A new section titled "Coronary Therapeutic Services and Procedures" was added to the Medicine section of the 2013 CPT manual. This new section introduces new codes 92920-92944 for coronary angioplasty, coronary atherectomy and placement of intracoronary stents in the coronary arteries and coronary artery bypass grafts. These new codes replace codes 92980-92984 & 92995-92996. The Coronary Therapeutic Services and Procedures section begins with guidelines that provide instruction for use of the codes, definitions of the major coronary arteries, recognized coronary branches, coronary artery bypass grafts, and describe the how the codes are built on a progressive hierarchy. This article is Part One of a two part article on these codes. Part One will introduce and discuss the base codes 92920 through 92934 -Angioplasty, Atherectomy, Placement of Intracoronary stents, and a combination code. Part Two will cover codes 92937-92944-Coronary Therapeutic Service and Procedures on Coronary Bypass Grafts, Coronary Revascularization services occurring during a myocardial infarction, and Coronary Revascularization services with the presence of chronic total occlusion.
Indications for Coronary Therapeutic Services
When are coronary artery therapeutic services needed? Coronary artery revascularization is necessary when the coronary arteries are no longer able to provide oxygenated blood to the heart muscle. Coronary artery blockage is usually caused by a buildup of plaque on the interior of the coronary artery often caused by atherosclerosis. Percutaneous coronary intervention (PCI) is the first step in resolving the issue of blockage within the coronary artery. The objective of percutaneous coronary intervention is to remove this plaque from the coronary artery and restore oxygenated blood flow to the heart muscle. There are three basic procedures available to restore blood flow to the coronary artery by percutaneous transluminal catheterization. They are angioplasty, atherectomy and the placement of intracoronary stents. The catheter is threaded through the body by way of the femoral artery, brachial artery or less common the subclavian artery.
Highlights of the Percutaneous Coronary Invention (PCI) Guidelines (code 92920 thru 92933)
1. The new codes are built on a progressive hierarchy with more intensive services inclusive of the less intensive services.
2. New PCI codes include all the work of accessing and selectively catheterizing the vessel, accessing the lesion, radiological supervision and interpretation directly related to the intervention(s) performed, closure of the arteriotomy when performed through the access sheath, and imaging performed to document completion of procedure.
3. The codes in this section include:
a. Angioplasty (e.g., balloon, cutting balloon, wired balloons, cryoplasty).
b. Atherectomy (e.g., directional, rotational, laser)
c. Stenting (e.g., balloon expandable, self-expanding, bare metal, drug eluting, covered).
d. Each code in the above families includes balloon angioplasty when performed.
4. Special conditions are provided for when diagnostic angiography may be reported separately if performed at the same time as the coronary interventional procedure. Otherwise the work of the angiography is captured (included) in the percutaneous coronary revascularization services codes (92920-92944).
5. Major Coronary Arteries are:
1) Left main coronary artery (LCA)
2) Left anterior descending (LAD)-branches (diagonal)
3) Left circumflex (LCX) - branches (marginals)
4) Right coronary artery (RCA)- branches (posterior descending, posterolaterals)
5) Ramus intermedius (RI)
6. Coronary Artery Branches:
a. Up to two (2) coronary artery branches of the left anterior descending (diagonals), left circumflex (marginals) and right (posterior descending, posterolaterals) are recognized. Left main and ramus intermedius coronary arteries DO NOT have recognized branches for reporting purposes.
b. All PCI(s) performed in any segment (proximal, mid, distal) of a coronary branch are reported with one (1) code
c. PCI is reported for up to two (2) branches of a major coronary artery. Additional PCI in a third branch of the same major coronary artery is not separately reportable.
7. Only one (1) 'base' code from this family maybe reported for revascularization of a major coronary artery and its recognized branches.
The remaining coding guidelines for coronary artery bypass grafts will be discussed in" Coronary Therapeutic Services and Procedures Coding Part Two."
What are base codes? The PCI base codes discussed in this article are 92920, 92924, 92928, and 92933. The PCI base code which includes the most intensive service provided for the target vessel should be reported. The hierarchy of these services is built on an intensity of service ranked from highest to lowest as 92933 > 92924 > 92928 > 92920.
The base codes descriptions are listed below with their add-on codes for any additional branch treated:
||Each Additional Branch
||Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
||Percutaneous transluminal coronary atherectomy, with coronary angioplasty; single major coronary artery or branch
||Percutaneous transcathether placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
||Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
The diagram to the left illustrates the three interventions: Angioplasty, Atherectomy and Intracoronary stent placement. The CPT code 92933 is a code that includes all three procedures performed on the same vessel during the same encounter.
Only one code per major coronary artery or branch maybe utilized. Read the documentation carefully and use the code that best represents the most intensive procedure or procedures performed.
Each base code 92920, 92924, 92928 & 92933 represents a single major coronary artery or branch. When more then one branch of a major coronary artery is treated, report an add-on code (e.g., +92921, +92925, +92929, or +92934) for that additional branch. The add-on codes hierarchy is as a follows:
92934 > 92925 > 92929 > 92921
Using the images in this article and the documentation scenarios below we can better understand the application of these new codes.
Scenario #1: Patient presents with 73% occlusion of her left main coronary artery (LCA).
Procedure performed: Coronary angioplasty on the left main coronary artery. Code 92920
Scenario #2: Patient presents with 80% occlusion to his Left anterior descending (LAD), and 69% occlusion of the first descending diagonal (D1) branch. Procedure performed: Atherectomy of the left anterior descending (LAD) and Atherectomy of the first diagonal branch of the LAD. Code: 92924 and +92925, Rationale: Each code represents intervention on a single major coronary artery or branch. Encounters where both the major coronary artery (LAD), and an additional diagonal (D1) branch of the major coronary artery are treated there is a code assigned for each.
There are many steps to applying the correct code for the percutaneous coronary intervention (PCI) procedures. First you should identify the major coronary arteries and branches that received intervention. Second you will have to identify all the interventions (e.g., angioplasty, atherectomy, intracoronary stent placement). Finally, choose the single code that reflects the most intense service to that major coronary artery or branch of a major coronary artery. Additional codes may apply if the encounter interventions are performed on different major coronary arteries. The guidelines in this section provide further instruction when more complex procedures occur during the surgical procedure.
Next month, in Coronary Therapeutic Service and Procedures Part Two (2), we will discuss the Coronary Artery Bypass graft PCI codes, guidelines and coding interventions that are complicated due to a myocardial infarction and chronic total occlusion of a coronary vessel. Part Two will highlight guidelines and application of PCI codes 92937-92944. We will summarize part one with part two in this final article.
Lindsey Asmus RHIT CCS CCS-P CCDS, Approved AHMA ICD 10 CM/PCS Trainer is the Educator/Developer for Precyse University. She has over 10 years experience coding and auditing in both inpatient and outpatient settings. She taught as an adjunct Instructor at an AHIMA approved college in the Health Information Technology associate programs. She is currently a co-facilitator of the Florida CSA and Studying for the CCS, community of practice (COP) for AHIMA members
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