Understanding the 92928 CPT Code: A Comprehensive Guide for Cardiologists and Billers

CPT Code 92928 is crucial in interventional cardiology, specifically when billing for percutaneous coronary interventions (PCI) that involve angioplasty with stent placement. Accurate use of this code can ensure full reimbursement and reduce the risk of claim denials or audits. We will explain how this code works, how to use it correctly, and how to maximize revenue while staying compliant.

What Is CPT Code 92928?

The CPT Code 92928 is defined as, ercutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch.

How to Understand the Components of 92928?

The 92928 code includes both:

• Balloon angioplasty (opening the narrowed artery)
• Stent placement (inserting a mesh tube to keep the artery open)

You do not report these separately if 92928 is used — the angioplasty is bundled into the procedure.

How to Bill CPT Code 92928 Correctly?

To bill 92928 correctly, follow these guidelines:

1. Identify the target vessel — only one major artery or branch per line item.
2. Use a supporting diagnosis code, such as:

• I25.10 – Atherosclerotic heart disease of native coronary artery
• 21.4 – Non-ST elevation myocardial infarction

1. Use correct place of service (POS) — usually 21 (inpatient hospital) or 22 (outpatient).
2. Verify provider type and facility eligibility with payer policies.

How Does 92928 Differ from Similar CPT Codes?

Here’s a quick comparison:

How Much Does CPT Code 92928 Pay?

Medicare and private payers vary in reimbursement:

• Medicare 2024 national average (facility-based):
• $1,050 to $1,300 for professional fee
• $10,000 to $12,000 including facility/hospital fees

How Is Modifier Usage Important for 92928?

Modifiers are essential when:

• Multiple vessels are treated: Use 92928 for the primary, and 92929 for each additional.
• Different coronary territories:
• Modifier RC for Right Coronary Artery
• Modifier LC for Left Circumflex
• Modifier LD for Left Anterior Descending
•   Same session, multiple services: Use modifier 59 to denote distinct procedural services.

 How to Document Procedures for 92928?

A compliant operative note must include:

• Indication for procedure (e.g., chest pain, elevated troponin, angiogram findings)
• Access site (e.g., radial, femoral)
• Vessel treated and pre-/post-stenosis percentages
• Balloon and stent size, type, and number
• Complications, if any
• Post-op plan

How to Bill for Multiple Vessel Interventions?

If multiple arteries are treated:

• • Use 92928 for the first vessel
  • Use 92929 for each additional major vessel

• Include appropriate territory modifiers (LC, LD, RC)

How Does Medicare View 92928 Billing?

Medicare accepts 92928 when:

• It meets medical necessity (via ICD-10 diagnosis codes)
• It’s performed by a credentialed provider at an approved facility
• Claims are clearly coded with modifiers when needed
• CMS also encourages reporting through MIPS (Merit-based Incentive Payment System) for quality metrics on PCI.

How to Avoid Common Billing Errors with 92928?

• Top mistakes to avoid:
• Double billing angioplasty (92920) with 92928
• Failing to append modifiers for multiple vessels
• Inadequate documentation of procedure details
• Billing for multiple stents in same vessel as separate codes
• Using 92928 for non-coronary vessels (not allowed)

How to Optimize Reimbursement for 92928?

• Validate pre-authorizations for elective PCI
• Ensure correct NCD/LCD policies (National or Local Coverage Determinations)
• Use clean claims with ICD-10 + CPT + Modifiers + POS
• Conduct internal audits to catch under- or over-billing
• Outsource complex cardiac billing to specialized medical billing teams

Final Thoughts: Why 92928 CPT Code Is Key to Interventional Cardiology

The 92928 CPT Code is more than just a billing line — it represents life-saving procedures in cardiovascular care. By understanding how it works, how to code it accurately, and how to avoid pitfalls, providers can ensure timely reimbursements and high-quality patient outcomes. Given the complexity of cardiovascular billing, mastering 92928 is essential for both clinical and financial success in modern cardiology practices.