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:  

 

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 two 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 of 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 of Multiple Operative Fields: Bilateral ovarian veins for pelvic congestion syndrome, two or more intracranial aneurysms in different territories, or a trauma patient who presents with bleeding in both the spleen and pelvis.  

There is no separate code for the radiological supervision and interpretation component of the procedure with all roadmapping 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 the criteria are 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.