Cardiology Coding Alert

Question: Can you bill multiple stents to different arteries of the heart? For example, if the doctor does a stent to the RC and LC, and angioplasty to the LD, should you bill 92928-RC, 92928-LC, and 92920-LD?

Codify Member

Answer: For your scenario, you may report one intervention code per major coronary artery.

As you describe, the codes and modifiers are:

• 92928-RC, Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch; Right coronary artery
• 92928-LC, … Left circumflex coronary artery
• 92920-LD, Percutaneous transluminal coronary angioplasty; single major coronary artery or branch; Left anterior descending coronary artery.

According to CPT^® guidelines, you should use one base code per major coronary artery for percutaneous coronary intervention (PCI) procedures performed during the same session. The term base code lets you know not to use one of the add-on codes CPT^® includes for coronary branches (more on that in the Tip below).

Be sure to watch for special cases outlined in the guidelines. For instance, if the physician uses a single intervention to treat a lesion that takes up space in two different vessels, you should report just one code rather than reporting each vessel separately. Alternatively, if the physician uses the kissing balloon technique on a bifurcation lesion of a major artery and branch, the guidelines state you may report a base code and an “additional branch” code when warranted, depending on the documentation provided.

Tip: If a case involves branches of the major arteries, you need to check your payer’s rules for reimbursement information. CPT^® now includes separate add-on “additional branch” codes, but Medicare bundles payment for those branch codes into the major artery codes.