Percutaneous coronary intervention (PCI) coding brings to mind Winston Churchill’s line about “a riddle wrapped in a mystery inside an enigma.” Making assumptions about what certain descriptor terms mean and which services are bundled into PCI is sure to lead to errors.
You can remove at least one layer of PCI coding confusion by reviewing these FAQs with answers from CPT® guidelines and the National Correct Coding Initiative Policy Manual for Medicare Services (NCCI manual). For even more clarity, review the official CPT® and Medicare resources, and check your payers’ policies, too.
• Service taken place through the skin is called Percutaneous. In the case of PCI, the physician makes a small incision in the skin and inserts a thin guidewire and catheter into a blood vessel. The physician uses imaging to assist with threading the catheter through the vascular system to the target area.
• Coronary is the term for vessels that surround and supply the heart.
• Intervention means the procedure was for the treatment of a condition.
The basics aren’t enough when it comes to PCI coding, though, so let’s discuss in deeper.
• Lists stent placement
• Balloon angioplasty as types of PCI
The related CPT® codes are 92920 - +92944. The CPT® guidelines that go together with these codes offer more insight into the types of services the codes cover: “angioplasty (eg, balloon, cutting balloon, wired balloons, cryoplasty), atherectomy (eg, directional, rotational, laser), and stenting (eg, balloon-expandable, self-expanding, bare metal, drug-eluting, covered).”
The physician may perform more than one type of PCI at a session, and there are CPT® codes for different combinations performed on a single vessel. For instance, atherectomy, stent, and angioplasty are all included in the descriptor for 92933 Percutaneous transluminal coronary atherectomy, with the intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch.
In short, physicians perform PCI to restore blood flow through blockages in the arteries that supply the heart.
CPT® guidelines define PCI more technically as a type of percutaneous revascularization aimed at treating occlusive disease of the coronary vessels. Revascularization is a term for restoring adequate blood supply to a body part. And, according to CPT® Assistant (December 2014), “Coronary occlusive disease refers to narrowing and/or blockage of the coronary arteries.”
Category I25 Chronic ischemic heart disease has many ICD-10-CM codes related to coronary disease.
PCI is specific to coronary arteries and their branches, but not all resources use the same terms when describing these vessels. Fortunately, both the NCCI manual and CPT® guidelines list the same five major coronary arteries and recognize the same branches for reporting purposes.
Your PCI coding typically will depend on the type of vessels (native circulation, bypass graft), the number of vessels (single, additional), and services (angioplasty, atherectomy, stenting). The CPT® code set also includes 92941 for PCI of total or subtotal occlusion during acute myocardial infarction and 92943/+92944 for PCI of a chronic total occlusion.
You should report one code to represent all PCI procedures performed in all segments (proximal, mid, distal) of a single major coronary artery or a single branch, according to both CPT® and the NCCI manual. For instance, you’ve seen that 92933 represents angioplasty, stenting, and atherectomy in a single vessel.
But watch for services that involve both the patient’s native circulation and bypass graft. CPT® guidelines state that you may report PCI through a bypass graft separately when the physician treats one segment of a major coronary artery through the native circulation and then accesses another segment of the same artery through a coronary artery bypass graft for treatment. The NCCI manual includes similar wording.
Use a bypass graft code for the access to major artery through the graft. The descriptors for both 92937 and +92938 begin with this wording (emphasis added): Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous) …
PCI services in multiple vessels also provide opportunities to report multiple codes. When the physician performs PCI in an additional major coronary artery or an additional coronary artery bypass graft, report an additional appropriate base code. “PCI performed during the same session in additional recognized branches of the target vessel should be reported using the applicable add-on code(s),” CPT® guidelines state.
“Medicare does not pay separately for PCI in a branch of a major coronary artery as this payment is included in the payment for the PCI code for the corresponding major coronary artery,” per the NCCI manual.
The Medicare Physician Fee Schedule assigns add-on codes +92921, +92925, +92929, +92934, +92938, and +92944 status “B.” This means payment for each code is bundled into payment for other covered services performed on the same date.
Although the codes won’t bring separate payment from Medicare, organizations may opt to report the branch codes for internal tracking or to provide data to payers on how common branch procedures are. This data may influence payers’ future payment decisions.
If you do report the codes, the NCCI manual echoes CPT® by stating that you may report only one PCI code “for each of up to two branches of a major coronary artery with recognized branches.” You should not report PCI of third third branch of a major coronary artery.
According to AAPC, cardiovascular coding has moved more toward an all-in-one-code approach, and PCI is a good example. If you read only the code descriptors, you’ll miss that CPT® guidelines state that these codes encompass:
• Accessing and selectively catheterizing the vessel;
• Traversing the lesion;
• Radiological supervision and interpretation related to the PCI;
• Arteriotomy closure through the access sheath; and
• Imaging to document PCI completion.
Chapter XI of the NCCI manual also reminds us that the codes include other services that are part of a typical PCI such as ECG tracings to assess chest pain. There are services you may report together with PCI, however, such as +92973 Percutaneous transluminal coronary thrombectomy mechanical and diagnostic coronary angiography (93454-93461). As you may have guessed, you can find answers about when it’s appropriate to use those codes by reading the CPT® guidelines and the NCCI manual.Back