Knowledge Base Article

I am often thankful that I do not have to deal with the verbose writings of the legal profession. But sometimes medical terminology, medical coding descriptions and Medicare regulations can offer similar challenges. Take for example the CPT code 92941- with words like “percutaneous transluminal” and “atherectomy” in the description, you wouldn’t think the confusion would be about the term “acute myocardial infarction” but evidently it is.

CODE DESCRIPTION

CPT code 92941

Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel.

Luckily, the AMA has clarified what constitutes an acute MI for the use of this CPT code. According to the ZHealth Online Newsletter for March 21, 2014, the AMA states that all of the following criteria must be met in order to support the assignment of CPT code 92941:

• EKG changes consistent with an AMI, such as:
• ST elevation not attributable to a bundle branch block or pericarditis
• New or undetermined left bundle branch block
• New or evolving Q waves
• Persistent horizontal ST depressions in the anterior leads consistent with posterior ST elevation
• Ongoing ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, or asystole consistent with an AMI
• Ongoing symptoms suggestive of an AMI despite nonspecific EKG changes.
• Emergent coronary angiography and intervention. This is an essential component – it is not appropriate for the intervention to be scheduled, even from the day before. It must be performed immediately.
• The intervention is performed on a target lesion that is totally or sub-totally occluded (no or markedly reduced flow through the lesion).

It is not appropriate to report CPT code 92941 for non-cardiac chest pain, unstable angina, a non-ST elevation MI (unless it requires emergent intervention for a totally or sub-totally occluded lesion), or non-emergent interventions after a completed or recent MI.

Coders need to be sure the required components are present before assigning CPT 92941 for a coronary intervention. Like lawyers, coders must read the fine print.