Percutaneous transluminal revascularization and required elements for reimbursement

Q.

Does CPT^®code 92943 require a stent placement? I have a payer denying a claim because no stent was placed. The CPT code and full description are as follows:

92943  Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel

A.

The American Medical Association (AMA) has not answered that question specifically about CPT code 92943, but in CPT Assistant, January 2014, the following  was stated about 92941:

“Note that code 92941 includes any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed. Code 92941 is, therefore, appropriately reported if any one or more of these services is performed to treat the lesion.”  

Since all of the “combination of” codes in the percutaneous coronary intervention section of the CPT book use the same terminology, it is assumed that all of them would be assigned in the same fashion if only one of the named interventions is performed – for instance, if only angioplasty is performed, or only the atherectomy is performed.