Cardiac Catheterization and PCI

Cardiac Catheterization

Invasive procedure where a catheter is threaded through blood vessels into the heart to visualize structures, measure pressures, and assess function

Left Heart Catheterization

Catheterization of the left side of the heart including left ventricle and coronary arteries; most common type of cardiac cath

Right Heart Catheterization

Catheterization of right atrium, right ventricle, and pulmonary artery to measure right-sided pressures

Coronary Angiography

Imaging of coronary arteries using contrast dye; typically BUNDLED into cardiac cath codes 93454-93461

PCI (Percutaneous Coronary Intervention)

Therapeutic procedures to treat coronary artery blockages including angioplasty, stents, and atherectomy

PTCA (Percutaneous Transluminal Coronary Angioplasty)

Balloon angioplasty to open a blocked coronary artery by inflating a balloon inside the vessel

Coronary Stent

Mesh tube inserted into coronary artery to keep it open after angioplasty; can be bare metal or drug-eluting

Drug-Eluting Stent

Stent coated with medication to prevent re-narrowing of the artery; coded with 92928 (first vessel) or +92929 (additional)

Bare Metal Stent

Stent without medication coating; coded with 92933 (first vessel) or +92934 (additional)

Atherectomy

Removal of plaque from artery wall using a cutting or grinding device; highest hierarchy in same-vessel PCI coding

Code Range 93451-93461

Diagnostic cardiac catheterization codes including right heart, left heart, and combined procedures

Code Range 92920-92944

PCI (intervention) codes for angioplasty, stents, and atherectomy in coronary arteries

Base Code

The first/primary procedure code that stands alone (e.g., 92928 for first vessel stent)

Add-On Code

Additional procedure code that cannot be used alone; requires a base code (indicated by + symbol, e.g., +92929)

Code Per Vessel Rule

In PCI coding, you code each VESSEL treated, not each lesion or blockage within that vessel

Same Vessel Hierarchy

When multiple interventions occur in same vessel, code only the highest: 1) Atherectomy 2) Stent 3) Angioplasty

Bundled Service

A service included in another code that cannot be reported separately (e.g., angioplasty bundled when stent placed in same vessel)

LAD (Left Anterior Descending)

Major coronary artery; one of the vessels that may be treated during PCI

RCA (Right Coronary Artery)

Major coronary artery; one of the vessels that may be treated during PCI

LCX (Left Circumflex)

Major coronary artery; one of the vessels that may be treated during PCI

Congenital Cardiac Catheterization

Cardiac cath for congenital (birth) heart defects; uses codes 93593-93598, separate from acquired disease codes

Diagnostic Angiography Exception

Coronary angiography can be coded separately ONLY if performed without catheterization or in a separate session

Code 93451

Right heart catheterization only

Code 93452

Left heart catheterization only

Code 93453

Combined right and left heart catheterization

Code 92920

PCI with angioplasty only, single vessel (base code)

Code +92921

PCI with angioplasty, each additional vessel (add-on code)

Code 92928

PCI with drug-eluting stent, single vessel (base code)

Code +92929

PCI with drug-eluting stent, each additional vessel (add-on code)

Code 92924

PCI with atherectomy, single vessel (base code)

Code +92925

PCI with atherectomy, each additional vessel (add-on code)