The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD Percutaneous Coronary Interventions L34761.
Guidelines
Coronary thrombectomy performed with percutaneous transluminal coronary angioplasty (PTCA) and a stent insertion is separately reimbursable. Coronary thrombolysis (including coronary angiography) when performed by intracoronary infusion is separately reimbursable when performed preceding or subsequent to PTCA or atherectomy.
Codes 92920-92944 describe percutaneous revascularization services performed for occlusive disease of the coronary vessels (major coronary arteries, coronary artery branches, or coronary artery bypass grafts). These percutaneous coronary intervention (PCI) codes are built on progressive hierarchies with more intensive services inclusive of lesser intensive services. These PCI codes all include the work of accessing and selectively catheterizing the vessel, traversing the lesion, radiological supervision and interpretation directly related to the intervention(s) performed, closure of the arteriotomy when performed through access sheath, and imaging performed to document completion of the intervention in addition to the invention(s) performed. These codes include angioplasty (e.g., balloon, cutting balloon, wired balloons, cryoplasty), atherectomy (e.g., directional, rotational, laser); and stenting (e.g., balloon expandable, self-expanding, bare metal, drug eluting, covered). Each code in this family includes the balloon angioplasty, when performed. Diagnostic coronary angiography codes 93454-93461 and injection procedure codes 93563-93564 should not be used with PCI services 92920-92944 to report:
- Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the coronary intervention.
- Vessel measurement for the coronary intervention, or
- Post-coronary angioplasty/stent/atherectomy angiography, as this work is captured in the percutaneous coronary revascularization services codes (92920-92944).
Diagnostic angiography performed at the time of a coronary interventional procedure may be separately reportable if:
- No prior catheter-based coronary angiography study is available, and a full diagnostic study is performed, and a decision to intervene is based on the diagnostic angiography, or
- A prior study is available, but as documented in the medical record:
- The patient’s condition with respect to the clinical indications has changed since the prior study, or
- There is inadequate visualization of the anatomy and/or pathology, or
- There is a clinical change during the procedure that requires a new evaluation outside the target area of intervention.
Diagnostic coronary angiography performed at a separate session from an interventional procedure is separately reportable.
If a single lesion extends from one target vessel (major coronary artery, coronary artery bypass graft, or coronary artery branch) into another target vessel, but can be revascularized with a single intervention bridging the two vessels, this PCI should be reported with a single code despite treating more than one vessel (92928).
When bifurcation lesions are treated, PCI is reported for both vessels treated, use 92928 and 92929.
Codes 92973 (percutaneous transluminal coronary thrombectomy, mechanical), 92974 (coronary brachytherapy), 92978 and 92979 (intravascular ultrasound/optical coherence tomography), and 93571 and 93572 (intravascular Doppler velocity and/or pressure (fractional flow reserve or coronary flow reserve) are add-on codes for reporting procedures performed in addition to coronary and bypass graft diagnostic and interventional services, unless included in the base code. Non-mechanical, aspiration thrombectomy is not reported with 92973, and is included in the PCI code for acute myocardial infarction (92941), when performed (AMA CPT 2018 Professional Edition).
Angiography during the procedure, used to monitor the course of the intervention, is considered part of the PCI and is not separately billable to Medicare. Diagnostic angiography may be separately payable in situations where no previous catheter-based coronary angiography study is available, or a previous study is no longer adequate due to changes in the patient’s condition.
The deployment of a device for distal embolic protection during an interventional procedure is considered part of the more complex procedure and is not separately billable.
All interventions are within a single coronary artery. Each intervention may only be billed as a single procedure regardless of the number of lesions treated within that vessel. However, if four or more stents are placed in a single vessel, then it would be considered an "unusual procedural service" and eligible for additional reimbursement equivalent to that of an additional treated vessel.
Claims for PCI must include the appropriate modifiers to identify which vessel is undergoing a specific procedure. The modifiers are LD (left anterior descending coronary artery), LC (left circumflex coronary artery), RC (right coronary artery), LM (left main artery) and RI (rasmus intermedius artery).
Prophylactic insertion of a temporary transvenous pacemaker, repositioning or replacement of catheters and administration of medications during the procedure are included in the procedure and are not separately billable.
Intracoronary injections of drugs during diagnostic or therapeutic procedures are considered to be part of the procedure and are not separately reimbursable.
Coronary thrombectomy is bundled with atherectomy on CCI (correct coding initiative) edit tables and is not separately reimbursable when performed with it.
Thrombolytic infusion is bundled with stent placement on CCI tables and is not separately reimbursable when performed with intracoronary stent placement.
Percutaneous vascular closure devices (PVCD) may be used to facilitate closure of an arterial puncture site after angiography, cardiac catheterization, and interventional cardiology procedures in addition to or in place of manual compression, use of a mechanical clamp or a sandbag, or a combination of these methods. These services are inherent to the invasive procedure and are not separately payable.
CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 4 – Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 61.5 - Billing for Intracoronary Stent Placement (Rev. 2611, Issued: 12-14-12, Effective: 01-01-13, Implementation, 01-07-13)
Since CY 2003, under the OPPS, we assign coronary stent placement procedures to separate APCs based on the use of nondrug-eluting or drug-eluting stents APC 0104 (Transcatheter Placement of Intracoronary Stents) or APC 0656 (Transcatheter Placement of Intracoronary Drug-Eluting Stents), respectively). In order to effectuate this policy, we created HCPCS G-codes G0290 (Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel) and G0291 (Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel) for drug-eluting intracoronary stent placement procedures that parallel existing CPT codes 92980 (Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel) and 92981 (Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel), which are used to describe nondrug-eluting intracoronary stent placement procedures. For CY 2012 and years prior, CPT codes 92980 and 92981 have been assigned to APC 0104, while HCPCS codes G0290 and G0291 have been assigned to APC 0656.
Effective January 1, 2013, the AMA’s CPT Editorial Panel is deleting CPT codes 92980 and 92981 and replacing them with the following new CPT codes:
- CPT code 92928 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch)
- CPT code 92929 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));
- CPT code 92933 (Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch);
- CPT code 92934 (Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));
- CPT code 92937 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel);
- CPT code 92938 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure));
- CPT code 92941 (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel);
- CPT code 92943 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel); and
- CPT code 92944 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure)).
In order to maintain the existing policy of differentiating payment for intracoronary stent placement procedures involving nondrug-eluting and drug-eluting stents, we are deleting HCPCS codes G0290 and G0291 and replacing them with the following new HCPCS C-codes to parallel the new CPT codes:
- HCPCS code C9600 (Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch);
- HCPCS code C9601 (Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));
- HCPCS code C9602 (Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch);
- HCPCS code C9603 (Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure));
- HCPCS code C9604 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel);
- HCPCS code C9605 (Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure));
- HCPCS code C9606 (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel);
- HCPCS code C9607 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel); and
- HCPCS code C9608 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure)).
CPT codes 92928, 92933, 92929, 92934, 92937, 92938, 92941, 92943, and 92944 should be used to describe nondrug-eluting intracoronary stent placement procedures and are assigned to APC 0104. HCPCS codes C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, and C9608 are assigned to APC 0656.
