With Waves of 2026 Coding Changes Coming, it’s Time to Seek Knowledge Security in the Era of Economic Turbulence
A storm of economic uncertainty is looming over 2026, and you can’t afford to navigate the complexities without professional guidance for coding and compliance. With waves of coding changes coming, professionals who walk into 2026 without expert guidance will face a rising flood of costly new challenges.
Unlock expert guidance for cardiac cath and interventional coding plus peripheral procedural coding (carotids, lower & upper extremities, renal, visceral and more). The 2026 edition of Peripheral & Cardiology Coder is rewritten to reflect the important CPT®, RVU and payment-policy shifts that are changing how cath labs, coding teams, and revenue cycle leaders capture and protect reimbursement.
Do you struggle to pin down the exact words or phrases in physician documentation that support higher-value coding? Are procedure notes inconsistent across operators? Confused about modifier use by place-of-service or when diagnostic studies occur in the same encounter as an intervention? If you answered “yes,” the 2026 edition provides the precise, practical guidance you need to code accurately and avoid denials.
What’s new for 2026 — the changes that matter
This edition explains the specific coding and payment shifts you’ll see in practice and what they mean for claims, documentation, and auditing:
- Percutaneous Coronary Interventions (PCI) — clear guidance on how RVU changes affect physician payment: many base PCI codes (e.g., 92920, 92928) see RVU reductions while certain higher-complexity procedures (for example 92943, CTO PCI) receive RVU increases. We show how that affects code selection and documentation of complexity and time.
- Physiologic assessment tools — updated direction for FFR/iFR (93571, 93572) as RVU values increase and their documentation importance grows in PCI decision-making.
- Imaging adjuncts (IVUS/OCT) — practical counsel on 92978/92979 where IVUS/OCT remain critical clinically but are generally packaged under OPPS, impacting hospital reimbursement and charge capture.
- Lower Extremity Revascularization (37220–37235 series) — step-by-step explanation of new bundling/territory definitions, how angioplasty, atherectomy and stenting combinations should be reported, and how RVU realignments shift value toward atherectomy + stent combos. Emphasis on documentation needed to support appropriate code selection and avoid denials or RAC audit exposure.
- Peripheral & other cardiology procedures— refinements to electrophysiology and device services (pacemakers, ICDs, ablations) with add-on/site-specific guidance, and explanation of heightened scrutiny of catheter-based diagnostic study reporting (e.g., 93563–93568) when performed with interventions.
- Regulatory & site-of-service implications:
- OPPS packaging and Comprehensive APCs — what stays bundled (and why hospitals may not receive separate payment for add-ons such as FFR or IVUS).
- IPPS/DRGs — the inpatient DRG structure (DRGs 246–251) and how complications/CCs drive payment differences.
- ASCs — limited PCI coverage with flat, generally lower facility rates — and how that affects site-of-service decisions and charge capture.
Why hospitals, coders and revenue cycle teams need this guide now
- The 2026 coding shifts increase the risk of denials, underpayments, and audits unless documentation and charge capture are precise.
- OPPS packaging and RVU realignments change where value sits — between physician professional fees, hospital technical fees, and the site of service.
- Compliance teams and auditors must update workflows immediately to reflect new bundling rules and modifier guidance or face costly revenue leakage.
How the 2026 edition helps — practical, revenue-focused tools
MedLearn Publishing’s Peripheral & Cardiology Coder (2026 edition) gives you the resources to act now:
- Updated coding guides & quick charts that reflect 2026 CPT descriptor changes, bundling clarifications, and RVU realignments.
- RVU & payment reference tables showing physician RVU trends and hospital payment considerations (OPPS/ASC/DRG implications) so revenue teams can model impact.
- Case-based trainings that walk coders, auditors and clinicians through real-world scenarios (CTO PCI, FFR/iFR + PCI, IVUS/OCT in the cath lab, atherectomy + stent combos) and show correct code reporting and documentation examples.
- Procedural narratives & documentation templates — step-by-step explanations of how procedures are performed and the exact key words/phrases to capture in dictated reports to support higher-value coding.
- Modifier and site-of-service decision guides — clear rules for modifier usage with cardiac cath, PCI and peripheral interventions, including when diagnostic studies and interventions occur during the same encounter.
- Audit readiness tools — checklists and sample responses to common audit questions, plus guidance to reduce RAC and other post-payment review risk.
- Revenue cycle action items — practical steps for charge capture improvement, clinician education points, and coding workflow changes to protect revenue under the new rules.
2026 Features & Benefits
Our experts address the 2026 changes, common problem areas, and everyday coding tasks:
- Coverage of the latest 2026 code changes for peripheral (non-coronary) and cardiology procedures, with attention to RVU shifts and packaging rules.
- Detailed, body-system organization (head & neck, carotids, abdominal/renal/visceral, upper & lower extremities, venous procedures) with real-life case studies and dictated reports that highlight the exact phrases supporting correct CPT® assignments.
- Clear instruction on coding and documenting peripheral imaging and interventions performed in the same encounter — a growing practice embraced by many cath labs.
- Answers to updated FAQs such as: “How do we report diagnostic coronary cath with a PCI under the 2026 rules?” and “How should we capture combined angioplasty, atherectomy, and stent work in the same vessel?”
- Guidance for both hospital (technical/OPPS) and physician (professional) billing — with tables showing CPT/HCPCS codes, modifier guidance, RVUs and hospital payment considerations.
