92941 added to Inpatient only list for 2018
Well, CMS just made life harder for all. They added CPT 92941 to the inpatient only list. But of course there is no crosswalk to an ICD-10-PCS code.
92941 is Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, artherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
So now we have to figure out what qualifies for 92941
Clearly an acute ST elevation MI going to the cath lab from the ED and getting PCI does.
But what about a non-ST elevation MI going to the cath lab from the ED where the troponin is only slightly elevated.
What if the patient goes from the ED to the tele unit and then the next day the cath lab?
Part of it is defining "during acute MI." Is that during the hospital stay? During the time the patient is actively killing myocardial cells? During the 90 days from day 1?
And what is a subtotal occlusion? Does an MI with a 70% lesion that is dilated and stented count? 80%?
I thought I grasped everything until I saw this comment on AAPC: "Medicare is now down-coding CPT code 92941, with a diagnosis of NSTEMI , to 92928 or 92920. See CPT Assistant, January 2014 for additional information." Of course I have no access to CPT assistant.
It would be great to sort this out and guide our doctors to clearly and properly document so that the auditors will know it was an MI with occlusion.
92941 is Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, artherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
So now we have to figure out what qualifies for 92941
Clearly an acute ST elevation MI going to the cath lab from the ED and getting PCI does.
But what about a non-ST elevation MI going to the cath lab from the ED where the troponin is only slightly elevated.
What if the patient goes from the ED to the tele unit and then the next day the cath lab?
Part of it is defining "during acute MI." Is that during the hospital stay? During the time the patient is actively killing myocardial cells? During the 90 days from day 1?
And what is a subtotal occlusion? Does an MI with a 70% lesion that is dilated and stented count? 80%?
I thought I grasped everything until I saw this comment on AAPC: "Medicare is now down-coding CPT code 92941, with a diagnosis of NSTEMI , to 92928 or 92920. See CPT Assistant, January 2014 for additional information." Of course I have no access to CPT assistant.
It would be great to sort this out and guide our doctors to clearly and properly document so that the auditors will know it was an MI with occlusion.
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Comments
Maybe this will help.....In reading CPT Assistant, January 2014, the reference to reporting 92928 states "Does not meet 'During Acute MI' criteria". There is also a definition of "subtotal occlusion" noted in the article: "Subtotal occlusion means there is markedly reduced flow through the lesion. There is no number assigned here. The subtotal occlusion must be present in the setting of an acute myocardial infarction (MI). A chronic subtotal occlusion in a patient who does not experience acute MI would not meet the criteria for this code." This in my opinion just validates that if the patient is not having an acute MI, this code cannot be used. It isn't to be reported for all non-totally occluded vessels.
The March 2014 CPT Assistant notes that the key to reporting CPT 92941 is the language "during acute myocardial infarction." If a patient is admitted with an AMI on Monday and a stent is placed on Tuesday, then the stent was not placed during the AMI so code 92928 would be the appropriate code to report.
In the December 2014 CPT Assistant, they provide a coding example for CPT 92941. It notes that based on the patient's presentation and EKG changes, acute MI is suspected and the patient is taken emergently to the cath lab. 99% stenosis of the LD is found with a filling defect consistent with a thrombus and slowed flow through the vessel. Aspiration thrombectomy, is followed by angioplasty and then a stent is placed. Due to "no reflow", intracoronary medication is administered and normal antegrade flow is restored. "Code 92941 for the LD intervention." They note that this is an acute subtotal or total occlusion during an acute MI. They also note to report 93463 for the intracoronary medication administration.