Ask Dr. Z

We had a patient who had a left heart catheterization with PTCA and stent placement in the left circumflex. The patient was transferred back to a room and about a 1/2 hour after that procedure she developed acute onset substernal chest pain, ST elevation, nausea, vomiting, and diaphoresis. She was taken back to the cath lab and showed to have acute stent thrombosis after the previous stent placement. A successful PTCA of the stent thrombosis was done, and a stent was also placed distally in the left circumflex to ensure that there was no distal edge dissection. We billed codes 93458 and 92928-LC for the first procedure and codes 93454, 92928-LC, and 92941-LC (for PTCA of stent thrombosis) for the second procedure. Can we bill for both procedures done on the same day since the code is the same for the stent placement? And can we bill for two separate heart catheterization codes if they were done on both procedures?