Ask Dr. Z

How do we report a planned PTCA on a CTO (chronic total occlusion) when we were not able to get a guide wire past the lesion and are not able to place a catheter to do the angioplasty. The patient had a diagnostic LHC with cors which identified 100% stenosis in the proximal RCA, mid LAD and 70% stenosis in the 1st diagonal.

“014/300 Straight Prowater wire was unable to cross the lesion.
014/300cm Persuader 3 wire was unable to cross the lesion.
7FrAL.75 with side holes Wiseguide guiding catheter was used to cannulate the vessel and angiography was performed in two orthogonal planes.
014/300cm Persuader 3 wire was unable to cross the lesion.
A percutaneous intervention was attempted on the 100% lesion in the proximal RCA. Following intervention there was a 100% residual stenosis. This was not a bifurcation lesion. This was an ACC/AHA type C “high risk” lesion for intervention. There was no evidence of the transient no-reflow phenomenon. There was TIMI O flow before the procedure and TIMI O flow after the procedure.”

I reviewed questions in your data base but could not find any that address physician billing for incomplete PTCA. Do we report this service with modifier 52 on 92982 in addition to the diagnostic cath codes?

How would we report a PTCA if the guidewire is advanced into the vessel but the balloon catheter could not be expanded.

Thanks for your help.