Did you know that out of nearly 179,000 patients with STEMI and a culprit lesion across 582 US hospitals, 3.5% did not receive percutaneous coronary intervention (PC)? These patients faced significantly higher mortality rates (12.5% vs. 6.5%) than those who underwent the procedure.
These numbers reflect the significance of angioplasty procedures. But what about this guide? It will cover everything you need to know about billing, a critical service covered under CPT code 92920.
So, continue reading!
CPT Code 92920 – Description
CPT code 92920 covers the percutaneous coronary angioplasty of a single artery or branch of an artery in the heart. It is performed by inflating a balloon-tipped catheter, or tube, inside a blocked area of an artery/branch to widen a stenosis (constricted area), i.e., obstructing the flow.
Appropriate Use Cases for CPT Code 92920
Let’s review a few real-world clinical scenarios where CPT 92920 applies:
Stable Angina with Single Vessel Disease
Picture a 62-year-old female with a history of hyperlipidemia and hypertension. She comes to a cardiologist with worsening stable angina (Class III) despite proper medical therapy.
A nuclear stress test confirms reversible ischemia in the distribution of the right coronary artery (RCA). Besides, diagnostic angiography reveals a 90% focal stenosis in the mid-RCA.
Therefore, the cardiologist successfully advances a balloon-tipped catheter to the side of the lesion. He then inflates the balloon, successfully reducing the stenosis to less than 20%.
Since only angioplasty was performed on a single major artery without stent placement, the cardiologist should report CPT code 92920.
Non-ST-Elevation Myocardial Infarction (NSTEMI) Treatment
Imagine a 50-year-old male patient who is brought to the emergency room with NSTEMI. The attending physician performs an immediate catheterization, which shows a culprit lesion in the RCA.
Based on the findings, the physician determines that the vessel is too small for a standard drug-eluting stent. As a result, he performs a balloon-only angioplasty (CPT code 92920), a procedure that helps treat the stenosis.
Modifiers to Append with CPT Code 92920
Discussed below are some of the applicable modifiers for CPT 92920:
Modifier 51
What happens when you perform multiple procedures during the same surgical session, such as balloon angioplasty covered under CPT code 92920? You append modifier 51.
Modifier 59
When you perform two coronary angioplasties, you append modifier 59 to the second instance. It highlights to the payer that you performed both angioplasties in different anatomical sites (different vessels).
For example, if angioplasty is performed in both the LAD and the RCA, you should report the first CPT code 92920 without a modifier and the second with modifier 59.
Modifier LD
It is an HCPCS II anatomical modifier. You should append it to CPT 92920 when you perform the angioplasty in the LAD coronary artery.
Modifier RC
Similar to LD, RC is also an HCPCS II anatomical modifier. When reported with CPT code 92920, it indicates that the physician performed angioplasty in the RCA.
Note: Many payers prefer the anatomical modifiers (LD, RC) over the generic modifier 59.
Reimbursement Guidelines for CPT Code 92920
The following are the billing requirements for percutaneous coronary angioplasty of a single artery or branch:
Fulfill Documentation Requirements
Detailed documentation is key to timely claim processing. Here’s what you should include while billing for CPT code 92920:
- Explain the clinical indication for performing the procedure, e.g., NSTEMI, stable angina, etc.
- State the stenosis percentage before and after performing the angioplasty.
- Mention the specific vessel and branches that you treated.
- Describe the type and size of the balloon catheter.
Append Appropriate Modifier
The proper use of modifiers is essential to ensure coding specificity. In the case of percutaneous coronary angioplasty, modifiers 51, 59, LD, and RC are applicable. However, be wary, as their misuse or overuse may lead to audit risks or penalties.
Do Not Bill Angioplasty of Additional Branches Separately
As of January 2026, the add-on code for Percutaneous Transluminal Coronary Angioplasty (PTCA), CPT code 92921, which was used to report each additional branch of a major coronary artery treated, has been deleted. Therefore, you cannot bill inventions on additional branches separately. To simplify billing, percutaneous coronary interventions (PCI) on additional branches are now bundled into the primary codes for PCI procedures, like CPT code 92920.
Final Thoughts on CPT Code 92920
Cardiology is a complex specialty, and the coding guidelines related to its procedures follow suit. However, we tried our best to break down the essential reimbursement guidelines to help you prevent denials.
Just remember, CPT code 92920 covers percutaneous coronary angioplasty of an artery or branch without stent placement. Hopefully, with this, coding becomes a breeze. However, if you still struggle, feel free to outsource cardiology billing services to professionals, like NeuraBill.
