In the 2026 CPT code set, the American Medical Association (AMA) has enacted one of the most sweeping updates to cardiovascular procedural coding in years — completely redesigning the coding framework for both lower extremity revascularization and percutaneous coronary intervention (PCI). These changes address the limitations of legacy codes, better align coding with current clinical practice, and improve specificity by anatomical territory, lesion complexity, and procedural technique. American College of Cardiology+1
1. Lower Extremity Revascularization — Complete Restructure (37254–37299)
Arguably the most significant change for vascular and interventional coders is the replacement of the entire legacy LER code family:
Codes 37220–37235, which historically captured femoropopliteal/tibial/iliac angioplasty, stenting, atherectomy, and related services, have been deleted. American College of Cardiology
In their place, 46 new CPT codes have been introduced in the range 37254–37299. NC Medicaid
New Structure Based on Vascular Territory
These new codes are organized by specific vascular territories, reflecting clinical anatomy and procedural approaches:
Iliac arteries — codes 37254–37262
Femoral and popliteal arteries — codes 37263–37279
Tibial and peroneal arteries — codes 37280–37295
Inframalleolar (foot) arteries — codes 37296–37299 Harmony Healthcare
Within each territory, coders must distinguish between “straightforward” lesions (stenosis) and “complex” lesions (complete occlusion) — a critical coding distinction. Lesion complexity now drives separate reporting rather than lumping procedures into broad categories as in previous code sets. Harmony Healthcare
Bundling of Ancillary Services
The majority of procedural elements — including access, catheterization, imaging guidance (e.g., fluoroscopy), lesion crossing, and device deployment — are bundled into the primary code. Add-on codes may still exist for additional vessels or procedures where clinically appropriate. Coding Clarified
Clinical Documentation Requirement
Accurate coding under this new structure depends on clear documentation of:
The exact vascular territory treated,
Whether the lesion is stenotic vs. occluded,
The type of intervention (angioplasty, stent, atherectomy), and
Any image guidance or specialized device used. Coding Clarified
Documentation that does not capture this level of detail can make correct code selection difficult and increase the risk of undercoding or non-compliant billing.
2. Percutaneous Coronary Intervention (PCI) Code Updates
PCI codes have also been significantly revised to better reflect procedural complexity and resource utilization:
MUST BUY ICD-10 CM CODING EBOOKS
New PCI Codes
92930 — This new code covers intracoronary stent(s) placed with angioplasty in a single major coronary artery and/or its branch(es) when treating two or more distinct coronary lesions OR bifurcation lesions requiring intervention in both the main vessel and side branch. American College of Cardiology
92945 — This code reports revascularization of a chronic total occlusion (CTO) using combined antegrade and retrograde approaches, including any combination of stenting, atherectomy, or angioplasty. American College of Cardiology
Streamlining of Legacy PCI Codes
Multiple additional branch add-on codes previously used to capture interventions in coronary branches have been deleted (e.g., 92921, 92925, 92929, 92934, 92938, 92944). Instead, the base PCI codes have been revised to cover work within a single major artery and its branches. American College of Cardiology
Legacy thrombolysis codes (92975, 92977) have also been removed, reflecting the reduced clinical use of standalone intracoronary thrombolysis relative to modern interventional techniques. American College of Cardiology
Updated Lesion and Segment Definitions
The CPT updates include clarified definitions for:
What constitutes a coronary lesion,
How to identify coronary segments, and
How branches and bypass grafts are incorporated into coding logic. IMO Health
These refinements support consistent coding across providers and payers.
3. Practical Impact for Coders
Education and System Updates
Clinical coders, revenue cycle teams, and CDI professionals must ensure:
Encoder systems and charge masters are updated with all 37254–37299 LER codes,
PCI logic reflects the new hierarchy and deleted codes, and
Documentation templates reinforce capture of territory, lesion complexity, and intervention type. NC Medicaid
Clinical Documentation Improvement (CDI)
Precise clinical notes are essential — especially when differentiating stenosis vs. occlusion, or identifying multiple distinct coronary lesions, as these directly influence CPT code selection and reimbursement.
Compliance and Reimbursement
Failure to apply the correct new codes can result in:
Underpayment, or
Denials during audits due to obsolete code use (37220–37235 and deleted PCI add-ons). Coding Clarified
4. Conclusion
The 2026 CPT cardiovascular revascularization updates — especially the revamped lower extremity revascularization code family (37254–37299) and new PCI codes (92930 and 92945) — transform how vascular and coronary procedures are coded. These changes enhance clinical specificity, streamline procedural reporting, and align coding with contemporary practice, but they require robust documentation and systematic updates across HIM and revenue cycle platforms.