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Percutaneous transluminal coronary lithotripsy (PTCL), commonly referred to as intravascular lithotripsy (IVL), is a specialized medical procedure that utilizes ultrasound shock waves to effectively break down calcium deposits located within a coronary artery. This innovative technique is particularly beneficial in cases where traditional methods, such as high-pressure balloon angioplasty or atherectomy, may not yield successful results due to the presence of severely calcified plaque. The procedure is typically performed in conjunction with other interventions, such as balloon angioplasty and stent placement, to enhance the overall effectiveness of coronary artery treatment.
The concept of IVL is derived from the established practice of using acoustic pressure waves to fragment kidney stones, demonstrating its versatility in treating calcified lesions within the cardiovascular system. One of the key advantages of IVL is its ability to minimize injury to the surrounding coronary artery tissue, thereby reducing the risk of complications such as distal embolization, which can occur with more invasive debulking techniques. However, it is important to note that IVL is not suitable for all patients; specifically, it cannot be performed if the clinician is unable to pass a 0.014-inch guidewire across the calcified lesion, nor is it indicated for the treatment of restenosis within a stent.
Prior to the initiation of the IVL procedure, clinicians utilize percutaneous angiography to identify and measure the target lesions, ensuring precise treatment. The IVL procedure involves the use of a specialized catheter, typically 12 mm in diameter, which contains a disposable ultrasound core enclosed within a balloon. This catheter is advanced along a 0.014-inch guidewire to the site of calcification. Once positioned, the balloon is inflated to a pressure of 4 atmospheres, allowing the IVL device to emit a series of pulsed sound waves through its transmitters, effectively targeting the calcium deposits. Following the treatment, the balloon is deflated to allow any resulting bubbles to disperse, and the treatment cycle is repeated until the desired results are achieved. To assess the success of the procedure, intravascular ultrasound (IVUS) or optical coherence imaging may be employed post-procedure. In many cases, a stent may be placed across the lesion following the IVL treatment to further support the artery and maintain patency.
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The procedure of percutaneous transluminal coronary lithotripsy (PTCL) is indicated for specific clinical scenarios where traditional treatment methods may be inadequate. The following conditions warrant the use of IVL:
The procedural steps for performing percutaneous transluminal coronary lithotripsy (PTCL) are as follows:
After the completion of the percutaneous transluminal coronary lithotripsy (PTCL) procedure, patients are typically monitored for any immediate complications, although the rate of complications from IVL is low. Post-procedure care may include observation for signs of perforation of the artery, which can occur from either the balloon or the shockwave. Patients may also undergo follow-up imaging studies, such as intravascular ultrasound (IVUS), to assess the effectiveness of the treatment. Recovery time may vary depending on the individual patient's condition and the extent of the procedure performed. It is essential for healthcare providers to provide appropriate post-procedure instructions and ensure that patients understand the signs and symptoms to monitor during their recovery period.
| Short Descr | PERQ TRLUML CORONRY LITHOTRP | Medium Descr | PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY | Long Descr | Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Berenson-Eggers TOS (BETOS) | none | MUE | 3 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 92920 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch | 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 | 92975 | Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography | 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 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | LD | Left anterior descending coronary artery | RC | Right coronary artery | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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. | 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. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AO | Alternate payment method declined by provider of service | GP | Services delivered under an outpatient physical therapy plan of care | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | LC | Left circumflex coronary artery | LM | Left main coronary artery | LT | Left side (used to identify procedures performed on the left side of the body) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | RI | Ramus intermedius coronary artery | RT | Right side (used to identify procedures performed on the right side of the body) | TG | Complex/high tech level of care | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2024-01-01 | Added | Code Added. |
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