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Question: A patient was taken emergently to the cardiac catheterization lab due to an acute myocardial infarction (MI). The physician performed a balloon angioplasty only; no stent was placed because the occlusion was located in a very distal, codominant circumflex artery. The physician described this as a microinfarction and documented that the vessel was not suitable for stent implantation. The angioplasty was successful in opening the vessel, and the patient responded well. The plan is to continue medical therapy.

Should this procedure be reported with 92920, since no stent was placed, or is 92941 still appropriate in this case?

California Subscriber

Answer: You should report this scenario with 92941 (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel) rather than 92920 (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch).

Code 92941 is intended for percutaneous revascularization performed in the setting of an acute MI, and it includes any combination of angioplasty, stenting, or atherectomy. Therefore, the use of balloon angioplasty alone still qualifies under this code, as it is not dependent on whether a stent was placed.

The purpose of 92941 is to capture the emergent nature and clinical urgency of the intervention performed during an acute MI. In this case, the documentation confirms that the patient was experiencing an acute MI, was taken to the cath lab emergently, and underwent revascularization of the infarct-related artery. Even though the lesion was located in a distal portion of the circumflex artery and stenting was not feasible, the balloon angioplasty performed was intended to restore perfusion during the MI event. This meets the criteria for 92941.

On the other hand, you will use 92920 for percutaneous transluminal coronary angioplasty in stable clinical settings and does not account for the acute myocardial infarction context. It is not appropriate to use 92920 simply because no stent was placed.

Heads up: To support the use of 92941, the physician’s documentation should clearly state that the procedure was performed in response to an acute MI, identify the infarct-related artery, and describe the emergent or urgent nature of the intervention.

In summary, despite the absence of a stent, this case meets the CPT^® criteria for 92941 because it was an emergent revascularization for an acute MI and angioplasty was successfully performed. Therefore, 92941 is the correct code to report for this scenario.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor