CPT 2013 – Coronary Revascularization

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

92920

Percutaneous transluminal coronary angioplasty; single major coronary artery or branch

92921

… each additional branch of a major coronary artery (List separately in addition to code for primary procedure).

92924

Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch

92925

… each additional branch of a major coronary artery (List separately in addition to code for primary procedure).

92928

Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch

92929

… each additional branch of a major coronary artery (List separately in addition to code for primary procedure).

92933

Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch

92934

… each additional branch of a major coronary artery (List separately in addition to code for primary procedure).

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

92938

… each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure).

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.

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

92944

… 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.