The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 7 French (Fr) sheath, a 0.035-inch guidewire, a 3.0 mm diameter balloon angioplasty catheter, and a 3.0 mm x 18 mm drug-eluting stent. The procedure involved selective catheterization of the left main coronary artery and subsequent angiography of the LAD. The question asks for the appropriate CPT code for the stent placement. The core procedure is coronary angioplasty with stent placement. The relevant CPT code for this is found in the 92928 series, which covers percutaneous transluminal coronary angioplasty (PTCA) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and/or stent insertion, with or without angiography, by catheter. Specifically, 92928 is for the initial vessel treated. Since the physician performed angioplasty and then placed a stent in the LAD, this code accurately reflects the primary intervention. The documentation specifies a drug-eluting stent, which is a type of stent. The CPT code 92928 inherently includes the placement of a stent. There are separate codes for the imaging guidance (e.g., angiography), but the question focuses on the stent placement itself. The use of a 7 Fr sheath, 0.035-inch guidewire, and a 3.0 mm balloon are procedural details that support the complexity and type of intervention but do not alter the primary CPT code for the stent placement in the LAD. The selective catheterization of the left main coronary artery is a necessary step to access the LAD and is bundled into the primary procedure code. Therefore, the most appropriate code for the placement of a stent in the LAD during a PTCA is 92928.

The question assesses the understanding of CPT coding principles for interventional radiology procedures, specifically focusing on the correct application of modifiers when multiple distinct services are performed during a single session. The scenario describes a percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending (LAD) artery, followed by the placement of a stent in the same vessel. The base CPT code for PTCA without mention of stenting is 92920. However, the scenario explicitly states that a stent was also placed in the LAD. The correct CPT code for PTCA with stent placement in the LAD is 92928. When multiple distinct interventional procedures are performed on the same anatomical site or vessel, specific coding rules apply. In this case, the PTCA was performed *in conjunction with* stent placement in the same vessel. CPT guidelines for cardiovascular interventions indicate that when a stent is placed during a PTCA of the same vessel, the PTCA component is considered integral to the stenting procedure and is not separately reported. Therefore, only the more comprehensive procedure, the PTCA with stent placement, should be coded. The scenario does not describe any procedures on a different vessel, nor does it mention any separate diagnostic angiographic components that would warrant additional codes or modifiers. The focus is solely on the therapeutic intervention within the LAD. Thus, the correct coding approach is to report the single, most comprehensive code for the combined intervention. The correct CPT code for this scenario is 92928.

The question assesses the understanding of CPT coding principles for interventional radiology procedures, specifically focusing on the correct application of modifiers when multiple distinct services are performed during a single session. In this scenario, a physician performs a diagnostic angiography of the abdominal aorta and bilateral iliac arteries, followed by balloon angioplasty of the right common iliac artery and placement of a stent in the same vessel. The base procedure for diagnostic angiography of the abdominal aorta and bilateral iliac arteries is CPT code 75710 (Angiography, selective, bilateral lower extremity arteries; each additional vessel studied after the first). However, for the abdominal aorta and bilateral iliacs, the appropriate code for diagnostic angiography is 75625 (Aortography, abdominal, by catheter, selective or non-selective). The therapeutic intervention involves balloon angioplasty and stenting of the right common iliac artery. The CPT code for transluminal angioplasty of the iliac artery, including the common iliac, is 37226 (Angioplasty, percutaneous transluminal, with or without residual stenosis \(\geq\) 30% of iliac, common iliac, external iliac, or hypogastric artery; unilateral, initial vessel). The CPT code for insertion of a stent into the iliac artery, including the common iliac, is 37227 (Stent placement, percutaneous transluminal, with or without residual stenosis \(\geq\) 30% of iliac, common iliac, external iliac, or hypogastric artery; unilateral, initial vessel). When multiple distinct procedures are performed on the same anatomical site, modifiers are crucial. The primary procedure is typically coded without a modifier, and subsequent distinct procedures on the same anatomical site require the appropriate modifier. In this case, the diagnostic angiography (75625) is a separate and distinct service from the therapeutic interventions. The angioplasty (37226) and stenting (37227) are both performed on the right common iliac artery. According to CPT guidelines, when multiple vascular procedures are performed on the same vessel or contiguous vessels, the primary procedure is coded, and subsequent procedures on the same vessel or contiguous vessels require a modifier. However, when distinct procedures are performed on different vessels within the same anatomical region, or when a diagnostic procedure is followed by a therapeutic procedure, appropriate modifiers are applied to indicate the distinct nature of the services. The correct coding approach involves coding the diagnostic angiography (75625) and the therapeutic interventions. For the therapeutic interventions on the right common iliac artery, the angioplasty (37226) is performed, and then the stent is placed (37227). Since both are performed on the same initial vessel, the angioplasty is coded as the primary procedure, and the stenting, being a subsequent intervention on the same initial vessel, would typically be reported with modifier 59 (Distinct Procedural Service) if it were a separate encounter or performed on a different vessel. However, in this specific scenario, the angioplasty and stenting are performed on the same initial vessel. CPT guidelines for vascular procedures often bundle certain services or require specific sequencing. For angioplasty and stenting of the same initial vessel, the more complex procedure (stenting) is often reported with the primary code, and the less complex (angioplasty) may be reported with modifier 59 if it meets the criteria for distinctness, or it may be considered inclusive. However, a more nuanced interpretation for distinct vascular interventions on the same initial vessel involves coding the primary intervention and then reporting subsequent interventions with appropriate modifiers to indicate distinctness. In this case, the diagnostic angiography is clearly distinct. The angioplasty and stenting are both performed on the right common iliac artery. The correct coding would involve reporting the diagnostic angiography (75625). For the therapeutic interventions, the angioplasty (37226) and stenting (37227) are performed on the same initial vessel. The CPT manual specifies that when multiple vascular procedures are performed on the same vessel or contiguous vessels, the primary procedure is coded, and subsequent procedures on the same vessel or contiguous vessels require modifier 59 to indicate they are distinct. Therefore, the angioplasty would be coded as 37226, and the stenting, being a subsequent intervention on the same initial vessel, would be coded as 37227 with modifier 59 to indicate it is a distinct procedural service from the angioplasty on the same vessel. The diagnostic angiography is a separate diagnostic service. Therefore, the correct coding would be 75625 for the diagnostic angiography, 37226 for the angioplasty of the right common iliac artery, and 37227-59 for the stenting of the right common iliac artery. The question asks for the most appropriate coding combination. Let’s re-evaluate the scenario based on standard CPT coding for vascular interventions. Diagnostic angiography is typically coded separately. For therapeutic interventions on the same initial vessel, the primary procedure is coded, and subsequent procedures on that same vessel often require a modifier to denote distinctness. The angioplasty is performed, and then stenting is performed in the same vessel. The CPT guidelines for vascular procedures often consider the more complex procedure as the primary. In this case, stenting is generally considered more complex than angioplasty. However, the order of performance matters. If angioplasty is performed first, and then stenting is performed in the same vessel, both can be reported if they are distinct services. Modifier 59 is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. Considering the provided options, the key is to correctly identify the diagnostic procedure and the therapeutic procedures, and how they are linked or distinguished. The diagnostic angiography of the abdominal aorta and bilateral iliac arteries is a distinct diagnostic service. The angioplasty and stenting are therapeutic services performed on the right common iliac artery. When multiple therapeutic procedures are performed on the same initial vessel, the primary procedure is coded, and subsequent procedures on that same vessel require modifier 59. The correct approach is to code the diagnostic angiography as 75625. Then, for the therapeutic interventions on the right common iliac artery, the angioplasty is performed (37226), followed by stenting (37227). Since both are performed on the same initial vessel, and the stenting is a distinct procedure performed after the angioplasty, modifier 59 is appended to the stenting code to indicate it is a distinct procedural service. Therefore, the correct coding combination is 75625, 37226, and 37227-59.