CCSD code K4902 – Coronary angioplasty with intravascular ultrasound (femoro-brachial access)

Key takeaways

CCSD code K4902 covers coronary angioplasty guided by intravascular ultrasound (IVUS), laser included, through femoral or brachial access.

K4902 is a heart code in Chapter 8 of the CCSD schedule, with no connection to dental treatment.

Never bill K4902 alongside K4900, K4910 or K4912. The CCSD schedule lists each one as an unacceptable combination.

If a stent goes in during the IVUS-guided procedure, the case belongs on K4912, so the report must state stent status.

The descriptor names femoral or brachial access, so the report must record the access route to support K4902.

CCSD code K4902 covers IVUS-guided coronary angioplasty

CCSD code K4902 covers percutaneous transluminal angioplasty of one or more coronary arteries with intravascular ultrasound (IVUS). Access is through the femoral or brachial artery. The descriptor adds “including laser”, so a laser-assisted angioplasty with IVUS guidance stays on the same code.

An interventional cardiologist bills K4902 to the patient’s private medical insurer after treating a narrowed coronary artery. The ultrasound run is what separates it from plain balloon angioplasty.

CCSD stands for Clinical Coding & Schedule Development. Its schedule gives UK private medical insurers one shared set of procedure codes. K4902 sits in Chapter 8, thorax and intra-thoracic organs, under Heart – Cardiology. Our CCSD procedure codes guides cover the rest of the schedule.

Official descriptor

The CCSD descriptor for K4902 reads: Percutaneous transluminal angioplasty of coronary artery(ies) with intravascular ultrasound (including laser) – femo brachial access.

Each part of that wording rules out a neighboring code. That’s why the procedure report has to match it.

The K prefix follows Chapter K of OPCS-4, the UK procedure classification, which covers the heart. Dental procedures sit elsewhere, in the F codes.

IVUS is what turns a plain angioplasty into K4902

Coronary angioplasty widens a narrowed heart artery from inside. A balloon catheter travels up from an artery in the leg or arm. IVUS adds a miniature ultrasound probe on a catheter, which images the artery wall from within. An angiogram alone can’t show that.

A K4902 report should cover these steps:

1. Arterial access: A sheath goes into the femoral or brachial artery. This route is written into the K4902 descriptor.
2. Guide catheter and wire: A guide catheter sits at the opening of the coronary artery. A guidewire then crosses the narrowing.
3. IVUS imaging: The ultrasound catheter is pulled back through the segment. It measures vessel size, lumen area, plaque and lesion length.
4. Angioplasty: A balloon, or a laser catheter where one is used, opens the narrowing. Device sizing usually follows the IVUS measurements.
5. Final assessment: Angiography, often with a repeat IVUS run, confirms the result before the sheath comes out.

Whether a stent was placed decides the code. The schedule lists angioplasty with stent insertion and IVUS separately, as K4912.

Neighboring codes show where K4902 stops

K4902 belongs to a small family of coronary angioplasty codes. Read the table by what happened in the lab. Then pick the one code that matches the whole procedure.

The CCSD website marks K6511, K6513 and K6514 as “Pre 2025” entries, so their status may have changed. Recheck them before you rely on that part of the table.

K4902’s descriptor names femoral or brachial access only. If the cardiologist went in through the radial artery, confirm in the current CCSD schedule which code applies to a radial IVUS angioplasty.

Two questions separate K4902 from its unacceptable combinations

The CCSD schedule lists K4900, K4910 and K4912 as unacceptable combinations with K4902. Each one describes an overlapping coronary angioplasty. Claiming two of them would bill the same procedure twice.

So the quickest check comes down to two questions. Was IVUS used, and did a stent go in? The grid below maps each answer to one code.

No IVUS run means the case moves to K4900. A stent without IVUS moves it to K4910. Both IVUS and a stent point to K4912.

Registered users can read each code’s combination rules on the CCSD website, which requires a login. Recheck them whenever the schedule is updated.

Pre-authorization has to match the code you bill

K4902 is billed to a private medical insurance policy, so authorization runs through the patient’s medical insurer. UK insurers generally ask the patient to get authorization before planned treatment.

