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PTCA of the OM1 and PDA

Date: Feb 12, 2014

Question:

Given the severity of the OM ISR, the AV circumflex stenosis, and the ostial PDA stenosis, a decision was made to perform an intervention. Through 6F guide, a coronary wire was advanced to the distal AV circumflex. A Sprinter OTW balloon was attempted to be advanced, however was unsuccessful as the AV circumflex was jailed by the previously placed ostial OM1 stent. Attention was then turned to the ostial OM1 ISR. A wire was advanced to the distal OM1. The ISR was dilated using a 3.0 x 10mm Angiosculpt OTW scoring balloon at 14 atm. Post angiography demonstrated an excellent angiographic result with TIMI 3 distal flow. Attention was then turned to the ostial PDA lesion. Through a JR4 6F guide, a coronary wire was advanced to the distal PDA. The ostial PDA lesion was dilated using a Sprinter 2.0 x 12mm OTW balloon at 14 atm for 78 seconds. Post-angiography demonstrated an excellent result with TIMI 3 distal flow in the PDA and minimal residual stenosis. How should this medicare case be coded? 92920 x 2 or 92920 & 92921? 2 consultants-2 different opinions

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