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The interventional cardiologist utilizes a 6 French (Fr) sheath for vascular access and a 0.035-inch guidewire. The question focuses on the appropriate CPT coding for the primary procedure and the management of a specific complication. The primary procedure, PTCA with stent placement in a single coronary artery (LAD), is coded using CPT code 92928 (Percutaneous transluminal coronary angioplasty; with insertion of transluminal coronary angioplasty stent in a native coronary artery). During the procedure, a dissection occurs in the LAD, necessitating balloon angioplasty to address it. This secondary intervention on the same vessel, performed to manage a complication of the primary procedure, requires an add-on code. The appropriate add-on code for balloon angioplasty in conjunction with a stented native coronary artery is 92921 (Percutaneous transluminal coronary angioplasty; with insertion of transluminal coronary angioplasty balloon in a native coronary artery). When multiple procedures are performed on the same vessel during the same session, the primary procedure is reported with its full code, and subsequent interventions on that same vessel are reported with add-on codes. The use of a 6 Fr sheath and a 0.035-inch guidewire are standard procedural components and do not warrant separate CPT codes. The documentation supports the performance of both angioplasty and stenting in the LAD, with the angioplasty being performed to manage a complication. Therefore, the correct coding reflects both the stenting and the subsequent balloon angioplasty for the dissection.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 0.035-inch guidewire, a 6 French (Fr) sheath, and a 3.0 mm x 18 mm drug-eluting stent. The procedure involved balloon angioplasty prior to stent deployment. The question asks for the most appropriate CPT code for the primary procedure. To determine the correct coding, we must consider the core interventional procedure performed. The documentation clearly indicates a PTCA with stent placement. The CPT manual provides specific codes for these procedures based on the anatomical location and whether a stent is used. For coronary angioplasty with stent placement, the relevant CPT codes are found in the 92920-92944 range. Specifically, code 92928, “Percutaneous transluminal coronary angioplasty; with insertion of coronary artery stent(s), with or without balloon angioplasty,” is the most accurate descriptor for the documented procedure. This code encompasses the angioplasty and the stent insertion in a single coronary artery. The other options are less appropriate: – 92920 describes PTCA without a stent, which is not what was performed. – 92929 describes PTCA with stent placement in a *different* coronary artery or a *different* segment of the same artery, implying a more complex or multi-vessel intervention, which is not detailed here. – 92937 describes atherectomy, which is a different technique than angioplasty and stenting. Therefore, the correct CPT code reflecting the documented PTCA with stent placement in the LAD artery is 92928.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The interventional cardiologist utilizes a 6 French (Fr) sheath for vascular access, a 0.035-inch guidewire, and a balloon catheter with a diameter of 3.0 mm and a length of 20 mm. A drug-eluting stent measuring 3.0 mm in diameter and 18 mm in length is then deployed. The question asks for the appropriate CPT code for the primary procedure. To determine the correct CPT code, we need to consider the specific services performed. The core procedure is the angioplasty of a coronary artery with stent placement. The CPT manual provides specific codes for these interventions. First, we identify the code for percutaneous transluminal coronary angioplasty (PTCA) with stent. The relevant code for a single major coronary artery is 92928. This code encompasses the balloon angioplasty and the placement of a stent in a single coronary artery. Next, we consider if any other services require separate coding. The scenario mentions vascular access, but CPT guidelines generally bundle access into the primary procedure code unless specific complications or separate access sites are involved. In this case, the 6 Fr sheath access is standard for such procedures. The guidewire and balloon catheter are supplies used during the procedure and are not separately billable with their own CPT codes in this context. The drug-eluting nature of the stent is also incorporated into the primary procedure code. Therefore, the most accurate and comprehensive CPT code for the described intervention, which includes angioplasty and stent placement in the LAD artery, is 92928. This code reflects the technical performance of the angioplasty and the placement of the stent in a single coronary artery. The explanation of why this code is correct lies in understanding the bundling principles within CPT for interventional cardiology procedures, where the primary intervention and its associated components are captured by a single, specific code. This aligns with the Certified Interventional Radiology Cardiovascular Coder (CIRCC) University’s emphasis on precise coding that reflects the entirety of the service rendered, avoiding unbundling of services that are considered integral to the primary procedure.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 0.035-inch guidewire, a 6 French (Fr) sheath, and a 3.0 x 20 mm drug-eluting stent. The procedure involved balloon angioplasty prior to stent deployment. The key to correctly coding this scenario for Certified Interventional Radiology Cardiovascular Coder (CIRCC) University’s curriculum lies in understanding the nuances of CPT coding for cardiovascular interventions. Specifically, the base code for PTCA with stent placement in a major coronary artery is identified. The use of a drug-eluting stent is a critical detail that necessitates an add-on code. The documentation supports a single lesion treated in the LAD. Therefore, the correct coding involves the primary procedure code for coronary angioplasty with stent and the add-on code for the drug-eluting stent. The size of the guidewire and sheath, while important for procedural understanding, do not directly impact the CPT code selection in this context, nor does the specific balloon size, as the primary focus is on the intervention itself and the type of stent used. The question tests the coder’s ability to identify the core procedure and the specific technology employed, aligning with the rigorous standards of Certified Interventional Radiology Cardiovascular Coder (CIRCC) University’s focus on precise procedural coding.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 0.035-inch guidewire, a 6 French (Fr) sheath, and a 3.0 mm x 18 mm drug-eluting stent. The procedure involved balloon angioplasty prior to stent deployment. The question asks for the most appropriate CPT code for the primary procedure. To determine the correct code, we need to consider the core interventional procedure performed. The documentation clearly indicates a coronary angioplasty with stent placement. The specific artery involved is the LAD. Consulting the CPT manual for cardiovascular interventions, we look for codes related to percutaneous transluminal coronary angioplasty (PTCA). The codes for PTCA with or without stent placement are typically found in the 929xx series. Specifically, codes like 92928 (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch, with or without stent placement) are relevant. The documentation specifies “stent placement” and “balloon angioplasty,” indicating that both were performed. The code 92928 encompasses both angioplasty and stent placement when performed on a single major coronary artery. The size of the stent (3.0 mm x 18 mm) and the guidewire (0.035-inch) are procedural details that support the performance of the intervention but do not alter the primary CPT code for the service itself. The sheath size (6 Fr) is also a procedural detail. Therefore, the most accurate CPT code reflecting the physician’s work in performing angioplasty and stenting on the LAD artery is 92928. This code captures the complexity of the intervention on a single major coronary artery. Other codes might be considered for additional procedures or complications, but based on the provided information, 92928 is the primary code for the described service.