That authorization is tied to the procedure planned at the time. If the lab changes the plan, say by inserting a stent, the claim no longer matches. Tell the insurer once the procedure is done, before the invoice goes in.

The procedure report has to prove every part of the descriptor

Insurers can ask for the procedure report when they query a K4902 claim. Each element of the descriptor rules out a neighboring code, so the report needs all of them.

• Indication: The diagnosis and symptoms that justified intervention, with the earlier angiogram’s findings.
• Access route: Femoral or brachial, stated plainly. Without it, the code is unsupported.
• Vessels treated: Each coronary artery and segment, with the location and severity of the narrowing.
• IVUS findings: Vessel and lumen measurements, plaque description and lesion length, plus how they shaped treatment.
• Devices used: Balloon sizes and inflation pressures, and the laser catheter if one was used.
• Stent status: A clear statement that no stent was inserted. If one was, the case belongs on K4912.
• Result and complications: The final angiographic result, and any complication with how it was managed.
• Consent and authorization: The signed consent form and the insurer’s authorization reference.

A K4902 claim moves from cath lab to payment in five steps

Here’s the usual path from procedure to payment, and where each step can stall.

1. Procedure report signed: The cardiologist completes the report. A missing access route or IVUS finding stalls the claim here.
2. Code confirmed: Billing staff check the report against the descriptor and pick one angioplasty code.
3. Claim built: The invoice carries the code, the authorization reference, the provider number and the procedure date.
4. Claim submitted: It goes electronically through Healthcode or the insurer’s own portal. Keep the submission receipt.
5. Query or payment: The insurer pays, queries or rejects it. Answer any query with the procedure report attached.

Run this checklist before you submit a K4902 claim

Tick each line against the signed report before the claim goes out. One unticked line usually means a query later.

• IVUS was used, and the report records its measurements.
• No stent went in. If one did, switch to K4912.
• Access was femoral or brachial, and the report says which.
• K4900, K4910 and K4912 are not on the same claim.
• The authorization reference matches the procedure performed.
• The insurer was told about any change to the planned procedure.
• The consultant’s provider number and the procedure date are on the invoice.

Common mistakes get K4902 claims rejected

Watch for these six slips. Each one has a simple fix.

Insurers, not CCSD, decide what K4902 pays

The CCSD schedule defines the procedure, not the fee. Each insurer sets its own benefit for K4902. It publishes that figure through a fee schedule or provider portal, such as the Bupa fee schedule.

Where the consultant’s fee is higher than the insurer’s benefit, the patient may owe a shortfall. Explain that in the fee estimate before the procedure, so the invoice doesn’t come as a surprise.

Pabau keeps each K4902 claim tied to its authorization

A K4902 claim depends on the cath lab report, the consent form and the insurer’s authorization. When those sit in separate systems, the authorization reference is the easiest one to lose.

Pabau, the practice management software we build for private practices, raises each invoice from the patient’s record. The CCSD code, provider number and authorization reference travel with it. Its medical billing software sends UK claims through Healthcode and checks required fields first.

Billing staff then see submitted, pending, paid and rejected claims in one view. A rejected K4902 claim shows up quickly, so the reply goes out with the report attached.

Keep every K4902 claim tied to its authorization

Pabau raises CCSD-coded invoices from the patient record and carries the authorization reference onto each claim. Claim status through Healthcode sits in one view.

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Conclusion

K4902 rests on three facts in the report. IVUS was used, no stent went in, and access was femoral or brachial. Get one wrong and the claim belongs on a neighboring code.

So the work that matters happens before the invoice. Agree the planned code with the insurer, and make sure the report names the IVUS findings and access route. If the lab changes the plan, update the authorization first.

Book a demo to see how Pabau keeps CCSD codes, authorization references and claim status in one place.

Continue your research

Billing balloon angioplasty without IVUS? CCSD code K4900 covers coronary angioplasty without a stent or ultrasound guidance.

Stent inserted during the procedure? CCSD code K4910 explains the stent code and the access rules that come with it.

Billing other procedures to Bupa? Bupa CCSD codes walks through the chapter structure and the submission rules Bupa applies.

Need the fee behind the code? Bupa procedure codes fee schedule explains how benefit maximums are set per code and where shortfalls come from.

Frequently asked questions