2026 PCI Codes for Interventional Cardiology-General Coding Guidelines for PCI Nov 2025 Update

General Coding Guidelines for PCI Nov 2025 Update

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This document outlines the general coding guidelines for Percutaneous Coronary Intervention (PCI) procedures using Current Procedural Terminology (CPT) codes, primarily for reporting and billing purposes. PCI codes encompass various components such as vascular access, lesion traversal, imaging, embolic protection, and arteriotomy closure.

Key points include:

1. <strong>Single Artery/Brach Coding:</strong> Use the code representing the most intensive PCI service for a single artery or branch. Only one base PCI code per major artery and its branches can be reported except when treating additional major arteries or bypass grafts, which require their own codes.

2. <strong>Coronary Anatomy for Coding:</strong> Major coronary arteries include left main, left anterior descending, left circumflex, right, and ramus intermedius arteries. Branches are recognized only in left anterior descending, left circumflex, and right arteries (e.g., diagonals, marginals, posterolaterals). Bypass grafts are treated as major coronary vessels.

3. <strong>Lesion Definitions:</strong> A single coronary lesion extends from the proximal to distal ends, possibly spanning multiple coronary segments or crossing vessels through a single intervention. Two lesions are distinct if geographically separated.

4. <strong>Primary PCI CPT Codes:</strong> Codes 92920 to 92945 cover various PCI procedures including angioplasty, atherectomy, stenting for native arteries or bypass grafts, treatment of acute or chronic total occlusions, and combined antegrade-retrograde approaches.

5. <strong>Add-On Codes:</strong> Additional procedures such as coronary lithotripsy (92972), mechanical thrombectomy (92973), radiation delivery devices (92974), and intravascular imaging (IVUS/OCT) or flow measurements (93571, 93572) are reported separately as add-ons.

6. <strong>Diagnostic Angiography:</strong> Should be reported separately only when no prior study exists or when clinical changes necessitate evaluation of different areas.

7. <strong>Modifiers:</strong> Used to specify treated arteries or branches especially when lesions cross vessels but are treated in a single intervention.

The guidelines emphasize proper code selection to reflect the complexity of the PCI performed, ensuring accurate documentation and reimbursement. The information is sourced from the American Medical Association CPT editions and other authoritative references. The Society for Cardiovascular Angiography and Interventions (SCAI) provides this consensus guidance but advises consultation with clinical and legal experts for case-specific coding decisions.

Keywords

Percutaneous Coronary Intervention

PCI coding guidelines

Current Procedural Terminology

CPT codes

coronary artery anatomy

lesion definitions

primary PCI CPT codes

add-on codes PCI

diagnostic angiography reporting

coding modifiers PCI