The question assesses the understanding of CPT coding principles for interventional radiology procedures, specifically focusing on the application of modifiers when multiple distinct services are performed during a single session. In this scenario, a physician performs a diagnostic left heart catheterization with selective coronary angiography and then proceeds to perform a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The diagnostic left heart catheterization, including selective coronary angiography, is typically coded using CPT code 93458 (Left heart catheterization; with coronary angiography). The PTCA with stent placement in the LAD is coded using CPT code 92928 (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch, with thrombolytic therapy, with mechanicalthrombectomy, with stent, with directional atherectomy, and/or with rotational atherectomy, including angioplasty). When multiple distinct procedures are performed on the same day, modifiers are crucial for accurate billing and reimbursement. The primary procedure is typically reported with the base code, and subsequent distinct procedures are reported with appropriate modifiers. In this case, the PTCA with stent placement in the LAD is a distinct and more complex procedure than the diagnostic angiography. Therefore, it should be reported with the base code 92928. The diagnostic left heart catheterization with coronary angiography (93458) was performed as a separate diagnostic component. When a diagnostic procedure is performed and then a therapeutic procedure is performed on the same anatomical site or vessel, the diagnostic procedure may be reported with a modifier to indicate it was a separate, distinct service. Modifier 59 (Distinct Procedural Service) is generally used to identify a procedure or service, other than E/M services, that is identified as distinct or independent from other services performed on the same day. However, for cardiovascular procedures, specific vascular procedure modifiers are often more appropriate. Modifier 50 (Bilateral Procedure) is not applicable here as only one side is treated. Modifier 26 (Professional Component) and TC (Technical Component) are for splitting services, which is not the case here. Modifier 51 (Multiple Procedures) is used when multiple procedures, other than E/M services, surgical procedures, and diagnostic procedures, are performed on the same day by the same physician. However, CPT guidelines often indicate that modifier 51 is not appended to procedures that are already identified as distinct or to procedures that are not subject to the multiple procedure reduction. In the context of cardiovascular coding, when a diagnostic angiography is followed by a therapeutic intervention on the same vessel, the diagnostic angiography is often reported with modifier 26 if the professional component was performed, and the therapeutic intervention is reported with its full code. However, if the diagnostic angiography was a separate and distinct service that was not an integral part of the therapeutic intervention, modifier 59 might be considered. Given the scenario describes a diagnostic left heart catheterization *with* coronary angiography, and then a *subsequent* PTCA with stent, the most accurate coding approach is to report the diagnostic angiography with a modifier that signifies it was a separate service, and the therapeutic intervention with its primary code. Many coding guidelines suggest that when a diagnostic angiography is performed and then a therapeutic intervention is performed on the same vessel, the diagnostic angiography is reported with modifier 59 to indicate it was a distinct service, especially if it involved separate catheter manipulations or imaging sequences beyond what is inherently included in the therapeutic procedure’s baseline imaging. Therefore, reporting 93458 with modifier 59 and 92928 without a modifier is the most appropriate approach to reflect two distinct services performed. The correct coding sequence is to report the diagnostic procedure with the modifier indicating its distinctness and the therapeutic procedure as the primary service. The diagnostic left heart catheterization with coronary angiography is coded as 93458. The PTCA with stent placement in the LAD is coded as 92928. To indicate that the diagnostic procedure was a separate and distinct service from the therapeutic intervention performed on the same day, modifier 59 is appended to the diagnostic procedure code. Thus, the correct coding is 93458-59 and 92928.

The question assesses the understanding of the interplay between anatomical variations, procedural complexity, and appropriate CPT coding for interventional cardiovascular procedures, specifically within the context of Certified Interventional Radiology Cardiovascular Coder (CIRCC) University’s curriculum. The scenario describes a complex percutaneous transluminal coronary angioplasty (PTCA) with stent placement in a patient with significant anatomical challenges. The primary vessel treated is the left anterior descending (LAD) artery, a major coronary artery. The procedure involves multiple distinct steps: initial angiography to visualize the coronary anatomy, balloon angioplasty to open the stenosis, and placement of a drug-eluting stent (DES) to maintain patency. The use of intravascular ultrasound (IVUS) is a supplementary imaging modality used to optimize stent placement and assess lesion characteristics, which is often coded separately. The correct coding approach involves identifying the primary procedure, the specific anatomical location, the type of stent used, and any additional services performed. For a PTCA with stent placement in the LAD, the base CPT code would reflect this. The addition of a DES necessitates a specific code for the stent itself. The IVUS guidance, being a distinct diagnostic and guidance tool, is also separately reportable. Therefore, the correct coding would encompass the PTCA with stent, the DES, and the IVUS. Let’s break down the coding components: 1. **Percutaneous Transluminal Coronary Angioplasty (PTCA) with stent placement:** This is the core procedure. 2. **Drug-Eluting Stent (DES):** This requires a specific code to identify the type of stent used. 3. **Intravascular Ultrasound (IVUS):** This is a separate imaging and guidance service. Considering these components, the most accurate and comprehensive coding would involve a combination of codes representing each distinct service. The question requires the candidate to synthesize knowledge of CPT codes for cardiovascular interventions, understanding that multiple codes may be necessary to fully represent a complex procedure. The emphasis is on the interventional radiologist’s role in accurately capturing the full scope of services rendered, aligning with the rigorous standards expected at CIRCC University. The correct coding reflects the procedural complexity and the utilization of advanced technologies for optimal patient outcomes, a key tenet of interventional radiology.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a specific stent type and the administration of a particular anticoagulant. For accurate coding at Certified Interventional Radiology Cardiovascular Coder (CIRCC) University, understanding the nuances of CPT coding for cardiovascular interventions is paramount. The procedure involves opening a stenosed artery and implanting a device. The CPT code for PTCA with stent placement in a coronary artery is 92928. This code encompasses the balloon angioplasty and the insertion of the stent. The documentation specifies the LAD, which is a major coronary artery, and the use of a specific stent, which is relevant for device tracking but not for the primary CPT code for the intervention itself. The anticoagulant administration, while critical for patient care, is typically bundled into the global surgical package or coded separately with an appropriate HCPCS code if it meets specific reporting criteria, but it does not alter the primary CPT code for the angioplasty and stenting. Therefore, the most appropriate CPT code reflecting the core intervention described is 92928. This code accurately captures the complexity of opening a blocked coronary artery and implanting a stent, which is the central focus of the interventional procedure. Understanding the hierarchy and specificity of CPT codes is a foundational skill for CIRCC professionals, ensuring accurate reimbursement and adherence to regulatory standards.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 7 French (Fr) sheath, a 0.035-inch guidewire, and a 3.0 x 20 mm drug-eluting stent. The procedure involved selective catheterization of the left coronary artery, followed by balloon angioplasty and stent deployment. Post-procedure angiography confirmed successful revascularization. To determine the correct CPT code, we need to consider the primary procedure performed and any add-on codes. The core procedure is the angioplasty of the LAD. CPT code 92928 (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch) accurately reflects this. Since a stent was also placed in the same major coronary artery, an add-on code for stent placement is required. CPT code +92929 (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch, with insertion of intracoronary stent) is the appropriate add-on code for stent placement in conjunction with angioplasty of a single major coronary artery. The documentation specifies the LAD, which is a major coronary artery. The use of a 7 Fr sheath, 0.035-inch guidewire, and the specific stent size are details supporting the procedure but do not alter the primary coding. Therefore, the combination of 92928 and +92929 accurately captures the services rendered.

The scenario describes a patient undergoing percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 0.035-inch guidewire, a 6 French (Fr) sheath, and a 3.0 x 20 mm drug-eluting stent. The procedure involved balloon angioplasty prior to stent deployment. To accurately code this scenario for Certified Interventional Radiology Cardiovascular Coder (CIRCC) University’s rigorous curriculum, one must identify the primary procedural code and any applicable add-on codes. The primary procedure is coronary angioplasty with stent placement. The CPT code for percutaneous transluminal coronary angioplasty (PTCA) with insertion of a stent is 92928. This code encompasses the entire process of balloon angioplasty and stent deployment in a major coronary artery. The documentation specifies the LAD artery, which is a major coronary artery. The use of a drug-eluting stent does not alter the primary code for the angioplasty and stenting itself, but rather influences the selection of the stent type if a separate code for the device were applicable, which it is not in this context for the procedural code. The sheath size and guidewire diameter are descriptive elements of the procedure but do not dictate a separate CPT code. Therefore, the core procedure is captured by 92928. The explanation of why this is the correct approach involves understanding the hierarchical structure of CPT coding for cardiovascular interventions. Code 92928 is the most specific code for the combined intervention of angioplasty and stenting in a coronary artery. Other codes might exist for angioplasty alone, or for interventions in different vascular territories, but they are not applicable here. The documentation clearly indicates both angioplasty and stenting were performed. The focus for a CIRCC candidate is to recognize the primary service rendered and select the most appropriate, comprehensive code. This aligns with the principle of coding the most extensive procedure performed.

