Summary & Overview
CPT 0913T: Percutaneous Coronary Drug-Coated Balloon Angioplasty
CPT code 0913T represents a percutaneous coronary intervention that delivers therapeutic drugs via a medication-coated balloon catheter to a major coronary artery or branch, combined with mechanical dilation using a nondrug-coated balloon and intraprocedural imaging. This hybrid device-and-balloon technique is relevant nationally as it reflects evolving endovascular strategies to reduce restenosis and improve coronary patency without leaving a permanent implant. Payers and policymakers track adoption of these procedures because they can affect episode costs, device utilization, and post-procedure outcomes.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent and typical sites of service, payer coverage context, common billing modifiers, and where this code sits relative to related interventional cardiology services. The publication summarizes benchmarking metrics, common coding and billing considerations, and clinical context to inform billing staff, practice managers, and policy analysts. Data not available in the input is noted where applicable; the focus remains on the code’s clinical description, expected utilization setting, and the payer landscape nationally.
Billing Code Overview
CPT code 0913T describes a percutaneous coronary procedure in which the provider delivers therapeutic drugs via a catheter to a major coronary artery or its branch. The catheter includes a medication-coated balloon used to apply drug therapy directly to the vessel wall. The procedure also includes mechanical dilation of the artery with a nondrug-coated balloon and uses imaging techniques to guide and confirm the intervention.
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Service type: Percutaneous coronary drug-coated balloon angioplasty with adjunctive non–drug-coated balloon dilation and intraprocedural imaging
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Typical site of service: Hospital catheterization laboratory or outpatient interventional cardiology suite
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with exertional chest pain and a history of hypertension and hyperlipidemia presents with stable angina. Noninvasive testing (stress imaging) demonstrates ischemia in the distribution of the left anterior descending coronary artery. Coronary angiography identifies a focal, flow‑limiting atherosclerotic stenosis of a major coronary artery branch. The interventional cardiology team elects to perform a percutaneous drug‑coated balloon angioplasty with adjunct nondrug balloon dilation and intraprocedural imaging to optimize results. The procedure is performed in a hospital cardiac catheterization laboratory under conscious sedation with arterial access, selective coronary catheterization, angiographic guidance, intracoronary imaging (intravascular ultrasound or optical coherence tomography) to size the vessel and confirm lesion preparation, predilation with a nondrug‑coated balloon for mechanical dilation, followed by delivery of a medication‑coated balloon catheter to the target lesion to transfer antiproliferative drug to the vessel wall. Hemostasis is achieved at the vascular access site and the patient is observed in the post‑procedural recovery area before discharge or admission based on clinical status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Global surgery period indicator — no surgical package | Rarely used by payors; not typically applied to catheterization codes |
| 22 | Increased procedural services | When substantial additional work is documented beyond typical effort (e.g., complex anatomy, prolonged procedure)
| 23 | Unusual anesthesia | When general anesthesia is required for an otherwise ordinarily non‑GA procedure
| 52 | Reduced service | When the intended procedure is partially reduced or not completed as documented
| 53 | Discontinued procedure | When the procedure is terminated due to patient condition or intraoperative complication prior to completion
| 59 | Distinct procedural service | When a separate, distinct intervention is performed at a different anatomic site or session (use with caution and supporting documentation)
| 62 | Two surgeons | When two physicians of the same specialty perform distinct portions of the procedure
| 78 | Return to the operating/procedure room for a related procedure during the postoperative period | For urgent reintervention related to the index procedure
| 79 | (Not in provided list) | Data not available in the input.
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for surgical procedures | When an advanced practice clinician performs portion of the service under appropriate state law and payer policy
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208100000X | Cardiology | Interventional cardiologists perform percutaneous coronary interventions and DCB angioplasty |
| 208000000X | Internal Medicine | Hospitalists or cardiology consultants involved in pre/post procedural care
| 207RP1001X | Vascular Surgery | Vascular surgeons may perform endovascular coronary or peripheral interventions in select systems
| 282N00000X | Physician Assistant | PAs assist in procedural care and perioperative management
| 363A00000X | Registered Nurse Anesthetist | Provides anesthesia support when required
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Common chronic coronary artery disease indication for revascularization with balloon techniques |
| I25.110 | Atherosclerotic heart disease of native coronary artery with unstable angina | Indicates acute ischemic symptoms prompting percutaneous intervention
| I20.9 | Angina pectoris, unspecified | Symptomatic ischemia frequently leading to percutaneous coronary intervention
| I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site | Acute MI may require urgent percutaneous interventions; drug‑coated balloons used selectively
| I25.711 | Atherosclerosis of autologous coronary artery bypass graft with angina pectoris | Lesions in bypass grafts occasionally treated with balloon techniques
| I70.219 | Atherosclerosis of native arteries of the extremities, unspecified | Peripheral vascular atherosclerosis — included when peripheral drug‑coated balloon angioplasty is performed (procedure description focused on coronary; include for completeness)
| R07.9 | Chest pain, unspecified | Symptom code used when definitive ischemic diagnosis is pending
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92928 | Percutaneous transluminal balloon angioplasty, coronary artery, single major coronary artery or branch | Alternative or adjunct mechanical dilation; may be coded when nondrug‑coated balloon angioplasty is performed separately |
| 92920 | Percutaneous transluminal coronary thrombectomy, any method | Performed if intracoronary thrombus requires removal during the procedure
| 92950 | Cardiovascular service with insertion and placement of intracoronary stent(s) | Performed when lesion requires stent placement after balloon therapy; stenting is an adjunct or alternative to drug‑coated balloon therapy
| 75960 | Intravascular ultrasound, for imaging and diagnostic interpretation | Used when intravascular ultrasound (IVUS) guides sizing and confirms results
| 75822 | Diagnostic angiography, selective coronary, any number of vascular territories; with imaging supervision and interpretation | Diagnostic coronary angiography performed before or during the intervention
| 99024 | Postoperative follow-up visit, related to current procedure (global service) | Used for routine postoperative evaluation when payer policies require separate reporting