Quick-reference layout for busy professionals:
- Codes grouped by body system and CPT sequence for fast navigation.
- General coding guidelines, concise tables, and billing tips in each section.
- Case studies with commentary and full dictated reports at chapter ends, with highlighted key phrases you should train clinicians to use.
- Anatomical illustrations and flow charts to visually clarify complex procedures and territory/bundling rules.
Looking for more valuable coding education and news? Check out our Comprehensive Cardiology All-Access Pass.
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Introduction
Moderate (Conscious) Sedation
Cardiac Catheterization
Right Heart Catheterization
Right Heart Catheterization with Coronary Angiography
Right Heart Catheterization with Coronary and Bypass Graft Angiography (including SVG and IMA)
Left Heart Catheterization
Left Heart Catheterization With or Without Left Ventriculogram
Left Heart Catheterization With or Without Left Ventriculography and Coronary Angiography
Left Heart Catheterization With or Without Left Ventriculography,
Coronary Angiography and Bypass Graft Angiography (Including SVG and/or IMA)
Right and Left Heart Catheterization
Right and Left Heart Catheterization With or Without Left Ventriculography
Right and Left Heart Catheterization With or Without Left Ventriculography and Coronary Angiography
Right and Left Heart Catheterization With or Without Left Ventriculography, Coronary Angiography and Bypass (Including SVG and/or IMA) Angiography
Coronary and/or Bypass Graft Angiography (including SVG and/or IMA) Performed Without Concomitant Left Heart Catheterization Procedure
Coronary and Bypass Graft (including SVG and/or IMA) Angiography Without Concomitant Left Heart Catheterization
Congenital Heart Catheterization
New Directives for Congenital Catheterization
New 2022 Congenital Cardiac Catheterization Codes
Injection Procedures for Non-Congenital and Congenital Cardiac Catheterization
Intravascular Doppler Flow Reserve Measurement
Swan-Ganz Placement
Physiologic Exercise Study
Intravascular Doppler Flow Reserve Measurement
Renal Artery Angiography (Non-Selective) During Cardiac Catheterization
Iliac and/or Femoral Artery Angiography (Non-Selective) During Cardiac Catheterization
Vascular Closure Devices
Low Osmolar Contrast Media/Non-Ionic Contrast
Ambulatory Blood Pressure Monitoring
Cardiopulmonary Resuscitation
Typical Cardiac Catheterization Procedures and Codes
Coronary Interventions: Stenting, Angioplasty and Atherectomy of Major Coronary Arteries, Coronary Artery Branches and Bypass Grafts
Coronary Interventions
- Percutaneous Transluminal Coronary Angioplasty
- Percutaneous Transluminal Coronary Atherectomy
- Intracoronary Stent Placement (Bare Metal or Drug-Eluting)
- Combination (Multiple Interventions) Codes
- Interventions Within Bypass Graft or Through Graft
- Interventions for Acute Total/Subtotal Occlusion During Myocardial Infarction (MI)
- Interventions for Chronic Total Occlusion (CTO)
- Modifier Assignment
- Coding Examples
- Valvuloplasty
- Pulmonary Artery Angioplasty
- T-Wave Alternans
- Aortic Valve Procedures (TAVR/TAVI)
- TAVR/TAVI with Bypass Support
- Cardiac Assist—Intra-Aortic Balloon Assist/Intra-Aortic Balloon Pump (IABP)
- Transcatheter Mitral and Tricuspid Valve Procedures
- Coronary Thrombectomy and Intravascular Brachytherapy
- Endoluminal Imaging of Intracoronary Vessel or Graft
- Repair of Septal Defect
- Repair of Structural Heart Defect (Transcatheter Closure of Paravalvular Leak)
- Intravascular Catheter-Based Coronary Vessel or Graft Spectroscopy
- Transcatheter Vegetation Removal
- Percutaneous Transcatheter Closure of the Left Atrial Appendage
- Wireless Pressure Sensor Implantation
- Coronary Interventional Procedures and Codes
Noninvasive Vascular Diagnostic Studies
- General Guidelines
- Required Documentation for Duplex Studies
- Extremity Arterial Studies (Including Digits)
- Extremity Venous Studies (Including Digits)
Echocardiography: Fetal and Non-Fetal
- Fetal Echocardiography
- Non-Fetal Echocardiography
Cardiovascular Stress Tests/Exercise Stress Tests
Cardiovascular Illustrations and Guidelines
Frequently Asked Questions Related to Cardiac Catheterization Coding
Selective Catheter Coding (Non-Cardiac Procedures)
Component Coding
- Vascular Family
- Catheter Placements
Transcatheter Therapy Rules
Angiographic Radiology of the Head, Neck and Chest
Interventional Radiology of the Head, Neck and Chest
Angiographic Radiology of the Abdomen
Renal Angiography
Interventional Radiology of the Abdomen
Angiographic Radiology of the Upper Extremities
Interventional Radiology of the Upper Extremities
Angiographic Radiology of the Lower Extremities
Interventional Radiology of the Lower Extremities
- Coding Tips—Angioplasty, Stenting, Atherectomy
- Coding Tips—Thrombectomy and Thrombolysis
- Coding Tips—Lower Extremity Incompetent Veins
Case Studies
Appendix A
2022 Medicare Payment Rates
MPFS Status Codes
Hospital OPPS Status Indicators
Appendix B
Modifiers
- CPT Modifiers
- HCPCS Level II Modifiers
References