The scenario describes a patient undergoing a complex percutaneous transluminal coronary angioplasty (PTCA) with stent placement in a bifurcated lesion of the left anterior descending artery. The physician documents the use of two distinct drug-eluting stents (DES) and a specific technique for managing the bifurcation. For accurate CPT coding, the coder must identify the primary procedure and any add-on services. The primary procedure is the PTCA with stent placement. Since the physician used two DES, each stent placement is a billable service. The CPT code for PTCA with stent placement in a coronary artery is 92928. When a second or subsequent arterial stent is placed during the same session, the add-on code 92929 is used. Therefore, the correct coding would involve one unit of 92928 and one unit of 92929. The explanation of the bifurcation technique, while clinically relevant, does not typically generate a separate CPT code unless a specific, separately billable approach is documented and recognized by payers. The focus for coding is on the services rendered and the devices used. The question tests the understanding of coding for multiple stents in a single vessel, specifically in a bifurcated lesion, which requires knowledge of add-on codes and their appropriate application. This aligns with the advanced understanding of CPT coding for interventional cardiovascular procedures expected of a Certified Interventional Radiology Cardiovascular Coder (CIRCC) at Certified Interventional Radiology Cardiovascular Coder (CIRCC) University.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The coder must accurately reflect the complexity and specific services provided. The primary procedure is the angioplasty and stenting of the LAD. The documentation indicates the use of a drug-eluting stent (DES), which is a critical detail for accurate coding. Furthermore, the report details the use of a specific imaging modality, fluoroscopy, to guide the intervention, and the administration of contrast media. The question requires identifying the most appropriate CPT code that encompasses these elements. Considering the CPT coding guidelines for cardiovascular interventions, the procedure involves angioplasty and stent placement in a major coronary artery. The use of a drug-eluting stent necessitates a specific code that differentiates it from a bare-metal stent. The documentation clearly supports coding for the primary intervention. The use of fluoroscopy for guidance is typically bundled into the primary procedure code for interventional cardiology and radiology. Similarly, the administration of contrast media during an angiography or intervention is generally included. Therefore, the most comprehensive and accurate code would reflect the angioplasty with stent placement in a coronary artery, specifically noting the drug-eluting nature of the stent. The correct CPT code for percutaneous transluminal coronary angioplasty (PTCA) with insertion of a drug-eluting stent into the left anterior descending artery, including imaging guidance and contrast administration, is 92928. This code specifically covers the transluminal angioplasty of a coronary artery with a drug-eluting intracoronary stent. It implicitly includes the necessary imaging and contrast used for guidance during the procedure, as per standard coding practices for interventional cardiology and radiology.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a specific type of stent, a drug-eluting stent (DES), and notes the administration of dual antiplatelet therapy (DAPT) post-procedure. The question asks for the appropriate CPT code for the stent placement. To determine the correct CPT code, one must consult the CPT manual for interventional cardiology procedures. Specifically, codes for percutaneous coronary intervention (PCI) are relevant. The scenario details stent placement in a single major coronary artery (LAD). The CPT code for percutaneous transluminal coronary angioplasty (PTCA) of a coronary artery with intracoronary stent placement is 92928. This code encompasses the angioplasty itself and the placement of the stent. The documentation of a drug-eluting stent does not alter the base CPT code for the procedure itself, but rather informs the medical necessity and potential follow-up care. The mention of DAPT is a clinical management detail, not a factor in selecting the primary procedural CPT code for stent placement. Therefore, the correct CPT code for the described procedure is 92928.

The question assesses the understanding of coding principles for interventional radiology procedures, specifically focusing on the appropriate application of modifiers when multiple distinct services are performed during a single session. In this scenario, the physician performs a diagnostic angiography of the abdominal aorta and bilateral iliac arteries, followed by a percutaneous transluminal angioplasty (PTA) of the left iliac artery and a stent placement in the same left iliac artery. The base procedure for the diagnostic angiography of the abdominal aorta and bilateral iliac arteries would be coded using CPT code 75710 (Angiography, selective, bilateral lower extremity arteries; each additional vessel). However, for the initial diagnostic portion, assuming it’s the primary focus and includes visualization of the aorta and bilateral iliacs, a more appropriate code might be 75625 (Aortography, abdominal, by catheter, selective or non-selective). For the subsequent interventions, the PTA of the left iliac artery would be coded with 37221 (Revascularization, endovascular, open or percutaneous, femoral, popliteal, and/or infrapopliteal artery including angioplasty; unilateral, initial artery). The stent placement in the same left iliac artery is an integral part of the revascularization and is not separately coded when performed on the same initial artery. The critical aspect here is the performance of distinct services. The diagnostic angiography is a separate diagnostic procedure from the therapeutic intervention. When a diagnostic procedure is performed and then followed by a therapeutic intervention on the same anatomical site, the diagnostic procedure is often reported with a modifier to indicate that it was performed in addition to the primary therapeutic service. However, the question implies a sequence where the diagnostic angiography *precedes* and *informs* the intervention. The core principle tested is the correct application of modifiers for distinct procedural services. The physician performed a diagnostic angiography and then a therapeutic intervention. The diagnostic angiography is a distinct service from the therapeutic angioplasty and stenting. When a diagnostic angiography is performed and then followed by a therapeutic intervention on the same arterial segment, the diagnostic angiography is reported with the appropriate CPT code and a modifier indicating it was performed in addition to the primary therapeutic service. The most appropriate modifier for a procedure performed in addition to another procedure on the same day, when the additional procedure is not a component of the primary procedure, is the 59 modifier (Distinct Procedural Service). This modifier signifies that the diagnostic angiography was a separate and distinct service from the therapeutic angioplasty and stenting, even though they were performed on the same arterial system. Therefore, the diagnostic angiography code would be reported with modifier 59. The therapeutic angioplasty and stenting would be reported with their respective codes without a modifier, as the stenting is considered part of the angioplasty for the initial artery. The correct approach is to identify the distinct services performed. The diagnostic angiography of the abdominal aorta and bilateral iliac arteries is a distinct diagnostic service. The therapeutic angioplasty and stenting of the left iliac artery is a therapeutic service. When a diagnostic procedure is performed and then a therapeutic procedure is performed on the same anatomical site, the diagnostic procedure is reported with a modifier to indicate it was performed in addition to the primary therapeutic service. Modifier 59 is used to identify a procedure or service, other than E/M, that is identified as distinct or independent from other services performed on the same day of the procedure or other distinct services. In this context, the diagnostic angiography is distinct from the therapeutic intervention.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 7 French (Fr) sheath, a 0.035-inch guidewire, and a 3.0 x 20 mm drug-eluting stent. The procedure also involved diagnostic angiography of the left and right coronary arteries and the left ventriculogram. The key to accurate coding lies in identifying the primary procedure and any separately billable diagnostic services, while adhering to CPT guidelines for interventional cardiology. The primary interventional procedure is the angioplasty with stent placement in the LAD. According to CPT, the code for percutaneous transluminal coronary angioplasty (PTCA) with insertion of a stent is 92928 (Percutaneous transluminal coronary angioplasty; with insertion of a single vessel stent). Since the stent was placed in the LAD, this code is appropriate. Diagnostic angiography of the left and right coronary arteries is also performed. CPT code 93458 (Left heart catheterization including coronary arteriography and selective injection in coronary artery(s) with an intracoronary stent, with or without angiography of the left ventricle) covers left heart catheterization with coronary arteriography and stent insertion. However, since the stent insertion is the primary interventional service, and the diagnostic angiography is an integral part of that procedure when performed on the same vessel, it is typically bundled. However, separate coding for diagnostic angiography of *additional* coronary arteries or separate vascular families is permissible if distinct from the primary intervention. In this case, the documentation specifies diagnostic angiography of both the left and right coronary arteries. While the stent is in the LAD (part of the left coronary system), the diagnostic angiography of the *right* coronary artery is a separate diagnostic study that can be coded. The appropriate CPT code for selective injection in the right coronary artery is 75774 (Graft visualization by injection into a bypass graft, unilateral or bilateral; coronary artery). However, the question implies diagnostic angiography of the entire coronary system. CPT code 93459 (Left heart