AHA Coding Clinic® for ICD-9 - 2011 Issue 1; Ask the Editor

Dissection of Artery Occurring During Coronary Intervention

A patient underwent coronary angioplasty with stent deployment. During the procedure, the patient developed chest pain and ST-segment changes. Angiogram revealed a dissection throughout the proximal mid-portion of the vessel. A Voyager balloon was re-advanced into the vessel and multiple inflations were performed. A stent was advanced into the distal portion of the vessel next to the previously deployed stent with subsequent balloon inflations. A third stent was then advanced in the proximal portion of the vessel with balloon inflation. Additional arteriogram revealed control of the dissection and a widely patent vessel. When queried, the provider indicated that the dissection was a complication of the procedure. Should code 997.1, Cardiac complications, or code 998.2, Accidental puncture or laceration during a procedure, be assigned for complicated dissections occurring during percutaneous transluminal coronary angioplasty (PTCA)? What is the correct diagnosis code assignment for a clinically significant dissection occurring during PTCA? ...

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