July 2016 Q & A

Question: Does a CTO 92943 have to be staged?

Since a CTO is a CHRONIC total occlusion, does it need to be staged? They would know about it ahead of time, since it is chronic. But what if the doctor finds a CTO upon first diagnostic angiography, and is able to treat it with some type of intervention at that same session? Would that be billed as a 92943 along with the cardiac cath code (w/59)? Or, because it is the first time it was found, is the PCI code just the 92928, 92920, 92924, 92933 etc instead of 92943? Do we need to find prior documentation showing CTO was known about prior to intervention?

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