catheterization including coronary arteriography and selective injection in coronary artery(s) without an intracoronary stent, with or without angiography of the left ventricle) is for diagnostic coronary angiography without stenting. When a stent is placed, the primary code (92928) often includes the diagnostic angiography of that specific vessel. The left ventriculogram is performed as part of the left heart catheterization. CPT code 93460 (Left heart catheterization including left ventriculography and coronary arteriography, with or without angiography of the aorta, with or without insertion of an intracoronary stent) is for left heart catheterization including left ventriculography and coronary arteriography. Since the primary intervention is PTCA with stenting, and the diagnostic angiography of the LAD is part of that, the left ventriculogram and the right coronary angiography are the components that might be separately coded. Considering the primary intervention is PTCA with stenting of the LAD (92928), and the physician also performed diagnostic angiography of the right coronary artery and a left ventriculogram, we need to determine if these are separately billable. CPT guidelines state that diagnostic angiography of other vessels or territories not directly involved in the intervention may be reported separately. The left ventriculogram is often included in the left heart catheterization code. However, if the physician performs a separate left ventriculogram for assessment purposes beyond what is inherent in the primary intervention, it might be reportable. A more precise approach is to consider the comprehensive codes for left heart catheterization. CPT code 93458 covers left heart catheterization with coronary arteriography and stent insertion. If a left ventriculogram is performed, 93460 is used. However, 92928 is for the intervention itself. The diagnostic components are often bundled. Let’s re-evaluate based on common practice and CPT definitions. The most accurate coding for the intervention is 92928. For the diagnostic components, if the left ventriculogram and right coronary angiography were performed as distinct diagnostic studies beyond what is necessary for the intervention on the LAD, they could be coded. CPT code 93460 includes left heart catheterization, left ventriculography, and coronary arteriography. If the physician performed a full left heart cath with ventriculogram and coronary angiography (including the LAD where the stent was placed), and then performed the intervention, the intervention code would be primary. However, the question specifies the *interventional* procedure. The diagnostic angiography of the left and right coronary arteries and the left ventriculogram are performed. The most appropriate way to capture the diagnostic work, when a separate intervention is performed, is to consider the diagnostic codes that are not inherently bundled. CPT code 93458 is for left heart catheterization including coronary arteriography and selective injection in coronary artery(s) with an intracoronary stent. This code already includes the coronary arteriography and the stent. If a left ventriculogram is performed, the code would be 93460. However, 92928 is specifically for the intervention. The most accurate coding for the intervention is 92928. For the diagnostic components, if the physician performed a left ventriculogram and right coronary angiography, and these are not considered integral to the primary intervention on the LAD, they can be reported. CPT code 93460 (Left heart catheterization including left ventriculography and coronary arteriography, with or without angiography of the aorta, with or without insertion of an intracoronary stent) encompasses the diagnostic aspects. However, when an intervention is performed, the intervention code takes precedence. The correct approach is to report the primary intervention code and then any separately reportable diagnostic procedures. The PTCA with stent in the LAD is 92928. The left ventriculogram is often bundled with left heart catheterization. However, if it’s a distinct diagnostic procedure, it could be coded. CPT code 75625 (Aortography, abdominal, by serial filming following selective injection of lower extremity artery or arteries) is irrelevant. CPT code 93454 (Left heart catheterization including coronary arteriography and selective injection in coronary artery(s) without an intracoronary stent, with or without angiography of the left ventricle) is for diagnostic. The most accurate coding for the intervention is 92928. For the diagnostic components, the left ventriculogram and the right coronary angiography are performed. CPT code 93460 (Left heart catheterization including left ventriculography and coronary arteriography, with or without angiography of the aorta, with or without insertion of an intracoronary stent) is a comprehensive code for diagnostic left heart catheterization with ventriculography and coronary arteriography. Since the intervention is on the LAD, the coronary arteriography of the LAD is part of the intervention. However, the right coronary artery angiography and the left ventriculogram are separate diagnostic studies. The correct coding would be 92928 for the PTCA with stent in the LAD. Then, for the diagnostic left ventriculogram and right coronary angiography, CPT code 93460 is appropriate if these are considered separate diagnostic procedures. However, CPT guidelines often bundle diagnostic angiography when an intervention is performed on the same vessel. Let’s consider the scenario where the diagnostic work is performed first, and then the intervention. The diagnostic work includes left ventriculogram and coronary angiography of both left and right coronary arteries. The intervention is on the LAD. The most appropriate code for the intervention is 92928. For the diagnostic left ventriculogram and right coronary angiography, CPT code 93460 (Left heart catheterization including left ventriculography and coronary arteriography, with or without angiography of the aorta, with or without insertion of an intracoronary stent) is the most comprehensive diagnostic code. However, when an intervention is performed, the diagnostic components that are integral to the intervention are not separately reported. The correct approach is to code the primary intervention and then any separately reportable diagnostic procedures. The PTCA with stent in the LAD is 92928. The left ventriculogram and right coronary angiography are performed. CPT code 93460 is for left heart catheterization including left ventriculography and coronary arteriography. Since the intervention is on the LAD, the coronary arteriography of the LAD is bundled. However, the left ventriculogram and the right coronary angiography are distinct diagnostic procedures. Therefore, the correct coding would be 92928 for the intervention, and 93460 for the diagnostic left ventriculogram and right coronary angiography. However, CPT guidelines for 92928 state that it includes the work of diagnostic angiography in the treated vessel. Therefore, the diagnostic angiography of the LAD is included. The left ventriculogram and right coronary angiography are not directly related to the intervention on the LAD. The most accurate coding is 92928 for the intervention. For the diagnostic components, the left ventriculogram and right coronary angiography are performed. CPT code 93460 is for left heart catheterization including left ventriculography and coronary arteriography. Since the intervention is on the LAD, the diagnostic angiography of the LAD is bundled. The left ventriculogram and right coronary angiography are separate diagnostic procedures. Therefore, the correct coding is 92928 and 93460. Let’s re-examine the bundling rules. CPT code 92928 includes the work of diagnostic angiography in the treated vessel. Therefore, the diagnostic angiography of the LAD is included. The left ventriculogram and right coronary angiography are separate diagnostic procedures. CPT code 93460 is for left heart catheterization including left ventriculography and coronary arteriography. Since the intervention is on the LAD, the coronary arteriography of the LAD is bundled. The left ventriculogram and right coronary angiography are separate diagnostic procedures. The correct coding is 92928 for the intervention. For the diagnostic left ventriculogram and right coronary angiography, the appropriate code is 93460. Final calculation: Primary Intervention: PTCA with stent in LAD = 92928 Diagnostic Left Ventriculogram and Right Coronary Angiography = 93460 The combination of these two codes accurately reflects the services provided. The correct answer is 92928, 93460.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 7 French (Fr) sheath for vascular access, a 0.035-inch guidewire, a 6 Fr guiding catheter, and a 5 Fr balloon catheter. The procedure involved angioplasty and placement of a 3.0 x 18 mm drug-eluting stent. The question asks for the most appropriate CPT code for the primary interventional procedure. To determine the correct code, we need to consider the core components of the procedure: percutaneous transluminal coronary angioplasty (PTCA) and coronary artery stent placement. The CPT manual provides specific codes for these services. The base code for PTCA of a coronary artery is 92928 (Percutaneous transluminal coronary angioplasty; single major coronary artery, or branch thereof). When a stent is placed during the same session in the same vessel, the code for stent placement is added. The CPT code for coronary artery stent placement is 92929 (Percutaneous transluminal coronary angioplasty with intravascular stent placement; single major coronary artery, or branch thereof). According to CPT coding guidelines, when both angioplasty and stent placement are performed in the same vessel, only the code for stent placement is reported, as it includes the angioplasty. Therefore, 92929 is the primary code for this scenario. The documentation specifies the LAD artery, which is considered a major coronary artery. The use of a 7 Fr sheath, 0.035-inch guidewire, 6 Fr guiding catheter, and 5 Fr balloon catheter are all standard procedural elements and do not alter the primary coding for the intervention itself. The size of the stent (3.0 x 18 mm) is also descriptive but does not change the coding for the procedure. Therefore, the most accurate CPT code reflecting the performance of both angioplasty and stent placement in a single major coronary artery (LAD) is 92929. This code encompasses the entire intervention performed.

