Percutaneous coronary intervention (PCI) requests are unique in the way they need to be ordered therefore we want to provide some tips about how to go about submitting these:
We recommend submitting a PCI only AFTER heart catheterization has been completed and coronary anatomy known, as documented heart anatomy details are needed for the approval of PCI. If a heart cath and PCI take place at the same time, the PCI should be submitted as a retro authorization after the documented heart cath results are obtained.
“C” codes, such as C9600, are for hospital admin purposes and should not be SOLELY used when submitting PCI prior authorization. Doing so will result in delays and extensive review.
We recommend using only relevant CPT codes (see list and link below).
Recommended CPT codes for PCI:
CPT code for PCI | Description |
92920 | Percutaneous transluminal coronary angioplasty, single major artery or branch |
92921 | Percutaneous transluminal coronary angioplasty, each additional branch of a major artery |
92924 | Percutaneous transluminal coronary angioplasty, with coronary angioplasty when performed, single major coronary artery or branch |
To view the full CMS article for PCI billing and coding, click here.