On Demand: Coronary PCI in 2026: Navigating the New CPT Codes, Documentation Standards and Reimbursement Impacts-Presentation Slides

Presentation Slides

Pdf Summary

This 2025 MedAxiom presentation reviews important updates for coronary percutaneous coronary intervention (PCI) coding, documentation, and reimbursement effective January 1, 2026. Authored by Jammie Quimby and Linda Gates-Striby, it addresses new CPT coding changes, key documentation standards, and impacts on coding practices.<br /><br />Key points include a refresher on diagnostic cardiac catheterizations and coronary angiography procedures, clarifying terminology and coding for various heart cath types, including right, left, and combined heart catheterizations, as well as coronary graft access.<br /><br />The 2026 CPT updates introduce two new PCI codes: one for more complex coronary stenting involving two or more distinct coronary lesions (92930) and another for combined antegrade and retrograde approaches in chronic total occlusion (CTO) procedures (92945). The previous "additional lesion" PCI codes and some thrombolysis codes are deleted. Definitions for coronary lesions and coronary segments have been refined using National Cardiovascular Data Registry (NCDR) standards to improve coding accuracy. The document clarifies applying the single-intervention-per-artery rule and explains correct use of new and existing PCI codes including stenting, atherectomy, and PCI for acute myocardial infarction.<br /><br />The document emphasizes enhanced documentation detailing the clinical context, lesion identification, segment mapping, approach type, and adjunctive technologies such as intravascular ultrasound (IVUS), fractional flow reserve (FFR), and optical coherence tomography (OCT). Specific CTO coding guidelines focus on antegrade vs. retrograde techniques with detailed procedural language to prevent denials.<br /><br />Advanced CTO procedural techniques are explained, including antegrade wire escalation, subintimal tracking and reentry, retrograde wire escalation, and combined controlled antegrade and retrograde tracking (CART and reverse CART). The presentation highlights the complexity of CTO interventions and the necessity for comprehensive documentation to capture these nuances.<br /><br />Work RVU changes and Medicare National Correct Coding Initiative policies impacting PCI coding are addressed. The presentation also advises prior authorization for CTO codes and stresses that this guidance is educational and not official payer policy.<br /><br />In summary, the material prepares coding and clinical staff to navigate the 2026 CPT changes in coronary PCI coding, ensuring accurate documentation and reimbursement aligned with evolving procedural complexities.

Keywords

2026 CPT updates

PCI coding

coronary stenting

chronic total occlusion (CTO)

diagnostic cardiac catheterization

NCDR standards

antegrade and retrograde techniques

intracoronary imaging (IVUS, FFR, OCT)

work RVU changes

prior authorization for CTO codes