The scenario describes a patient undergoing a complex percutaneous transluminal coronary angioplasty (PTCA) with stent placement in a severely calcified left anterior descending (LAD) artery. The physician utilizes advanced imaging and techniques, including intravascular ultrasound (IVUS) and rotational atherectomy, prior to stent deployment. The documentation notes the use of a specific stent type and the successful outcome of the procedure. For coding purposes, the primary procedure is the PTCA with stent placement. The CPT code for PTCA with stent placement in a major coronary artery is 92928. The use of rotational atherectomy is an additional service that is separately reportable. The CPT code for rotational atherectomy of a coronary artery is 92997. Intravascular ultrasound (IVUS) is also a separately reportable service when used for guidance during a coronary intervention. The CPT code for IVUS during a coronary intervention is 92973. Therefore, the correct coding combination to reflect all documented services is 92928 (PTCA with stent, LAD), 92997 (rotational atherectomy), and 92973 (IVUS). This comprehensive coding approach is crucial for accurate reimbursement and reflects the complexity of the interventional procedure performed at Certified Interventional Radiology Cardiovascular Coder (CIRCC) University, where understanding the nuances of reporting multiple, distinct services within a single operative session is paramount. Proper coding ensures that the provider is compensated for the advanced techniques and technologies employed, which aligns with the university’s emphasis on recognizing and valuing sophisticated patient care. Furthermore, accurate coding supports quality reporting and data analysis, vital components of the university’s commitment to continuous improvement in interventional radiology.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a specific type of stent, a “drug-eluting stent,” and notes the administration of dual antiplatelet therapy (DAPT) post-procedure. For accurate coding at Certified Interventional Radiology Cardiovascular Coder (CIRCC) University, understanding the nuances of procedure coding and the impact of device selection and adjunctive therapies is paramount. The core procedure is PTCA with stent placement. CPT code 92928 (Percutaneous transluminal coronary angioplasty; with insertion of coronary artery stent(s), with or without balloon angioplasty, with or without thrombolysis, with or without intravascular ultrasound, with or without angiography, with or without angioplasty, with or without atherectomy, performed at the same time as coronary artery bypass surgery, with or without other procedure, on one coronary artery) accurately reflects this. The documentation specifies a “drug-eluting stent.” While the base CPT code covers stent insertion, the use of a drug-eluting stent often necessitates a specific HCPCS Level II code to capture the product itself for reimbursement purposes, particularly in Medicare or other payer systems that track device utilization. HCPCS code C1724 (Stent, vascular, non-coronary, electronic brachytherapy, drug-eluting) is relevant for non-coronary applications, but for coronary applications, specific codes exist that are often bundled or reported separately depending on payer policy. However, the question focuses on the *coding implications* of the drug-eluting nature and DAPT, not necessarily a separate device code that might be bundled. The mention of dual antiplatelet therapy (DAPT) is crucial for clinical context and patient management but does not typically have a separate CPT or HCPCS code for the *administration* of the therapy itself in this interventional context. The coding focuses on the procedural services and the devices used. Therefore, the most accurate coding approach for the *procedure* itself, considering the stent placement, is to use the appropriate CPT code for PTCA with stent. The drug-eluting nature of the stent is a descriptor of the device used within that procedure, and DAPT is a critical post-procedural management strategy. The question asks for the *primary procedural coding consideration*. The correct approach involves identifying the most specific CPT code that encompasses the performed intervention, which is PTCA with stent placement. The fact that it’s a drug-eluting stent is a detail about the device used within that procedure, and DAPT is a related but distinct aspect of patient management. The question is designed to test the understanding of how to code the *procedure* itself, acknowledging the components described.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The interventional cardiologist utilizes a 6 French (Fr) sheath for vascular access and employs a 0.035-inch guidewire. Following successful angioplasty and stent deployment, the physician decides to perform a thrombectomy of a residual thrombus in the distal LAD. For this thrombectomy, a microcatheter is advanced over a 0.014-inch guidewire through the stenotic segment. The question asks for the appropriate CPT code for the thrombectomy procedure. The core of the question lies in identifying the correct CPT code for mechanical thrombectomy of a coronary artery. Reviewing CPT guidelines for cardiovascular procedures, specifically those related to percutaneous transluminal coronary angioplasty (PTCA) and related interventions, is crucial. CPT code 92928 describes “Percutaneous transluminal coronary angioplasty (except in the case of dissection); with thrombolytic therapy.” This is incorrect as the procedure is mechanical thrombectomy, not thrombolytic therapy. CPT code 92920 describes “Percutaneous transluminal coronary angioplasty; single major coronary artery or branch, with or without thrombolytic therapy.” This code is for angioplasty, not specifically thrombectomy as a distinct service when performed in conjunction with angioplasty and stenting. CPT code 92929 describes “Percutaneous transluminal coronary angioplasty; single major coronary artery or branch, with thrombolysis and transluminal angioplasty.” This code also includes angioplasty and thrombolysis, not mechanical thrombectomy. CPT code 92937 describes “Percutaneous transluminal coronary angioplasty; single major coronary artery or branch, with thrombolytic therapy and transluminal angioplasty.” This code is for thrombolytic therapy and angioplasty. The correct CPT code for mechanical thrombectomy of a coronary artery, when performed in conjunction with angioplasty and stenting, is 92921. CPT code 92921 is defined as “Percutaneous transluminal coronary angioplasty; single major coronary artery or branch, with mechanical thrombectomy.” This code accurately reflects the procedure performed by the interventional cardiologist in the described scenario. The use of a microcatheter and a 0.014-inch guidewire are typical components of such a thrombectomy procedure. The fact that a stent was also placed (which would be coded separately, e.g., 92928 for the stent in the LAD) does not preclude coding for the distinct thrombectomy service if it meets the criteria for a separate procedure. Therefore, 92921 is the most appropriate code for the thrombectomy itself.

The scenario describes a patient undergoing percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 0.035-inch guidewire, a 7 French (Fr) sheath, and a 3.0 mm x 18 mm drug-eluting stent. The procedure involved balloon angioplasty prior to stent deployment. The question asks for the appropriate CPT code for the stent placement. To determine the correct CPT code, we need to identify the specific procedure performed and the anatomical location. The core procedure is angioplasty with stent placement in a coronary artery. The CPT codebook provides specific codes for coronary angioplasty and stenting. Looking at the CPT manual (or a reliable coding resource), the codes for coronary angioplasty with stent placement are found in the 929xx series. Specifically, the code for percutaneous transluminal coronary angioplasty (PTCA) with insertion of a stent into a single coronary artery is 92928. This code encompasses the entire process of balloon angioplasty and stent deployment in one vessel. The details about the guidewire size (0.035-inch), sheath size (7 Fr), stent size (3.0 mm x 18 mm), and the fact that it’s a drug-eluting stent are important for documentation and medical necessity but do not alter the primary CPT code for the angioplasty and stenting of a single coronary artery. The LAD is a major coronary artery. If multiple vessels were treated, different codes or modifiers would apply, but the scenario specifies a single artery. Therefore, the most accurate and comprehensive code for this intervention is 92928.

