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Percutaneous transluminal revascularization of a chronic total occlusion involves a minimally invasive procedure aimed at restoring blood flow in a coronary artery, coronary artery branch, or a coronary artery bypass graft that has been completely blocked for an extended period, specifically more than three months. A chronic total occlusion is characterized by a blockage of greater than 99% in the artery or graft. This procedure utilizes various techniques, including angioplasty, atherectomy, and the placement of stents, to achieve revascularization. The process begins with the preparation of the skin over the access artery, typically one of the femoral arteries, followed by puncturing the artery and placing a sheath to facilitate access. Under radiological guidance, a guidewire is navigated through the occluded artery. If angioplasty is indicated, a balloon catheter is advanced to the blockage site, where it is inflated to compress the plaque against the arterial wall, thereby widening the artery. Alternatively, atherectomy may be performed, which involves using a specialized catheter to shave plaque from the artery. If necessary, an intravascular stent is deployed to maintain the artery's patency. Following the procedure, completion angiography is conducted to confirm the success of the revascularization, and appropriate post-procedure care is implemented to ensure patient safety and recovery.
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The procedure is indicated for patients with chronic total occlusion of a coronary artery, coronary artery branch, or coronary artery bypass graft. This condition is characterized by a complete blockage of the artery or graft for a duration exceeding three months, which can lead to significant ischemic heart disease and related symptoms.
The procedure begins with the preparation of the skin over the access site, typically the femoral artery. The physician punctures the artery with a needle and places a sheath to facilitate access. Under radiological supervision, a guidewire is inserted and advanced through the sheath into the occluded coronary artery or bypass graft. If angioplasty is performed, a catheter with a balloon tip is advanced over the guidewire to the site of the occlusion. The balloon is then inflated, compressing the plaque against the arterial wall to restore blood flow. Alternatively, atherectomy may be performed, which involves using a specialized balloon catheter equipped with a cutting piston that shaves plaque from the arterial wall. As the plaque is removed, it is collected within the atherectomy device for removal upon withdrawal of the catheter. If necessary, an intravascular stent is deployed to maintain the artery's patency. The stent delivery catheter is carefully positioned at the site of the occlusion and deployed, followed by the removal of the catheter. A balloon catheter may be reintroduced and inflated to ensure proper seating of the stent. After the procedure, contrast is injected, and completion angiography is performed to verify that the artery is patent. Finally, all catheters are removed, pressure is applied to the vascular access site, and a pressure dressing is applied to promote hemostasis.
Post-procedure care involves monitoring the vascular access site for bleeding or hematoma formation. Patients may be advised to rest and limit physical activity for a specified period to promote healing. Follow-up appointments are typically scheduled to assess recovery and ensure the continued patency of the treated artery. Any signs of complications, such as chest pain or changes in symptoms, should be reported to the healthcare provider immediately.
| Short Descr | PRQ CARD REVASC CHRONIC ADDL | Medium Descr | PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL | Long Descr | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure) | Status Code | Bundled Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 2 | CCS Clinical Classification | 45 - Percutaneous transluminal coronary angioplasty (PTCA) |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 92924 | Resequenced Code MPFS Status: Active Code APC J1 Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch | 92928 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | 92933 | Resequenced Code MPFS Status: Active Code APC J1 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch | 92937 | Resequenced Code MPFS Status: Active Code APC J1 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel | 92941 | Resequenced Code MPFS Status: Active Code APC C Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel | 92943 | Resequenced Code MPFS Status: Active Code APC J1 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel | C9600 | Medicare Coverage: Special Coverage Instructions APC J1 ASC J8 Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | C9602 | Medicare Coverage: Special Coverage Instructions APC J1 Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch | C9604 | Medicare Coverage: Special Coverage Instructions APC J1 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel | C9606 | Medicare Coverage: Special Coverage Instructions APC C Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel | C9607 | Medicare Coverage: Special Coverage Instructions APC J1 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AO | Alternate payment method declined by provider of service | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | LC | Left circumflex coronary artery | LD | Left anterior descending coronary artery | LM | Left main coronary artery | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RC | Right coronary artery | RI | Ramus intermedius coronary artery | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2013-01-01 | Added | Added |
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