Ask Dr. Z

Patient comes to the cath lab through the ED and the physician performs a diagnostic coronary artery study followed by a stent placement in the right coronary (92928). Then later in the day, the doctor is notified of increasing chest pain, and a bedside echo demonstrates new inferoseptal wall motion abnormality with no effusion, so repeat right coronary angiography is performed with a change noted in RPDA, now complete occlusion; stent placed. Can both diagnostic studies be reported on the same day? I came up with codes 93454-26 and 93454-2676 because the initial diagnostic indicated, “…RCA: large, dominant. 90-95% prox. Small PDA with 50-70% mid… There was TIMI 2 flow into the distal PDA, which in the absence of symptoms, we elect to treat medically. Patient was given multiple IC doses of nitroprusside and nitroglycerin and begun on IV nitro drip.” And, there appears to be a change in clinical status with total occlusion. (Would a -78 modifier be appropriate on the second stent?) What are your thoughts?