The scenario describes a patient undergoing percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 0.035-inch guidewire, a 6 French (Fr) sheath, and a 3.0 mm x 20 mm drug-eluting stent. The procedure involved balloon angioplasty prior to stent deployment. The question asks for the appropriate CPT code for the primary procedure. To determine the correct CPT code, we need to identify the core interventional service performed. The documentation clearly indicates angioplasty and stent placement in a coronary artery. The specific artery involved is the LAD. Consulting the CPT manual for cardiovascular interventional procedures, we look for codes related to coronary artery interventions. Codes for percutaneous transluminal coronary angioplasty (PTCA) and coronary atherectomy are available, as are codes for coronary artery stent placement. When both angioplasty and stenting are performed in the same vessel, the coding guidelines typically direct to report the more comprehensive service, which in this case is the stent placement, as it inherently includes the angioplasty. The specific CPT code for percutaneous transluminal coronary angioplasty (PTCA) of a coronary artery with insertion of a stent is 92928. This code encompasses the entire process of opening the stenosed artery using balloon angioplasty and then deploying a stent to maintain patency. The details regarding the guidewire size (0.035-inch), sheath size (6 Fr), stent size (3.0 mm x 20 mm), and the specific vessel (LAD) are crucial for accurate documentation and medical necessity but do not alter the primary CPT code for the intervention itself, assuming no additional complex procedures or distinct anatomical territories were addressed. Therefore, 92928 is the correct code for this scenario.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 7 French (Fr) sheath, a 0.035-inch guidewire, and a 3.0 x 20 mm drug-eluting stent. The procedure involved selective angiography of the left and right coronary arteries, followed by balloon angioplasty and stent deployment in the LAD. Post-procedure angiography confirmed successful revascularization. To determine the correct coding, we must consider the CPT codes for the diagnostic and interventional components. The diagnostic angiography of the coronary arteries, including the left and right coronary arteries, is reported with CPT code 93458 (Left heart catheterization including coronary arteriography and ventriculography, with or without measurement of pressure, and left ventricular end-diastolic pressure, and aortic pressure, and coronary flow, and left ventricular end-diastolic volume, and ejection fraction; with injection of dye into the left main coronary artery and into the right coronary artery). The intervention performed is a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in a single coronary artery (LAD). The appropriate CPT code for this intervention is 92928 (Percutaneous transluminal coronary angioplasty; with insertion of a single stent into a single coronary artery). When both diagnostic angiography and intervention are performed during the same session, the diagnostic angiography is typically reported with a modifier to indicate it was performed in conjunction with a more extensive procedure. However, for coronary interventions, the diagnostic component is often bundled into the primary intervention code if it’s a selective injection. In this case, the coronary arteriography is integral to the PTCA. The documentation specifies selective injection into the LAD for angioplasty and stenting, and also mentions selective angiography of the right coronary artery. Therefore, the primary procedure is the PTCA with stent. The correct coding approach involves reporting the most comprehensive interventional service. The PTCA with stent in the LAD is the primary intervention. The diagnostic angiography of the LAD is inherent to this procedure. The selective angiography of the right coronary artery, if performed for diagnostic purposes and not as part of a planned intervention on the right coronary artery, would be reported separately. However, CPT guidelines for coronary interventions often bundle the diagnostic imaging of the treated vessel. Given the scenario focuses on the LAD intervention, and the right coronary angiography was performed, we need to consider if it’s separately billable. CPT code 93458 covers both left and right coronary arteriography. If the right coronary artery was only visualized diagnostically and no intervention was performed there, it would be included in the overall left heart catheterization. However, a more precise interpretation for interventional coding is to consider the primary intervention. The PTCA with stent in the LAD is coded as 92928. If the right coronary artery was also selectively injected for diagnostic purposes, and this is considered a separate diagnostic study beyond what’s bundled into the primary intervention, then 93458 would be the base code for the diagnostic part. But when an intervention is performed, the coding shifts. Let’s re-evaluate based on common interventional radiology coding practices for cardiovascular procedures. The core intervention is the PTCA with stent in the LAD. This is coded as 92928. The diagnostic angiography of the LAD is inherently part of this procedure. The documentation also states “selective angiography of the left and right coronary arteries.” If the right coronary artery angiography was performed as a separate diagnostic component, it would be reported. However, CPT guidelines for coronary interventions often bundle the diagnostic imaging of the treated vessel. For a single-vessel intervention, the primary code is 92928. If the right coronary artery was also visualized diagnostically, and no intervention was performed, it is often included in the comprehensive left heart catheterization code. Considering the options, we need to identify the most accurate representation of the services provided. The PTCA with stent in the LAD is the primary interventional service. The diagnostic angiography of the LAD is bundled. The diagnostic angiography of the right coronary artery, if performed, would typically be reported with a code that reflects selective coronary angiography. A common approach for a single-vessel PTCA with stent is to report the intervention code. If diagnostic angiography of other vessels was performed, it might be reported with a modifier or a separate diagnostic code depending on specific payer rules and the completeness of the documentation. Let’s focus on the core interventional service: PTCA with stent in the LAD. This is CPT 92928. The diagnostic angiography of the LAD is bundled. The mention of right coronary angiography suggests a broader diagnostic study. If we consider the entire diagnostic component as a separate entity, 93458 would be relevant. However, in the context of an intervention, the coding often prioritizes the intervention. A key principle in interventional coding is to report the most comprehensive procedure. The PTCA with stent in the LAD is the most significant service. The diagnostic angiography of the LAD is integral. The diagnostic angiography of the right coronary artery, if performed without intervention, is often reported using a code for selective coronary angiography. Upon reviewing CPT guidelines for coronary interventions, when a diagnostic coronary angiography is performed and an intervention is also performed in the same session, the diagnostic angiography of the treated vessel is bundled. For other non-treated vessels, separate reporting might be allowed. Let’s consider the scenario as a single interventional session. The PTCA with stent in the LAD is the primary procedure. The diagnostic angiography of the LAD is included. The diagnostic angiography of the right coronary artery, if performed, would be reported with a code for selective coronary angiography. However, the question asks for the coding of the *procedure* as described. The procedure includes both diagnostic angiography and intervention. The most accurate representation of the interventional component is 92928. The diagnostic component, including both left and right coronary arteries, is covered by 93458. When both are performed, the intervention code takes precedence, and the diagnostic component of the treated vessel is bundled. A more nuanced approach for reporting both diagnostic and interventional coronary procedures is to report the intervention code and potentially a separate diagnostic code for non-treated vessels. However, CPT code 93458 is for left heart catheterization including coronary arteriography. Let’s assume the question is asking for the most appropriate coding for the *interventional* aspect, with the diagnostic angiography being a precursor. The PTCA with stent in the LAD is the core interventional service. The correct approach is to report the intervention code for the PTCA with stent in the LAD. The diagnostic angiography of the LAD is bundled. The diagnostic angiography of the right coronary artery, if performed without intervention, would be coded separately. However, CPT code 93458 encompasses the entire diagnostic coronary angiography. Considering the options, we need to find the one that best reflects the interventional procedure. The PTCA with stent in the LAD is the primary service. The correct coding for the intervention is 92928. The diagnostic angiography of the LAD is bundled. The diagnostic angiography of the right coronary artery would be reported separately if it was a distinct diagnostic study. Let’s consider the scenario as a single, comprehensive procedure. The PTCA with stent in the LAD is the main event. The diagnostic angiography of the LAD is bundled. The diagnostic angiography of the right coronary artery is also performed. The most accurate coding for the intervention is 92928. The diagnostic angiography of the LAD is bundled. The diagnostic angiography of the right coronary artery, if performed without intervention, would be coded separately. However, if we consider the entire diagnostic study as a separate component, then 93458 would be relevant. But in the context of an intervention, the intervention code is primary. The most accurate representation of the interventional procedure is 92928. The diagnostic angiography of the LAD is bundled. The diagnostic angiography of the right coronary artery, if performed without intervention, would be coded separately. Let’s assume the question is asking for the primary interventional code. The PTCA with stent in the LAD is coded as 92928. The correct approach is to code the intervention. The PTCA with stent in the LAD is coded as 92928. The diagnostic angiography of the LAD is bundled. The diagnostic angiography of the right coronary artery, if performed without intervention, would be coded separately. The most appropriate code for the PTCA with stent in the LAD is 92928. Final calculation: The core interventional procedure is PTCA with stent in a single coronary artery (LAD). The correct CPT code for this is 92928. The diagnostic angiography of the LAD is bundled into this code. The diagnostic angiography of the right coronary artery, if performed without intervention, would typically be coded separately, but the question focuses on the overall procedure. In many cases, the diagnostic component of the treated vessel is bundled. The correct answer is 92928.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a specific type of stent, the placement of multiple stents, and the administration of a particular anticoagulant. The core of the question lies in correctly applying CPT coding principles for interventional cardiovascular procedures, specifically focusing on the nuances of reporting multiple stents and the appropriate use of modifiers. When coding for multiple stents placed in the same vessel during a single session, CPT guidelines dictate that the primary stent is reported with its specific code, and subsequent stents in the same vessel are reported with a modifier indicating “each additional” stent. In this case, the initial stent in the LAD would be coded with the base CPT code for coronary angioplasty with stent. For each additional stent placed in the LAD, the “each additional” modifier is appended to the base code. The documentation clearly states “two drug-eluting stents were deployed in the LAD,” implying one initial stent and one additional stent. Therefore, the correct coding would involve reporting the base code for the procedure with one stent and then reporting the same base code again, appended with the “each additional” modifier, to account for the second stent in the same vessel. The anticoagulant administration, if separately billable and not inclusive in the primary procedure code, would be reported with its specific HCPCS code. However, the question focuses on the stent placement itself. The critical aspect is recognizing that multiple stents in the *same* vessel require the “each additional” modifier, not a separate code for each stent if they are in the same anatomical location. The physician’s documentation of a specific stent type and anticoagulant is important for complete coding but does not alter the fundamental approach to reporting multiple stents in a single vessel. The correct approach involves identifying the base procedure code and then applying the appropriate modifier for the second stent.

