May 5, 2023 | By Stacie L. Buck, RHIA, CCS-P, RCC, RCCIR, CIRCC
It is no secret that interventional radiology is one of the most difficult specialties for coders and auditors to master. In particular, coding correctly for embolization procedures can be tricky due to the multiple coding considerations involved. This article provides tips that will have you coding and auditing some of the most common embolization procedures like a pro!
Correct code selection for embolization procedures begins with clearly identifying the clinical indication being treated. The following is a list of common clinical indications for each code in the 37241 – 37244 range:
37241 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (e.g., congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)
- Venous malformations
- Capillary hemangiomas
- Visceral varices (gastric, esophageal) (ie, CARTO (coil assisted retrograde transvenous obliteration), BRTO (balloon occlusion retrograde) obliteration
- Note: If bleeding varices are the reason for the embolization, code 37244 will be assigned instead.
- Incompetent ovarian veins (pelvic congestion)
- Lymphatic malformations (vascular malformations primarily lymphatic)
- Patent perforators siphoning flow from extremity venous bypass grafts
37242 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (e.g., congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)
- Arteriovenous (AV) malformations
- Arteriovenous fistulas (AVF)
- Note: This code is not utilized for embolization of a dialysis AVF.
- Embolization performed prior to another planned interventional procedure (ie, prophylactic embolization occlusion of non-targeted vessel)
- Note: A prophylactic embolization is when the physician opts to occlude a different vessel from the one that is the target of the planned intervention. The most common example is when prior to treatment of a liver tumor (37243), the gastric artery or gastroduodenal artery may be embolized prior to treating the liver tumor. In these instances, code 37242 is assigned rather than 37243. Should both procedures be performed during the same session, only code 37243 should be assigned.
37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
- Tissue ablation
- Benign or malignant tumor of liver, kidneys, uterus or other organs (i.e., Transcatheter arterial chemoembolization (TACE), Selective internal radiation therapy radioembolization (SIRT)
- Organ infarct or ischemia
37244 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation
- Gastrointestinal (GI) bleed
- Trauma induced hemorrhage of viscera or pelvis
- Chylorus effusion of thoracic duct
- Hemoptysis (bronchial)
- Post partum hemorrhage
If there are two clinical indications present, the code should be selected based on the immediate clinical indication that necessitated performance of the procedure. For example, if a patient presents with a ruptured aneurysm and the embolization was performed to stop the bleeding, code 37244 is assigned rather than code 37242, since the procedure was initiated to treat a bleed after the aneurysm has ruptured.
Embolization codes are assigned once per operative field, therefore it is important to understand what constitutes a single operative field versus multiple operative fields.
The number of vessels treated does not determine the number of embolization codes assigned, rather the number of organs being treated determines the number of embolization codes assigned. Generally, a single organ is considered a single operative field, although in the November 2013 issue of CPT Assistant, the AMA noted that 2 separate lesions treated in the liver, both right and left lobes, are counted as two operative fields, with the embolization code being assigned twice. When bilateral organs are treated, each is considered its own operative field, and an embolization code is assigned for each.
Examples Single Operative Field: multiple vessels targeted for treatment of a bladder tumor, multiple vessels treated in one leg, or bilateral uterine arteries treated for fibroids or post-partum hemorrhage.
Examples Multiple Operative Fields: bilateral ovarian veins for pelvic congestion syndrome, 2 or more intracranial aneurysms in different territories, or a trauma patient who presents with bleeding in both the spleen and pelvis.
There are also a few procedure components bundled into codes 37241-37244.
There is no separate code for the radiological supervision and interpretation component of the procedure with all road mapping and intraprocedural guidance (75894) and completion angiography (75898) being included with the surgical code. CPT® codes 75894 and 75898 are utilized with codes 61624 and 61626, not 37241-37244. Additionally, any non-selective catheterization (36140, 36160, 36200, 36005, 36010) is bundled with 37241 – 37244 and should not be coded separately.
All other components of the embolization procedure may be coded separately. These components include but are not limited to: selective catheter placements (36245 – 36248, 36215-36218), diagnostic angiography when criteria is met, intravascular ultrasound (IVUS) (+37252-+37253), ultrasound guidance for vascular access (+76937), moderate sedation (99151-99157) and Y-90 administration (79445). The codes for chemoembolization (96420) and closure of arteriotomy (G0269) are reported for facility coding only. They are not reported for professional component billing.
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