning at 7:53 with CP, jaw pain, sweating. EKG showed ST elevation V3 and aVF, ST depression V2 and aVL. Patient taken to cath lab emergently. Would 92941 be appropriate in this scenario?

Non Primary PCI with NSTEMI

"Patient was brought emergently to cath lab for NSTEMI. Coronary angiography was performed, and then aspiration thrombectomy and PCI with drug-eluting stent to RCA was performed, which was considered to be the culprit vessel. The RCA had 99% stenosis." The physician also documented, "Patient did not undergo primary PCI." Should we still report code 92941-RC?

Chronic Total Occlusion 92943

Can I report CPT codes 92941 and 92943 in an "elective status" scenario? Or only in "emergency status" situations? If the patient has a CTO and goes in for an elective PCI, is it okay to report code 92943?

STEMI Bypass

Our interventionalists are asking when an AMI patient has intervention in a bypass graft, is there an additional code available to report, since both drug eluting stent in bypass graft (92937) and STEMI/bypass acute total/subtotal occlusion (92941) are performed?

CPT 92972 with atherectomy/angioplasty/DES stent placement

Code 92972 has replaced 0715T in 2024 for percutaneous transluminal coronary lithotripsy. If atherectomy and/or angioplasty with stent is performed as well, should the C9600-C9608 series be coded or in conjunction with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975?

Acute MI

Patient came in with acute myocardial infarction, and the physician performed aspiration thrombectomy to the LC and RC, and then the patient coded and expired. Would you report code 92941 for this where aspiration thrombectomy was the only procedure performed?

STEMI and CTO Same Vessel

The physician dictated 100% 26 mm long thrombotic culprit lesion in the mid LC was successfully stented during acute MI. He also states 100% 38 mm long CTO lesion in the second OM was successfully stented. If I bill the STEMI code 92941-LC, what would be the appropriate code for the CTO in the branch?

Acute NSTEMI

On a previous question you stated there is no timeline to define exact timing for an acute NSTEMI, but that it would not extend to several days. What then would be the definition of "several"? We have a patient who was admitted on the 1st and had diagnostic catheterization on the 2nd, but because of patient's history of GI bleed the intervention wasn't done until the 4th. Would this still be considered acute? Also...in the CPT code description for 92941 it states "during acute myocardial infarction".  What exactly do they mean by that?

0715T when coronary lithotripsy is performed.

Can we get clarification on when/when not to use 0715T when a coronary lithotripsy is performed? The CPT Codebook states the following: "Use 0715T in conjunction with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975."  It looks like it can be used for angioplasty, atherectomy, or stent placement. Can we also use it with drug-eluting stent placement?

Acute Stemi in progress during intervention

If an inpatient is scheduled for a heart cath but goes into an acute MI while being taken to the cath lab and/or goes into an acute Mi during intervention, can I bill code 92941? When reading the code it seems to indicate that intervention during an acute AMI would be appropriate if supported by the documentation. Our physician's argument is that the MI during the intervention has greatly increased the complications of the case. Any guidance you can share with us would be greatly appreciated.

MI with Multiple Culprit Lesions

I work for an acute care hospital facility. Patient arrives in process of having an STEMI. The physician describes multiple "culprit" lesions and doesn't identify only one as the cause of the MI. Is it correct to code more than one intervention utilizing the acute MI codes such as C9604, C9606, and 92941 if the physician decribes several culprit lesions?

0715T coding with C1761 and 92920

(For percutaneous transluminal coronary lithotripsy, use 0715T). (Use 0715T in conjunction with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975)

Patient had a 92920 along with 0715T. Which requires c1761 for the0715T. We are being told not to report code 92920 with c1761. But 0715T requires the c1761. Would we change the supply code c1761 to possibly c1725?

CPT code +0715T

Can you please help? My provider states Shockwave 0715T is a form of atherectomy. I am having a hard time understanding this because Shockwave is an add-on code to 92920, 92924, 92928, 92933, 92941, 92943, and 92975. It seems to me that if it was a form or part of an atherectomy that they would have just added Shockwave to the 92924 or 92933 description. Also what code should this be compared with since there is not a Medicare fee schedule? Is it most similar to 92975?

Return to cath lab after primary stenting earlier in the day

This patient had left heart cath with selective right and left coronary angiography (93458-26-59) along with PCI with stent to the LAD for STEMI (92941-LD) and stent to the RCA (92928-RC). In the recovery room, while undergoing echocardiography, he developed ventricular fibrillation and was returned to the cath lab, suspecting another cardiac event. He underwent right and left coronary angiography (93454) at this time but no stent. What modifier do I require on the 93454? I do not believe it would be -76 because it isn't the same CPT code. I am now debating between -78 and -59. 

Code C9606

In an earlier Q&A, you recommend code 92941 for treatment of an MI with angioplasty, atherectomy, OR stent placement... or all of these. If a drug eluting stent is used, code C9606 applies for hospitals. Would code C9606 be the correct code to report if the patient had ONLY a drug eluting stent placed in the LAD?

Cath Lab Critical Care

I am in need of some guidance coding critical care performed during cath lab procedures. For example, in an op report for a stent placement for a patient with an acute MI, the op report would say, "Spent 70 minutes of critical care time stabilizing patient with acute MI." Would I be able to report code 99291 in addition to 92941? In what cases, if any, is it okay to bill for critical care that is performed during a procedure, or is it considered bundled?