Ask Dr. Z

Physician states he utilized a 6 French cath for engagement of the RCA. It was difficult to engage the ostium and he attempted to use side holes. More stable support was achieved with AL 0.75 cath. Engaged without difficulty. Lesion was crossed utilizing 014 Prowater guidance. At this point after crossing the lesion attempted to cross the severe stenosis in the proximal RCA. He was unable to cross. Subsequently exchanged for 1.2 x 12 threader dilation sys. and PTCA was performed in the mid lesion with some improvement. Then attemped to dilate with 2.0 x 6 sprinter dilation sys. and was unable to cross utilizing the 2.25 x 12 resolute onyx stent. What is the correct way to code this? Code the attempted RCA stent with modifier 74? The angioplasty was successful but if you go with charging the PTA instead of the stent to the RCA, can you still change the supply charge for the stent? I understand you should charge was actually done, but how does your facility not lose the cost of stent that was attempted.