Cardiology Question for the Week of December 25, 2023

Question:

For 2024, what code do we report for percutaneous transluminal coronary lithotripsy and can you explain more details about the service?

Answer:

This service is reported with 92972. Coronary intravascular lithotripsy (Coronary IVL) is a procedure that utilizes a lithotripter device delivered to the site of a calcified coronary lesion where it is used to fracture the lesion via the generation of sonic pressure waves. It was developed from the already-established procedure of lithotripsy used to treat kidney stones. The device currently available on the market for coronary IVL is the Shockwave Coronary IVL catheter by Shockwave Medical. There are several other coronary IVL catheters in development at this time, from Fastwave Medical and Cardiovascular Systems Incorporated, that have yet to come to market.

The Shockwave Coronary IVL catheter utilizes a balloon delivered to the lesion site that makes contact with the inner lumen walls of the diseased coronary vessel. Through this balloon, pressurized saline is delivered in a circular motion through the inner lumen of the balloon. An electrode catheter contained within the center of the balloon generates electrical impulses along the course of the interior of the balloon. This creates vaporizing bubbles that transmit sonic pressure waves through the pressurized swirling saline. These pressure waves are then transmitted to the surface of the interior lumen of the vessel walls. The waves fracture the calcium, pressing the material into the interstitial layers of the coronary wall, making the lesion more pliable and reducing the degree of stenosis. This is typically followed with the application of stenting to the area, which is a separately reported service.

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