Coronary artery disease (CAD) is the most common type of heart disease, affecting around 1 in 20 adults aged 20 or above in the U.S. CAD is, in fact, so severe that it claimed nearly 371,506 American lives in 2022.
Percutaneous transluminal coronary angioplasty (PTCA), also known as percutaneous coronary intervention (PCI), can treat such blockages. While healthcare providers perform roughly 900,000 PCIs every year, they dread one thing about this procedure: coding!
You might have seen CPT code 92920 before as a cardiovascular surgeon. But if you have ever struggled with what this code actually includes, read on to learn everything about it.
CPT Code 92920 – Description
CPT code 92920 refers to angioplasty, a procedure to open blocked coronary arteries due to CAD. Specifically, it describes percutaneous transluminal coronary angioplasty (PTCA) performed on a single artery or one of its branches.
So, what happens during this procedure? A cardiovascular surgeon compresses plaque (fatty deposits in the artery walls that restrict blood flow) against the artery lining to improve circulation.
To do this, they insert a catheter with a deflated balloon into the narrowed or blocked artery. Then, they inflate the balloon multiple times to press the plaque against the artery wall, widening the artery.
In simple terms, healthcare providers use CPT code 92920 to report a PTCA procedure without stent placement.
Scenarios Where CPT Code 92920 is Applicable
Here are some scenarios where CPT code 92920 is applicable:
Performing PTCA to Unblock Narrowed Anterior Descending Artery
Did you know that around 9 million Americans suffer from angina? Since angina is the most common symptom of ischemic heart disease (caused by narrowed heart arteries), let’s begin with a straightforward case.
Suppose a 48-year-old man with a history of coronary artery disease experiences crushing chest pain during physical activity, especially while walking or exercising. The pain usually subsides with rest, but the episodes last longer and become more intense over time.
Hence, he finally visits a cardiologist. After a thorough evaluation, the physician discovers that the patient is a chain smoker. He then performs several diagnostic tests to identify the main reason behind the pain. The results reveal a narrowed artery in the anterior wall due to plaque buildup.
To improve blood flow and relieve angina symptoms, the cardiologist performs a PTCA without stenting and reports the procedure using CPT code 92920.
Performing PTCA to Widen Diagonal Branch
Let’s consider another example! Assume a 55-year-old man with diabetes begins experiencing increasing chest discomfort and pain. After trying and failing to manage the symptoms with medications, he visits a hospital.
The physician evaluates the patient, reviews his medical history (including CAD), and suspects a coronary artery blockage. Further diagnostic testing confirms a 90% stenosis (narrowing of a passageway) in a diagonal branch of the left anterior descending artery.
He decides to address this problem with percutaneous transluminal coronary angioplasty without stenting. The main reason? The small size of the vessel! He inserts a catheter with a deflated balloon through a small incision (in the arm or groin) and guides it to the narrowed vessel.
After that, he inflates and deflates the balloon several times to open the artery. The billing team uses CPT code 92920 to report this intervention.
Performing PTCA to Treat Restenosis
Around 1 in 4 people develop in-stent restenosis after angioplasty. Let’s say a 49-year-old woman previously underwent percutaneous coronary intervention. She arrives at a hospital three months following her initial procedure after experiencing angina symptoms again.
The cardiologist examines her condition, conducts several assessments, and diagnoses in-stent restenosis in her right coronary artery. The primary cause for this recurrence? The forming of scar tissue under the stent!
The cardiologist performs another PTCA to re-open the narrowed segment within the existing tube. He does not place a new stent. Therefore, he uses CPT code 92920 to bill for this procedure.
Applicable Modifiers for CPT Code 92920
Depending on what you want to communicate, you can use the following modifiers with CPT code 92920:
Modifier 53
Did you attempt the PTCA procedure, but it was unsuccessful? Apply modifier 53 to CPT code 92920 to file a claim for such attempts. However, you can only use this modifier under two conditions:
- If you discontinued the procedure to save the patient’s life.
- Anesthesia had already been administered.
For example, a cardiologist attempted to unblock the patient’s left anterior descending artery using percutaneous transluminal coronary angioplasty twice but had to stop the procedure.
