Summary & Overview
CPT 92920: Percutaneous Coronary Intervention, Single Artery
CPT code 92920 is a nationally recognized billing code for percutaneous transluminal coronary intervention, targeting a single major coronary artery or its branches. This procedure is central to interventional cardiology, providing minimally invasive treatment for patients with coronary artery disease. The code is widely utilized in hospital outpatient departments and ambulatory surgery centers, reflecting its importance in acute cardiac care.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication offers a comprehensive overview of payer coverage, clinical benchmarks, and policy updates relevant to 92920. Readers will gain insight into the clinical context of the procedure, typical sites of service, and how this code fits within broader cardiovascular care pathways. The summary also highlights related codes and common modifiers, supporting accurate billing and compliance.
This article is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on coding, reimbursement, and clinical application of percutaneous coronary interventions. It provides a clear understanding of the national landscape for 92920, including payer coverage and regulatory considerations.
CPT Code Overview
CPT code 92920 describes a percutaneous transluminal coronary intervention performed on a single major coronary artery and/or its branch(es). This procedure is a key component of interventional cardiology, typically conducted in a hospital outpatient setting (POS 22) or an ambulatory surgery center (POS 24). The code is used to report minimally invasive treatment of coronary artery disease, where a catheter is inserted to restore blood flow in blocked or narrowed arteries. This intervention is critical for patients experiencing acute coronary syndromes or other significant cardiac events, offering a less invasive alternative to open-heart surgery.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the hospital outpatient department or ambulatory surgery center with symptoms suggestive of acute coronary syndrome, such as chest pain or shortness of breath. The patient may have a history of unstable angina or myocardial infarction. After diagnostic evaluation, the interventional cardiologist determines that percutaneous transluminal coronary angioplasty is indicated to treat a significant stenosis in a single major coronary artery or its branch. The procedure is performed using catheter-based techniques to restore blood flow, often as part of emergency or urgent care for acute coronary events.
Coding Specifications
- Modifier
63: Used when the procedure is performed on infants weighing less than 4 kg. This modifier indicates the increased complexity and risk associated with performing the procedure on very small patients.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207RC0000X | Cardiovascular Disease Physician |
207RI0011X | Interventional Cardiology Physician |