Modifiers

When submitting a particular service on a claim, it is sometimes necessary to report a modifier with the CPT® code. A modifier allows a way to indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. Modifiers also enable health care professionals to effectively respond to payment policy requirements established by other entities. Some modifiers apply to either physician or hospital outpatient claims; some may only be relevant for one or the other. A complete list of modifiers is included in the HCPCS and CPT® coding books; the concept of modifiers does not apply to ICD-10-PCS procedure codes.

Hospital Inpatient Reimbursement 

Selecting the Appropriate ICD-10-PCS Code

ICD-10-PCS, including the ICD-10-PCS Official Guidelines for Coding and Reporting, replaced ICD-9-CM procedure codes for dates of discharge for inpatients that occur on or after October 1, 2015. ICD-10-PCS is not related to ICD-10-CM, but was developed specifically to meet healthcare needs for a procedure code system

The ICD-10 updates for the Fiscal Year (FY) 2017 represents the first code update since the implementation of ICD-10-CM/PCS in the US.

The following table lists some of the most commonly used code categories for coronary procedures. Given the large number of individual procedure codes available for procedures in ICD-10-PCS, please refer to your coding reference book or coding software to look up the associated Body Part, Approach, Contrast, Device and/or Qualifier that best aligns to the procedure performed as identified below

Common ICD-10-PCS Coronary Procedure Code Categories 

Procedure	Description
Angiography and Other Imaging
B21– – – –	Imaging of heart, fluoroscopy
B31– – – –	Imaging of upper arteries, fluoroscopy
B22– – – –	Computed tomography, heart
B32– – – –	Computed tomography, upper arteries
B24–ZZ3	Intravascular imaging of coronary vessels
Measurement and Monitoring
4A023N –	Measurement, cardiac, percutaneous, sampling and pressure (cardiac cath)
4A033– –	Measurement, arterial, percutaneous
Percutaneous Angioplasty / Stent Placement
027–3 – –	Percutaneous dilation of coronary arteries
037–3 – –	Percutaneous dilation of upper arteries
Percutaneous Atherectomy or Thrombectomy
02C–3ZZ	Percutaneous extirpation of coronary arteries
03C–3ZZ	Percutaneous extirpation of upper arteries
Other Supportive Therapies
3E0– – – –	Injection or infusion
5A0– – – –	Extracorporeal assistance (includes supersaturated oxygen therapy, balloon pump, impeller pump)
02HA3R–	Insertion of percutaneous external heart assist device
02PYXDZ	Non-operative removal of heart assist system

Under ICD-10-PCS, the 4th character Body Part for coronary interventions indicates number of sites within the coronary arteries, so a single code may capture all services provided. However, if different methodologies are used in different sites (e.g., angioplasty only, angioplasty with stenting, or atherectomy), or if multiple root operations with different objectives are performed on the same body part, code each separately