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Coronary artery bifurcation lesions are frequently encountered in cardiac catheterization laboratories and are associated with more complex procedures and worse clinical outcomes than nonbifurcation lesions. Therefore, anatomical and physiological assessment of bifurcation lesions before, during, and after percutaneous coronary intervention is of paramount clinical importance. Physiological assessment can help interventionalists appreciate the hemodynamic significance of coronary artery disease and guide ischemia-directed revascularization. However, it is important to understand that the physiological approach for bifurcation disease is more important than simply using physiological indexes for its assessment. This joint consensus document by the Korean, Japanese, and European bifurcation clubs presents the concept of a physiological approach for coronary bifurcation lesions, as well as current knowledge, practical tips, pitfalls, and future directions of applying physiological indexes in bifurcation percutaneous coronary intervention. This document aims to guide interventionalists in performing appropriate physiology-based assessments and treatment decisions for coronary bifurcation lesions., Competing Interests: Funding Support and Author Disclosures Dr Pan has received minor lecture fees from Abbott and Philips. Dr Banning has received institutional funding of a fellowship from Boston Scientific; and has received speaker fees from Boston Scientific, Abbott, Medtronic, Philips/Volcano, and Miracor. Dr Johnson has received consultancy and speaker fees from Abbott Vascular, Boston Scientific, and Terumo; and has received institutional funding for fellowships from Boston Scientific and Terumo. Dr Lefèvre has received speaker and proctorship fees from Abbott, Boston Scientific, Terumo, and Edwards Lifesciences. Dr Chatzizisis has received speaker honoraria, advisory board fees, and research grant support from Boston Scientific; and has received advisory board fees and research grant support from Medtronic. Dr Lassen has received speaker fees from Medtronic, Boston Scientific, Biotronik, Abbott, and Biosensors. Dr Stankovic has received speaker fees from Medtronic, Abbott, Boston Scientific, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)