Interventional Radiology Coding Update

Transcription

Interventional Radiology
Coding Update
online supplement
2 012
eighteenth edition
2012 Interventional Radiology Coding Update: Online Supplement
Coding for Endovascular and Interventional Procedures & Services
Society of Interventional Radiology
American College of Radiology
Edition 2012
Copyright © 2012 by the Society of Interventional Radiology and the
American College of Radiology. All rights reserved. No part of this
publication covered by the copyright hereon may be reproduced or copied
in any form or by any means—graphic, electronic or mechanical, including
photocopying, taping or information storage and retrieval systems—without
written permission of the publishers.
CPT® five-digit codes, nomenclature and other data are copyright © 2011
American Medical Association. No fee schedules, basic units, relative values
or related listings are included in CPT. The AMA assumes no liability for the
data contained herein. CPT is a listing of descriptive terms and five-digit
numeric identifying codes and modifiers for reporting medical services
performed by physicians. This edition of the Guide contains only CPT terms,
codes and modifiers that were selected by SIR for inclusion in this
publication.
table of contents
5
Foreword
7
Glossary of Acronyms
9
Categories of CPT® Codes Implemented in 2012
11
New and Revised Interventional Radiology Codes for 2012
11 Category II CPT Codes Implemented in 2012
11 Computed Tomography and Magnetic Resonance
Imaging
12 Category III CPT Codes Implemented in 2012
12 Endovascular Repair Involving Visceral Branches
12 Category I CPT Code Changes Implemented in 2012
12 Vertebroplasty/Kyphoplasty
12 Lung and Liver Biopsies
13 Arterial Catheter Placement
13 Changes to Introductory Guidelines and New Headings
13 Arteriovenous (AV) Shunts for Dialysis
14 Lower-extremity Endovascular Revascularization
15 Renal Angiography (New Codes for 2012)
16 Vena Cava Filter Procedures (New Codes for 2012)
17 Abdominal Paracentesis (New Codes for 2012)
2012
INTERVENTIONAL
RADIOLOGY
C O D I N G U P D AT E
PA G E
4
ONLINE SUPPLEMENT
TA B L E O F
CONTENTS
18 New Diagnostic Radiology Codes for 2012
18 CTA of Abdomen and Pelvis (New Code for 2012)
18 Pain Management Updates
18 Facet Joint Nerve Destruction by Neurolytic Injection
Per Nerve Level
19 Sacroiliac Joint Injection
19 Hospital Outpatient Prospective Payment System
21
Frequently Asked Questions
26
Individual Coverage Request Sample Letters
26
Percutaneous Radiofrequency Ablation of Pulmonary Tumor(s)
31 Ovarian Vein Embolization (OVE) to Treat Pelvic Congestion
Syndrome (PCS)
37 MRI of the Pelvis for UFE
41
Sample 2012 Charge Sheets
2012
INTERVENTIONAL
RADIOLOGY
PA G E
5
ONLINE SUPPLEMENT
FOREWORD
foreword
The Society of Interventional Radiology (SIR)/American College of Radiology
(ACR) 2012 Interventional Radiology Coding Update is intended to inform
physicians and coders of the changes in interventional radiology coding for
2012, as well as provide some common examples of coding scenarios. In
2012, the trend continued towards creating new endovascular codes that
bundle all components of a procedure into a single code.
This 2012 Interventional Radiology Coding Update is not intended to be a
comprehensive resource on all coding matters but, rather, is focused on
what is new in 2012. As always, we encourage users to refer to the CPT 2012
code book Professional Edition or Standard Edition for a complete code
listing and coding guidance. For additional reference, SIR’s coding resources
for 2010 and 2011 and ACR’s Radiology Coding Source (www.acr.org/rcs)
also offer useful and relevant information on coding.
In 2011, the Centers for Medicare and Medicaid Services (CMS) continued to
identify existing codes for revision and revaluation through its code
screening process. Some of the screens used by CMS to identify codes for
revision are high-volume, frequently billed code pairs, or fastest growing
utilization. Once a code change proposal is presented to the American
Medical Association’s (AMA’s) CPT Editorial Panel, it then goes through the
process of being assigned a relative value unit (RVU), which is determined
by the AMA/Specialty Society Relative Value Scale Update Committee (RUC).
This process is ongoing throughout the year. Despite some criticism of this
process, we expect that for the foreseeable future CMS will continue to use
the RUC process as its primary means to ensure code value relativity and
recommend values.
