92928

Percutaneous transluminal coronary angioplasty, with stent placement(s), single major coronary artery or branch;

CPT code 92928 describes the percutaneous transluminal coronary angioplasty (PTCA) procedure, which includes the placement of one or more stents, performed on a single major coronary artery or branch. This is a minimally invasive cardiac procedure used to treat coronary artery disease (CAD), a condition where the coronary arteries become narrowed or blocked due to the buildup of plaque (atherosclerosis). The procedure aims to restore adequate blood flow to the heart muscle. During PTCA, a catheter with a balloon is advanced through a blood vessel (typically in the groin or wrist) to the site of the coronary artery blockage. The balloon is then inflated to compress the plaque against the artery walls, thereby widening the narrowed vessel. Following balloon angioplasty, a stent – a small, expandable mesh tube – is typically deployed at the site of the expanded plaque to keep the artery open and prevent it from narrowing again (restenosis). Stents can be bare-metal (BMS) or drug-eluting (DES), with DES releasing medication over time to further reduce the risk of restenosis. This code specifically applies to the initial treatment of one major coronary artery or one significant branch. Subsequent interventions on additional vessels during the same session would be reported with add-on codes. The procedure is usually performed in a cardiac catheterization laboratory under local anesthesia with conscious sedation. Patients are monitored closely during and after the procedure. This intervention is crucial for improving symptoms like angina, preventing myocardial infarction, and enhancing the quality of life for individuals with significant coronary artery blockages. The complexity can vary based on the anatomy of the lesion, vessel tortuosity, and presence of calcification.

Clinical Indications

  • Symptomatic coronary artery disease (e.g., stable angina, unstable angina) refractory to optimal medical therapy.
  • Non-ST-elevation myocardial infarction (NSTEMI).
  • ST-elevation myocardial infarction (STEMI) – as primary percutaneous coronary intervention (PCI).
  • Acute coronary syndromes (ACS).
  • Ischemia documented by non-invasive stress testing (e.g., stress echocardiography, nuclear stress test) in patients with significant coronary stenoses.
  • Significant coronary artery stenosis (typically >70%, or >50% in specific high-risk scenarios) in vessels supplying viable myocardium.
  • Post-CABG (Coronary Artery Bypass Graft) graft stenosis.
  • Prior PCI restenosis.

Procedure Steps

  1. Patient Preparation: Obtain informed consent, administer local anesthetic at the access site (femoral or radial artery), and provide conscious sedation.
  2. Vascular Access: Puncture the chosen artery (femoral or radial) and insert an introducer sheath.
  3. Catheter Advancement: A guiding catheter is advanced over a guidewire through the arterial system to the ostium of the target coronary artery under fluoroscopic guidance.
  4. Coronary Angiography: Contrast dye is injected through the guiding catheter to visualize the coronary anatomy and identify the location and severity of the stenosis.
  5. Lesion Crossing: A specialized guidewire is carefully advanced through the guiding catheter, across the stenotic lesion in the target coronary artery.
  6. Balloon Angioplasty (if performed separately): A balloon catheter is advanced over the guidewire to the lesion. The balloon is inflated one or more times to dilate the narrowed artery.
  7. Stent Delivery and Deployment: A stent, mounted on a balloon catheter, is advanced over the guidewire to the previously dilated or target lesion. The balloon is inflated to deploy the stent, expanding it against the artery wall.
  8. Post-Deployment Optimization (if needed): Further balloon inflations (post-dilation) or use of intravascular imaging (e.g., IVUS, OCT) may be performed to optimize stent expansion and apposition.
  9. Final Angiography: Repeat angiogram is performed to confirm successful revascularization, assess residual stenosis, and check for complications (e.g., dissection, distal embolization).
  10. Catheter Removal and Hemostasis: The guiding catheter, guidewire, and sheath are removed. Hemostasis is achieved at the access site using manual compression, a closure device, or a compression device.
  11. Post-Procedure Care: Patient monitoring for complications and administration of antiplatelet medications.

Coding Guidelines

  • CPT code 92928 describes the initial percutaneous transluminal coronary angioplasty with stent placement in a single major coronary artery or branch.
  • This code is used once per operative session for the first vessel treated with angioplasty and stent.
  • If additional major coronary arteries or branches are treated with angioplasty and stent during the same operative session, add-on codes 92929 (for each additional major coronary artery or branch) should be used.
  • CPT codes 92928-92929 include all imaging guidance necessary to perform the angioplasty and stent placement, including roadmapping, fluoroscopy, and diagnostic angiography performed immediately prior to the intervention (if not separately reported within 30 days).
  • Diagnostic catheterization performed on the same day as a therapeutic intervention in the same vascular family is generally not reported separately, as it is considered bundled. However, if a complete diagnostic study was performed and separately interpreted prior to the decision for intervention, it may be separately reported if documented as a distinct procedural service.
  • A "major coronary artery or branch" refers to the right coronary artery (RCA), left main coronary artery (LMCA), left anterior descending artery (LAD), circumflex artery (LCX), and significant branches thereof (e.g., diagonal, obtuse marginal, posterior descending artery).
  • Do not report 92928 with codes for atherectomy (92973, 92974) in the same vessel.
  • Codes 92928-92941 are to be used for therapeutic interventions on native coronary arteries and coronary artery bypass grafts.
  • The use of drug-eluting vs. bare-metal stents does not change the CPT code.

Associated ICD-10 Codes