Therapeutic Cardiovascular Services

Coronary Angioplasty, Atherectomy and Stent Placement

HMSA plans cover therapeutic cardiovascular services and HMSA payment includes recognition for the initial vessel and for “each additional vessel” up to two.

Applicable Codes

Procedure codes recognized by HMSA for the placement of intracoronary stents, coronary angioplasty, and coronary atherectomy include the following:

Claims Filing Instructions

When filing claims for the codes referenced above, the CMS 1500 claim form should be completed based on the procedure or procedures performed. Because 92981, 92984 and 92996 are represented by CPT as “each additional” vessel, modifier code -51 does not apply.

Site-specific modifiers should be used to indicate which arterial branch is being treated.

Example

The surgeon performs balloon angioplasty on a 53-year-old male with arteriosclerotic heart disease. The procedure is performed first on the left coronary artery, followed by a second procedure on the circumflex branch of the artery. The claim would be billed as follows:

ICD-9-CM

ICD-10-CM

Notes:

• CPT codes 92980, 92982, and 92995 should not be billed together.
• If performing both 92980 and 92982, bill 92980 only. 92982 is incidental to 92980 and should not be billed separately.
• If performing 92995 and 92982, bill 92995 only. 92982 is an integral part of 92995 and should not be billed separately.
• If performing 92980 and 92995, bill 92980 only. 92995 is incidental to 92980 and should not be billed separately.

Revision History