In this Update, we often use the CPT code short descriptor. Readers are
encouraged to refer to the long descriptors in the CPT 2012 code book
2012
INTERVENTIONAL
RADIOLOGY
PA G E
6
ONLINE SUPPLEMENT
FOREWORD
Professional Edition or Standard Edition. The long descriptors contain
additional useful information about the code, such as instructions on the use
of other codes that are often reported together and code pairs that should
not be reported together.
SIR and ACR thank all of our CPT and RUC advisers who volunteer their
time and expertise in the coding process
2012
INTERVENTIONAL
PA G E
7
RADIOLOGY
ONLINE SUPPLEMENT
G L O S S A RY
glossary of acronyms
AAA
ABN
ABPTS
ACO
ACR
AMA
APC
ASC
AV
AVF
CAC
CMD
CMS
CPT
DRG
E&M
HCPCS
HOPPS
ICD-CM
ICD-9-CM
IDE
IDTF
IVC
IVUS
LCD
MUE
NCCI
NEC
NCHS
Abdominal Aortic Aneurysm
Advanced Beneficiary Notice
American Board of Physical Therapy Specialties
Accountable Care Organization
American College of Radiology
American Medical Association
Ambulatory Payment Classification
Ambulatory Surgical Center
Arteriovenous
Arteriovenous Fistula
Carrier Advisory Committee
Carrier Medical Director
Centers for Medicare and Medicaid Services
Current Procedural Terminology
Diagnosis-related Group
Evaluation and Management
Healthcare Common Procedure Coding System
Hospital Outpatient Prospective Payment System
International Classification of Diseases, Clinical Modification
International Classification of Diseases, Ninth Revision,
Clinical Modification
Investigational Device Exemption
Independent Diagnostic Testing Facility
Intravascular Vena Cava
Intravascular Ultrasound
Local Coverage Determination
Medically Unlikely Edit
National Correct Coding Initiative
Not Elsewhere Classified
National Center for Health Statistics
OF
ACRONYMS
2012
INTERVENTIONAL
PA G E
8
RADIOLOGY
ONLINE SUPPLEMENT
G L O S S A RY
NOS
NP
PA
PIN
POS
PQRS
PTA
RAC
RBMA
RBRVS
RFA
RS&I
RS/IS&I
RUC
RVS
RVU
SIR
SOAP
TAA
Not Otherwise Specified
Nurse Practitioner
Physician’s Assistant
Provider Identification Number
Place of Service
Physician Quality Reporting System
Percutaneous Transluminal Angioplasty
Recovery Audit Contractor
Radiology Business Management Association
Resource-based Relative Value Scale
Radiofrequency Ablation
Radiological Supervision and Interpretation
Radiological Supervision and Interpretation/Imaging Supervision
and Interpretation
RVS Update Committee
Relative Value Scale
Relative Value Unit
Society of Interventional Radiology
Subjective Evaluation, Objective Evaluation, Assessment and Plan
Thoracic Aortic Aneurysm
OF
ACRONYMS
2012
INTERVENTIONAL
RADIOLOGY
PA G E
9
ONLINE SUPPLEMENT
C AT E G O R I E S
OF CPT CODES
C AT E G O RY I
C AT E G O RY I I
categories of
CPT
®
codes
CPT code proposal requests submitted to the AMA CPT Editorial Panel must
identify what category of CPT code is being sought. The Panel reviews
requests for three types of CPT codes.
C AT E G O R Y I C O D E S
These represent established services and procedures, performed by a variety
of providers, in multiple geographical locations, with appropriate FDA
approval for all aspects of the procedure.
C AT E G O R Y I I C O D E S
These codes are used to track performance measures. They are intended to
facilitate data collection and not serve for billing purposes. Category II
codes also are used in the Physician Quality Reporting System (PQRS) to
report quality measures related to services provided under the Medicare
Physician Fee Schedule. The PQRS is a voluntary pay-for-performance
program in Medicare. It offers a financial incentive to physicians and other
eligible professionals who successfully satisfy quality measures related to
their services.
C AT E G O R Y I I I C O D E S
These are issued for emerging technologies not meeting standards for a
Category I code.
