**Overview**  
  
Percutaneous coronary intervention (PCI), commonly known as coronary
angioplasty or simply angioplasty, is a non-surgical procedure used to treat
the stenotic (narrowed) coronary arteries of the heart found in coronary heart
disease. These stenotic segments are due to the buildup of the cholesterol-
laden plaques that form due to atherosclerosis. During PCI, a cardiologist
feeds a deflated balloon or other device on a catheter from the inguinal
femoral artery or radial artery up through blood vessels until they reach the
site of blockage in the heart. X-ray imaging is used to guide the catheter
threading. At the blockage, the balloon is inflated to open the artery,
allowing blood to flow. A stent is often placed at the site of blockage to
permanently open the artery.  
  
Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive
procedure to open blocked coronary arteries, allowing blood to circulate
unobstructed to the heart muscle.  
  
 **Indications:**  
Percutaneous coronary intervention (PCI) may be indicated in the management of
patients with:

  * acute coronary syndrome (e.g., acute myocardial infarction, unstable angina);
  * a history of significant obstructive atherosclerotic disease;
  * restenosis of a coronary artery previously treated with intracoronary stent or another revascularization procedure;
  * chronic angina; or
  * silent ischemia

Intracoronary ultrasound (IVUS) may be separately covered when needed to
assess the extent of coronary stenosis if equivocal on angiography, or when
needed to assess the patency and integrity of a coronary artery during
percutaneous coronary intervention. Alternatively, intravascular Doppler
velocity and/or pressure derived coronary flow reserve measurement may be
performed to assess the degree of stenosis within a vessel. Intracoronary
ultrasound or fractional flow reserve measurement should be performed on an
individual artery as clinically indicated. Both procedures are not considered
medically necessary unless written documentation is submitted to support
medical necessity. Intracoronary ultrasound and Doppler fractional flow
reserve studies can be required in multivessel coronary artery disease (CAD).  
  
A diagnostic cardiac catheterization to assess the nature of the lesion(s)
prior to the intervention is a covered service. The diagnostic cardiac
catheterization may be performed at any time prior to the PCI, including the
same day as the PCI. Performance of a diagnostic cardiac catheterization and
interventional procedure on the same day is increasingly the standard of
practice. If the diagnostic catheterization is done within 30 days of the PCI,
it is usually not necessary to repeat the catheterization unless there is a
documented change in the patient's condition. While there may be reasons for
delaying the interventional procedure (e.g., transfer from a community
hospital to a tertiary center, excessive dye load, further treatment planning
or evaluation of angiography, etc.), it is recommended that both procedures be
performed during the same encounter when medically appropriate, with detailed
discussion of benefits and risks of PCI. Separation of these procedures for
the purpose of circumventing the multiple surgery pricing, or for the
convenience of physician or hospital scheduling, is considered an
inappropriate practice and may subject the services to review and denial for
medical necessity. The decision to stage these procedures is deferred to the
judgment of the interventional cardiologist and individualized only to the
clinical needs of the patient. (e.g., dye load already received; need to
correlate findings with other test results, etc.). Reasons for delaying an
indicated percutaneous coronary intervention should be documented in the
medical record. Unless there is a new clinical event, a change in
symptomatology, abnormal examination or other test results, a repeat
diagnostic catheterization within three months of the last diagnostic
catheterization and prior to the percutaneous coronary intervention is
generally not reimbursable and is considered not reasonable and necessary.  
  
 **Limitations:**  
Generally, PCI is not indicated for:

  1. Patients that can be managed medically.
  2. Right heart catheterization and insertion of a Swan - Ganz catheter are not generally medically necessary for a PCI and will be denied, unless medically necessary when performed incident to a diagnostic catheterization prior to the intervention.
  3. Standby services of a surgeon or anesthesiologist are not covered services.
  4. Patient with stable CAD.