Ask Dr. Z

The patient was brought in for a scheduled PCI of the RCA after a recent a diagnostic angiogram showed a 90% stenosis. However, the provider documented they were only able to probe the lesion a couple times with a guidewire and did not have adequate resources to continue. The end result is an unsuccessful crossing of the RCA lesion with plans for another PCI attempt in the future at a different facility. The patient had a coronary angiogram done during this procedure, so the question is: do we code for the coronary angiogram only even though the patient had a prior catheterization? Or do we code for an attempted intervention with a -74 modifier? I was thinking if we can't bill for this second coronary angiogram, we would only code a catheter placement into the aorta.

This is a hypothetical situation with the hope to better understand when an attempt could be coded for scheduled PCIs. There is, of course, grey area when it comes to what the provider might document for such a scenario.