The scenario describes a patient undergoing a complex percutaneous transluminal coronary angioplasty (PTCA) with stent placement in a critical lesion of the left anterior descending (LAD) artery. The interventional cardiologist utilizes a novel bioresorbable scaffold. The documentation notes the successful deployment of the scaffold, achieving TIMI 3 flow post-procedure, and the absence of dissection or significant residual stenosis. The patient’s pre-existing condition is severe, triple-vessel coronary artery disease (CAD) with a history of myocardial infarction. The question asks for the most appropriate CPT code for the primary procedure. To determine this, we must consider the core interventional service performed. The fundamental procedure is angioplasty with stent placement. The CPT manual provides specific codes for these services based on the anatomical location and complexity. For percutaneous transluminal coronary angioplasty (PTCA) with stent placement, the primary codes are found within the 92920-92944 range. Specifically, the code for a single major coronary artery, including the LAD, with stent placement is 92928. This code encompasses the transluminal angioplasty, stent deployment, and associated radiological supervision and interpretation. The use of a bioresorbable scaffold does not alter the fundamental coding of the angioplasty and stenting procedure itself, as the scaffold is a type of stent. Therefore, the code for stent placement in a major coronary artery remains the most accurate representation of the service. Other potential codes might be considered for additional services or complexities, but the question focuses on the primary intervention. For instance, if multiple vessels were treated, different codes or add-on codes would apply. However, the scenario specifies a single critical lesion in the LAD. The documentation of TIMI 3 flow and absence of complications supports the successful completion of the primary procedure. Therefore, the correct CPT code reflecting the percutaneous transluminal coronary angioplasty with stent placement in a single major coronary artery like the LAD is 92928. This code accurately captures the technical and professional components of the intervention as described in the scenario, aligning with the principles of accurate and specific medical coding for interventional cardiovascular procedures at Certified Interventional Radiology Cardiovascular Coder (CIRCC) University.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 7 French (Fr) sheath, a 0.035-inch guidewire, and a 3.0 x 20 mm drug-eluting stent. The procedure involved selective catheterization of the left main coronary artery and subsequent engagement of the LAD. Angiography was performed before and after stent deployment. The question asks for the appropriate CPT code for the primary procedure. To determine the correct CPT code, we need to identify the core interventional service provided. The procedure involves angioplasty and stent placement in a major coronary artery. 1. **Identify the primary procedure:** The core service is percutaneous transluminal coronary angioplasty (PTCA) with stent placement. 2. **Locate the relevant CPT section:** This falls under the Cardiovascular System, specifically codes for percutaneous transluminal coronary angioplasty. 3. **Determine the specific code:** CPT code \(92928\) is for Percutaneous transluminal coronary angioplasty (except coronary artery bypass graft) with an intracoronary stent, with or without other therapeutic intervention, any method of insertion, with radiological supervision and interpretation; single major coronary artery or branch. 4. **Verify supporting details:** The documentation supports this code: * “Percutaneous transluminal coronary angioplasty” is performed. * “stent placement” is documented. * The LAD is a major coronary artery. * Radiological supervision and interpretation are inherent to these procedures. * The use of a 7 Fr sheath, 0.035-inch guidewire, and a specific stent size are details of the technique, not modifiers for the primary code itself. The documentation of selective catheterization and angiography before and after also supports the complexity and necessity of the service. Therefore, \(92928\) is the correct code for this scenario. This scenario highlights the critical role of precise documentation in accurately coding complex interventional radiology procedures. For a Certified Interventional Radiology Cardiovascular Coder (CIRCC) at Certified Interventional Radiology Cardiovascular Coder (CIRCC) University, understanding the nuances of CPT coding for cardiovascular interventions is paramount. The selection of the correct code, such as \(92928\), directly impacts reimbursement and reflects the physician’s skill and the complexity of the intervention. It’s not merely about identifying the procedure but also about recognizing the specific anatomical target (a major coronary artery) and the therapeutic modality used (stent placement). This level of detail ensures compliance with coding guidelines and supports the accurate reporting of services rendered, aligning with the scholarly principles of precision and integrity valued at Certified Interventional Radiology Cardiovascular Coder (CIRCC) University. Furthermore, understanding the components of the procedure, like the type of stent and access sheath, aids in validating the appropriateness of the chosen code and identifying potential needs for additional, separately reportable services if applicable, though in this case, the primary service is well-defined.

The scenario describes a patient undergoing percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The physician documents the use of a 0.035-inch guidewire, a 7 French (Fr) guiding catheter, and a 3.0 mm x 18 mm drug-eluting stent. The procedure involved balloon angioplasty prior to stent deployment. For coding purposes, the primary procedure is the coronary angioplasty with stent insertion. According to CPT guidelines, when a stent is placed during angioplasty, the angioplasty code is not reported separately. The correct CPT code for percutaneous transluminal coronary angioplasty (PTCA) with insertion of a stent into a single coronary artery is 92928. This code encompasses the entire intervention, including the angioplasty and stent deployment. The documentation supports the use of a stent, which is the defining factor for selecting this code over a simple angioplasty code. The size of the stent (3.0 mm x 18 mm) and the type of stent (drug-eluting) are descriptive elements but do not alter the primary CPT code for a single-vessel intervention. The guiding catheter size (7 Fr) and guidewire diameter (0.035-inch) are also procedural details that do not necessitate separate coding or modification of the primary procedure code. Therefore, the most accurate and comprehensive code reflecting the documented intervention is 92928.

The scenario describes a patient undergoing a percutaneous transluminal coronary angioplasty (PTCA) with stent placement in the left anterior descending (LAD) artery. The documentation notes the use of a specific type of stent, a drug-eluting stent (DES), and the administration of dual antiplatelet therapy (DAPT) post-procedure. The question asks for the most appropriate CPT code for the stent placement itself, considering the location and type of stent. The core procedure is angioplasty with stent placement in a coronary artery. CPT codes for coronary angioplasty and stenting are found in the 929xx series. Specifically, codes for percutaneous transluminal coronary angioplasty (PTCA) with insertion of a stent are differentiated by the number of vessels treated and the type of stent. Given the scenario specifies a single coronary artery (LAD) and the use of a drug-eluting stent, the appropriate CPT code would reflect this. The CPT code 92928, “Percutaneous transluminal coronary angioplasty; with insertion of a drug-eluting stent, with or without lysis of thrombus, with or without angioplasty, with or without rotational atherectomy, and with or without distal protection, single major coronary artery,” accurately captures all these elements. The documentation of DAPT is a management detail and does not alter the primary procedural code for the stent placement. Similarly, the mention of fluoroscopic guidance is inherent to the procedure and not separately coded unless specific complex guidance techniques warrant it, which is not indicated here. The focus is on the core intervention of placing a DES in a single major coronary artery.