Ask Dr. Z

Multi-faceted question for different scenarios; however, all have the same end question regarding the -74 modifier. Report lower level code or what you intended to do?

• Diagnostic coronary and physician is attempting to stent a coronary lesion. He states he easily crosses the lesion with a guidewire but is not able to cross with a balloon or stent. Do we charge 92920-74 or 92928-74?

• Physician is performing staged staged PCI but cannot cross the lesion with the wire. Physician spent considerable amount of time on the effort (greater than 10 minutes). 92920-74 or 92928-74?

• Diagnostic coronary and a lesion is found in the LAD. 10 minutes are spent attempting to cross the lesion without success and determine it is CTO. 92920-74 or 92943-74?

Auditors prefer we use the higher code but would appreciate your guidance. The only thing I found in Q&A was in regards to an aborted cardiac cath and the advice is "report the lower level procedure".