When a patient arrives with symptoms of a blocked artery, time is of the essence. It is a high-stakes clinical event that demands immediate, life-saving intervention.
Interventional cardiologists are the heroes in these crucial moments. They use advanced procedures, such as CPT code 92928, to restore blood flow and save lives.
However, due to billing complexities, they are often not rightfully reimbursed or face denials against this procedural code. Thus, our billing specialists decided to empower cardiologists. How? By dedicating this guide to simplifying the billing and reimbursement guidelines related to CPT 92928.
So, without further ado, let’s get started!
CPT Code 92928 – Description
CPT code 92928 covers stent placement with coronary angioplasty. In this procedure, a physician inflates a balloon-tipped catheter into the blocked area and places a stent to expand the narrowed walls of the vessel. It is an integral procedure that helps treat stenosis of a single major coronary artery or its branch.
Scenarios Where CPT Code 92928 is Applicable
Here, let’s take a look at a few real-world clinical scenarios to understand where this CPT code applies:
Patient with an Acute Heart Attack
Do you know that someone has a heart attack every 40 seconds in the U.S.?
Picture a 55-year-old male patient who arrives at the emergency room with severe chest pain and shortness of breath. The physician immediately orders an electrocardiogram (ECG) to confirm a heart attack.
During an emergency cardiac catheterization, the cardiologist finds a 90% blockage in the patient’s left anterior descending (LAD) coronary artery.
As a result, the cardiologist performs a coronary angioplasty with stent placement to open the blocked vessel and restore blood flow.
Here, CPT code 92928 applies.
Treatment of In-Stent Restenosis
Consider a 72-year-old female patient with a stent placed in her circumflex artery three years ago. She visits the cardiologist and complains of recurring chest pain.
Thus, the cardiologist orders a follow-up angiogram. The findings reveal that the artery has re-narrowed within the original stent.
Therefore, the cardiologist performs a second angioplasty and places a new stent inside the first one. The aim was to restore adequate blood flow.
The cardiologist will report CPT code 92928 to bill for the procedure.
Patient with Unstable Angina
Imagine a 52-year-old male patient with a history of chest pain and hypertension with exertion. He undergoes a stress test, which confirms the ischemia diagnosis.
For context, ischemia is a condition characterized by reduced blood flow in certain parts of the body. This reduced blood flow means that the tissues are not receiving the necessary oxygen. Moreover, this puts the patient at risk of life-threatening complications, such as a heart attack.
Now, let’s go back to the scenario. After a confirmed diagnosis of ischemia, the cardiologist orders a subsequent diagnostic angiogram. It reveals 75% stenosis in the patient’s right coronary artery (RCA). Thus, the cardiologist performs an angioplasty with stent placement to reduce the symptoms and risk of a heart attack.
Here, CPT code 92928 applies for billing angioplasty with a stent.
Applicable Modifiers for CPT Code 92928
Discussed below are the applicable modifiers for accurately billing angioplasty with stent placement:
Modifier 51
What happens when you conduct a diagnostic cardiac catheterization and find a blockage in a major coronary artery? Instead of stopping, you perform the stent placement with angioplasty.
Now, it means that you rendered multiple procedures during the same session. Thus, you will report CPT code 92928 with modifier 51. It will result in 100% reimbursement for the procedure with the highest fee schedule, and for the other service, you will receive a 50% payment.
Modifier LC
Append modifier LC to CPT code 92928 when the physician performs the angioplasty on the left circumflex artery. For the unversed, it is a branch of the left main coronary artery.
Modifier LD
Did the physician open the LAD coronary artery to perform the procedure? If yes, apply modifier LD to ensure coding accuracy. Many are also familiar with it as the anterior interventricular artery.
Modifier LM
If the cardiologist performs angioplasty on the left main coronary artery, report the procedure with modifier LM.
Modifier RC
Apply modifier RC to CPT code 92928 when the provider revascularized the RCA.
Modifier RI
Was the angioplasty done on a variant coronary artery? If yes, do not forget to append the modifier RI to indicate it to the payer. It is also known as the ramus intermedius coronary artery.
CPT Code 92928 – Billing & Reimbursement Guidelines
The following are some of the essential billing and reimbursement guidelines related to angioplasty with stent placement:
Ensure Comprehensive Documentation
Regardless of the payer, the procedure covered under CPT code 92928 must be medically necessary to ensure reimbursement. Your documentation plays a key role in supporting this. Thus, you should strive to ensure that your documentation is complete and accurate. Here’s a brief overview of what it should include:
- Clinical justification of why the physician initiated angioplasty. Some common clinical indications include acute myocardial infarction (heart attack) and unstable angina.
- Surgical notes detailing the anatomical site of the stenosis, the type of stent, and the outcome of the intervention.
- Attach diagnostic tests such as ECGs, stress tests, or angiograms to support the medical necessity of the service.
Report CPT Code 92928 for a Single Major Coronary Artery
Note that CPT 92928 covers stent placement for a single major coronary artery. So, what happens when the cardiologist treats additional vessels during the same session?
Report CPT 92929 (add-on code) for each additional branch of a major coronary artery.
Append Appropriate Modifiers
Coding specificity is integral to ensure accuracy while billing for CPT code 92928, and that’s where modifiers come into play. You must append the appropriate coronary artery modifiers to indicate the anatomical site where the physician performed stent placement.
Some of the common applicable modifiers for this procedural code include 51, LC, LD, LM, RC, and RI. You can find more details on their proper usage in the ‘Applicable Modifiers for CPT Code 92928’ section.
Summary
With that said, it’s time to wrap up this detailed guide! But, before concluding, why not recap the key takeaways for more clarity?
First, we explained the CPT code 92928 descriptor. It covers angioplasty with stent placement on a single major coronary artery or branch.
Next, we shared a few real-world clinical scenarios. These include patients with unstable angina, treatment of in-stent restenosis, and patients with an acute heart attack.
We also listed some of the applicable modifiers for this code, including 51, LC, LD, LM, RC, and RI.
Finally, we discussed the key billing and reimbursement guidelines for CPT 92928.
Hopefully, you will rise above the billing challenges associated with CPT 92928 by mastering the details provided in this guide. However, if you still find it challenging, consider partnering with MediBillMD for professional cardiology billing services.
