Question: When the cardiologist places a stent in a coronary bypass graft, which modifier should we use? For example, if the patient has a saphenous vein graft going from the aorta to the right coronary artery, should we use a modifier to identify the graft?
Answer: Typical payer policies will instruct you to append modifier RC (Right coronary artery) for the case you describe.
Here’s why: When the cardiologist places a stent in a coronary graft, you should use an anatomic modifier just as you would if she placed the stent in a native coronary vessel. For many payers, you will find written policies instructing you to base the modifier you use for the graft on the vessel the blood flows into.
Modifiers: The modifiers in question are RC, LC (Left circumflex coronary artery), and LD (Left anterior descending coronary artery).
In your example, the graft attaches to the aorta and the right coronary artery, allowing blood to flow into the right coronary artery. Therefore, when reporting stent placement in this graft, you should append modifier RC. For instance, you may append RC to 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel).
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National Government Services (NGS), Part B carrier for Indiana, supports this modifier use in its “Local Coverage Article for Percutaneous Coronary Interventions – Supplemental Instructions Article (A50611).” The article states that “Medicare recognizes only three coronary arteries when...
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