CPT® Code 92996

Code deleted, see 92924, 92925, 92933-92944

Official Description

Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure)

Common Language Description

The procedure described by CPT® Code 92996 refers to a percutaneous transluminal coronary atherectomy, which is a minimally invasive technique used to remove atherosclerotic plaque from the coronary arteries. This procedure can be performed using mechanical methods or other techniques, and it may be accompanied by balloon angioplasty, which involves the inflation of a balloon to further open the artery. The process begins with the preparation of the skin over the access artery, typically one of the femoral arteries, followed by puncturing the artery with a needle and placing a sheath to facilitate access. A guidewire is then inserted and navigated through the aorta into the occluded coronary artery. During the atherectomy, a specialized balloon catheter equipped with a cutting piston is utilized to shave away plaque from the arterial wall. The cutting piston advances through a window on the catheter, effectively removing the plaque and pushing it into the device for extraction upon completion of the procedure. Multiple passes may be made with the atherectomy device to ensure thorough plaque removal. After the atherectomy is completed, a balloon-tipped angioplasty catheter may be introduced to the blockage site, where it is inflated to compress any residual plaque and smooth the arterial wall. Finally, contrast material is injected, and a completion angiography is performed to confirm that the treated artery remains open and patent. It is important to note that CPT® Code 92996 is specifically used to report the atherectomy of each additional coronary artery, following the primary procedure reported with CPT® Code 92995.

1. Indications

The procedure indicated by CPT® Code 92996 is performed for patients with significant coronary artery disease characterized by the presence of atherosclerotic plaque that obstructs blood flow in the coronary arteries. The following conditions may warrant the use of this procedure:

Coronary Artery Disease Patients with atherosclerosis leading to narrowed or blocked coronary arteries, resulting in reduced blood flow to the heart muscle.
Angina Pectoris Individuals experiencing chest pain or discomfort due to inadequate blood supply to the heart, often triggered by physical exertion or stress.
Myocardial Ischemia Patients showing signs of insufficient blood flow to the heart muscle, which may lead to heart attacks if not addressed.
Acute Coronary Syndrome Patients presenting with unstable angina or non-ST elevation myocardial infarction (NSTEMI) may require urgent intervention to restore blood flow.

2. Procedure

The procedural steps for CPT® Code 92996 are as follows:

Step 1: Access Site Preparation The procedure begins with the preparation of the skin over the access artery, typically the femoral artery. The area is cleaned and sterilized to minimize the risk of infection.
Step 2: Artery Puncture and Sheath Placement A needle is used to puncture the artery, and a sheath is placed to provide access for the subsequent instruments. This sheath allows for the introduction of the guidewire and other devices needed for the procedure.
Step 3: Guidewire Insertion A guidewire is inserted through the sheath and advanced through the aorta into the blocked coronary artery. This guidewire serves as a pathway for the atherectomy device.
Step 4: Atherectomy Procedure The atherectomy is performed using a specialized balloon catheter that features a cutting piston. The catheter is navigated to the site of the blockage, and the cutting piston is advanced to shave plaque from the arterial wall. The plaque is collected in the device for removal.
Step 5: Balloon Angioplasty (if applicable) After the atherectomy, a balloon-tipped angioplasty catheter may be advanced to the blockage site. The balloon is inflated to compress any remaining plaque and smooth the arterial wall, enhancing blood flow.
Step 6: Completion Angiography Following the atherectomy and any balloon angioplasty, contrast material is injected, and a completion angiography is performed to ensure that the treated artery is patent and that blood flow has been restored.

3. Post-Procedure

After the completion of the atherectomy procedure, patients are typically monitored for any complications, such as bleeding or vascular injury at the access site. Recovery may involve observation in a healthcare setting for a few hours to ensure stability. Patients may be advised to limit physical activity for a short period following the procedure to allow for healing. Follow-up appointments are often scheduled to assess the success of the procedure and to monitor the patient's cardiovascular health. Additionally, patients may receive instructions regarding medication management, lifestyle modifications, and any necessary cardiac rehabilitation to support recovery and prevent future cardiovascular events.

Short Descr	CORONARY ATHERECTOMY ADD-ON
Medium Descr	CORONARY ATHERECTOMY ADD-ON
Long Descr	Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure)
Status Code	Active Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	45 - Percutaneous transluminal coronary angioplasty (PTCA)