As mentioned in my previous post, here are the new CPT codes for coronary revascularization (Table 1). The new codes will help support reimbursement for treating sidebranches as well as the more complex interventions involving bypass grafts, chronic total occlusions, and ST-elevation myocardial infarction. Effective January 1, 2013, you will no longer use 92980, 92981, 92982, 92984, 92995, and 92996.
Here are some distinguishing key elements that will help you determine which code to use:
- Angioplasty, atherectomy, and/or stent placement
- Single major coronary artery or branch vs. each additional branch
- Native artery vs. coronary artery bypass graft
- Chronic total occlusion (CTO)
- Service performed during acute myocardial infarction (AMI)
| Table 1 – New Coronary Revascularization Codes | |
| Percutaneous transluminal coronary angioplasty; single major coronary artery or branch | |
| … each additional branch of a major coronary artery (List separately in addition to code for primary procedure). | |
| Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch | |
| … each additional branch of a major coronary artery (List separately in addition to code for primary procedure). | |
| Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | |
| … each additional branch of a major coronary artery (List separately in addition to code for primary procedure). | |
| Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch | |
| … each additional branch of a major coronary artery (List separately in addition to code for primary procedure). | |
| 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 | |
| … each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure). | |
| 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. | |
| 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 | |
| … each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure). | |
The first eight CPT codes are pretty straightforward and all include angioplasty, when performed. These codes support reporting revascularization for each major coronary artery and branch treated. For CPT coding purposes, the major coronary arteries are left main, left anterior descending, left circumflex, right, and ramus intermedius. The following chart can be used as a guide for these codes.
| Table 2 – Percutaneous Coronary Interventions | ||||
|
PTA |
Atherectomy |
Stent |
Atherectomy w Stent |
|
| Base Code |
92920 |
92924 |
92928 |
92933 |
| Ea Addl Branch Code |
92921 |
92925 |
92929 |
92934 |
The final series of codes, 92937-92944, are all-inclusive codes, incorporating all interventions (stent, atherectomy, angioplasty) performed within an artery or graft. The base codes are distinguished by revascularization (1) through coronary artery bypass graft, (2) of acute total/subtotal occlusion during myocardial infarction, and (3) of chronic total occlusion of a coronary artery, coronary artery branch, or coronary artery bypass graft. Each base code has its own “each additional branch” code for reporting additional revascularizations. Table 3 outlines the use of each code.
| Table 3 – Coronary Revascularization for Patients with History of CABG, STEMI, or CTO | |||||||
|
CABG |
STEMI |
CTO |
|||||
| Base Code |
92937 |
92941 |
92943 |
||||
| Ea addl branch |
92938 |
92943 |
92944 |
||||
Please consult your local payers for their specific guidelines on the appropriate use of these codes and how they will be covered and reimbursed.
CPT codes and their descriptors are copyright 2012 by the American Medical Association.
