Ask Dr. Z

A patient presents for diagnostic coronary angiography. Per the procedure report: "There was 100% occlusion in the proximal to mid left main coronary artery due to leaflet from a pre-existing surgical bioprosthetic valve after valve-in-valve TAVR with complete effacement of the sinuses by the transcatheter heart valve with no visible antegrade filling of the left main during this or by prior angiograms performed after TAVR. This lesion meets the definition of a chronic total occlusion, greater than three months old." A CTO device was used to facilitate crossing the chronic total occlusion prior to intervention, and balloon angioplasty was performed. Since the left main's occlusion was not caused by atherosclerosis, intimal hyperplasia, thrombus, inflammation, etc., but rather by an aortic valve leaflet, does revascularization code 92943 still apply? If not, what CPT code should be reported and why?