Cardiology Coding Alert

Question: We have a coronary intervention operative report indicating that the physician performed a percutaneous transluminal coronary angioplasty (PTCA) in the LIMA graft to the first diagonal and placed a stent in the proximal left circumflex coronary artery. Which codes should I report?

Ohio Subscriber

Answer: According to CPT^®, you should look to percutaneous coronary intervention (PCI) codes 92920-92944 to report percutaneous revascularization services performed for occlusive disease of the coronary vessels, which occurs when the coronary arteries are narrowed and/or blocked.

For this scenario, report the PTCA in the left internal mammary artery (LIMA) graft to the first diagonal with base 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).

Because the first diagonal is a branch of the left anterior descending, make sure to append modifier LD (Left anterior descending coronary artery) to the code.

To report the stent in the left circumflex, choose 92928 (Percutaneous transcatheter placement of intracoronary stent[s], with coronary angioplasty when performed; single major coronary artery or branch), appending modifier LC (Left circumflex coronary artery) to the code.

Per the 2017 CPT^® manual, all PCI service codes include:

• Getting access to and selectively catheterizing the target vessel
• Traversing the lesion 
• Radiological supervision and interpretation (S&I) related to the coronary intervention(s) the cardiologist performed
• Closing artery incisions occurring via the access sheath

Imaging showing the conclusion of the coronary intervention in addition to the actual intervention.