The main reason? Severely elevated blood pressure! In short, he abandoned the procedure to protect the patient’s well-being. The billing team conveyed this information using modifier 53 with CPT code 92920.
Modifier LD
This HCPCS modifier helps pinpoint the specific artery involved in PTCA. Append modifier LD to CPT code 92920 if you opened up the left anterior descending coronary artery, also known as the anterior interventricular artery.
Modifier RC
To specify that the PTCA was performed on the right coronary artery, use modifier RC with CPT 92920.
Modifier LC
If you performed the PTCA procedure on the left circumflex artery (a branch of the left main coronary artery), apply modifier LC to CPT code 92920.
Modifier LM
Did you know there is also a modifier to specify procedures performed on the left main coronary artery? Use modifier LM with CPT code 92920 if you revascularized this artery.
Modifier RI
What if the surgeon performed PTCA on a variant coronary artery (ramus intermedius coronary artery)? In that case, append modifier RI to CPT code 92920.
What is the difference between CPT 92920 and 92928?
Have you ever mistakenly used CPT code 92928 instead of 92920? You’re not alone! There is only a minor difference between the two codes.
As mentioned before, CPT code 92920 describes a percutaneous transluminal coronary angioplasty. In contrast, CPT code 92928 refers to stent placement in a single major coronary artery or one of its branches. It is typically performed alongside angioplasty.
In simple words, healthcare providers use CPT 92928 to report their efforts of inserting a small mesh tube (stent) to keep the artery open. This stenting helps to prevent restenosis.
The following table provides a clearer view of the key differences between CPT codes 92920 and 92928:
| Features | CPT Code 92920 | CPT Code 92928 |
|---|---|---|
| Procedure | Percutaneous transluminal coronary angioplasty | Percutaneous transcatheter placement of intracoronary stent + coronary angioplasty |
| Stent Placement | No | Yes |
| Purpose | Dilating narrowed vessels | Dilating narrowed arteries + avoiding restenosis |
CPT Code 92920 – Billing & Reimbursement Guidelines
Avoid payment delays, denials, and other complications while billing for CPT code 92920. Follow our billing and reimbursement guidelines:
Use CPT Code 92920 Correctly
The first and foremost important coding rule is to understand the code. Remember, use 92920 only for a simple percutaneous transluminal coronary angioplasty procedure. In simple words? Use it to report the treatment of a single narrowed or blocked major coronary artery or one of its branches.
Keep one more thing in mind! CPT code 92920 does not cover stent placement with PTCA. Many providers mistakenly bill PTCA + stenting under 92920 instead of 92928, resulting in claim denials.
Use Appropriate Modifiers to Specify the Artery Involved
Be as specific as you can while using CPT code 92920. Use appropriate modifiers, such as RC, LD, LC, LM, or RI, to specify which artery you have revascularized via PTCA. This step will help you avoid payment delays.
Verify PTCA’s Medical Necessity with Documentation
Insurance companies require strong justification for invasive procedures, including angioplasties. Therefore, don’t forget to document important details, like specifying which artery you treated and the absence of a stent. Additionally, record the following information:
- Patient’s symptoms
- Appropriate diagnosis (ICD-10) codes supporting your decision to perform PTCA (e.g., 121.4, 125.10, 125.11, or 120.9)
- Lesion severity
- Any complications or follow-up plans
Review Payer-Specific Policies
You know the drill! Different payers have different coding and documentation rules. Some insurance companies may bundle CPT 92920 with other coronary procedures. Therefore, review their policies and verify NCCI edits, especially if you are billing PTCA with other services.
Summary
Coding can be super easy if you know all the requirements! To summarize, CPT code 92920 refers to a minimally invasive cardiology procedure used to revascularize a blocked or narrowed major coronary artery or one of its branches. The medical term for it? Percutaneous transluminal coronary angioplasty (PTCA)!
In short, this code covers only simple angioplasty without stent placement. We have detailed how it works, from a basic description to three real-world examples, including unblocking the anterior descending artery, widening the diagonal branch, and treating restenosis, so you can apply it correctly.We have also highlighted the appropriate modifiers and shared helpful billing tips to aid you in avoiding common mistakes. Are you still feeling unsure? Let a specialist like MediBillMD handle your coding. Our cardiology billing services cover everything from angioplasty coding to complete claims management.
