Percutaneous Coronary Intervention (PCI)*

Outpatient Coding for PCI

CPT codes 92920 -92944

• They’re reported by major coronary arteries and their branches. Modifiers must be used to identify each, otherwise, the payer may deny the service.

– Left main coronary (modifier LM)

– Left anterior descending artery (LD)

– Left circumflex (LC)

– Right coronary artery (RC)

– Ramus intermedium artery (RI)

• This is a variant coronary artery resulting from trifurcation of the left main coronary artery. It is present in ~20% (range 15-30%) of the population.

Coding CPT example:

• A balloon was used for a main right coronary artery, a stent in the posterior descending of the artery, and a second stent was placed in the left circumflex

Code 92928-RC (percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery of branch.)

– plus 92921 –RC

– 92928- LC (percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch.)

Documentation for CPT/HCPCS

Make sure that documentation includes every component of the code’s description

• Plus: any other regulations like LCD/NCDs

What is included in the PCI code?

Make sure that documentation includes every component of the code’s description

PCI coding hierarchy

Stent

• 92928, 92929 or 92933, 92934

Atherectomy

• 92924 and 92925

Just the Balloon

• 92920 and 92921

• Each code in the family, including balloon angioplasty and when it was performed.

• Diagnostic coronary angiography codes (93454-93461) and injection procedure codes (93563-93564) should not be used with percutaneous coronary revascularization services (92920-92944) to report:

Contrast injections, angiography, road mapping, and/or fluoroscopic guidance for the coronary intervention

Vessel measurement for the coronary intervention

Post-coronary angioplasty/stent/atherectomy angiography, as this work is captured in the percutaneous coronary revascularization services codes (92920-92944).

References and Additional Notes:

* This tool is not intended to diagnose, evaluate or treat patients. Each provider is responsible for the clinical and diagnostic decisions pertinent to their patient’s medical care.

** CMS-HCC scores are based on CMS’ 2020 community-nondual-aged enrollees.