Additional information regarding the different categories of CPT codes can
be found on the AMA Web site at
www.ama-assn.org/ama/pub/physician-resources/solutions-managing-yourpractice/coding-billing-insurance/cpt/.page
C AT E G O RY I I I
2012
INTERVENTIONAL
PA G E
RADIOLOGY
10
ONLINE SUPPLEMENT
C AT E G O R I E S
OF CPT CODES
OTHER HCPCS
CODES
OTHER HCPCS CODES
CMS may also issue Level II Healthcare Common Procedure Coding System
(HCPCS) codes to report physician services. For example, G-codes are
temporary codes issued by CMS to describe procedures and professional
services. S-codes are temporary codes issued by CMS, often at the request of
a commercial carrier. While S-codes are NOT eligible for use within the
Medicare program, commercial carriers may elect to utilize these codes to
facilitate claims processing.
A listing of current HCPCS Level II codes may be found at:
www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp
2012
INTERVENTIONAL
PA G E
RADIOLOGY
11
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
C AT E G O RY I I
NEW AND REVISED
interventional radiology
codes for 2012
Effective Jan. 1, 2012, the CPT code set reflects a number of changes
compared to 2011. Several new codes have been introduced, and editorial
revisions have been made to some existing codes.
C AT E G O R Y I I C P T C O D E S I M P L E M E N T E D I N 2 0 1 2
C o m p u t e d To m o g r a p h y a n d
Magnetic Resonance Imaging
Category II codes 3 1 1 1 F and 3 1 1 2 F, for reporting Measure #10: Stroke
and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic
Resonance Imaging (MRI) Reports, have been editorially revised to denote
that these codes apply to intracranial hemorrhage.
3 1 1 1 F CT or MRI of the brain performed in the hospital within 24 hours
of arrival OR performed in an outpatient imaging center, to confirm initial
diagnosis of stroke, TIA or intracranial hemorrhage (STR)
3 1 1 2 F CT or MRI of the brain greater than 24 hours after arrival to the
hospital OR performed in an outpatient imaging center for purpose other
than confirmation of initial diagnosis of stroke, TIA or intracranial
hemorrhage (STR)
2012
INTERVENTIONAL
PA G E
RADIOLOGY
12
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
C AT E G O RY I I I
C AT E G O R Y I I I C P T C O D E S I M P L E M E N T E D I N 2 0 1 2
E n d o v a s c u l a r R e p a i r I n v o l v i n g Vi s c e r a l B r a n c h e s
For the category III code, 0 0 8 0 T, Endovascular repair using prosthesis…,
revisions have been made to include language to better describe the
procedures that are intended as part of this service. This includes the
removal of language specific to a particular device.
C AT E G O R Y I C P T C O D E S I M P L E M E N T E D I N 2 0 1 2
Ve r t e b r o p l a s t y / Ky p h o p l a s t y
An edit has been made to the code descriptor for vertebroplasty
(2 2 5 2 0 – 2 2 5 2 2 ) to denote that bone biopsy is included in the codes,
when performed. This edit now pertains to vertebroplasty
(2 2 5 2 0 – 2 2 5 2 2 ), as well as kyphoplasty (2 2 5 2 3 – 2 2 5 2 5 ). Providers
should not report a bone biopsy separately, if performed.
Additionally, CMS has approved direct Practice Expense (PE) inputs for
kyphoplasty performed in the office setting for 2012. Providers should
always confirm with the relevant carrier to ensure that a particular
procedure is permitted in the office (nonfacility) setting, as local carrier
policies may differ.
Lung and Liver Biopsy Codes
Code 3 2 4 0 5 Biopsy, lung or mediastinum, percutaneous needle and code
4 7 0 0 0 Biopsy of liver, needle; percutaneous have both been revised to
note that moderate sedation is included in these procedures. When
moderate sedation is included in a code, the CPT protocol is to denote the
inclusion with the symbol ⊙.
C AT E G O RY I
2012
INTERVENTIONAL
PA G E
RADIOLOGY
13
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
C AT E G O RY I
Arterial Catheter Placement
For 2012, the moderate sedation (⊙) designation is noted as inherent in the
procedures for codes 3 6 2 0 0 , 3 6 2 4 5 , 3 6 2 4 6 , 3 6 2 4 7 , 3 6 2 4 8 and
3 7 2 0 3 and not separately reportable.
Changes to Introductory Guidelines
and new headings
A r t e r i o v e n o u s ( AV ) S h u n t s f o r D i a l y s i s
Two new headings in the Current Procedural Terminology (CPT) 2012 code
book are found under the Surgery, Cardiovascular System, Arteries and Veins,
Vascular Injection Procedures Subsection listed as Diagnostic Studies of
Arteriovenous (AV) Shunts for Dialysis and Interventions for Arteriovenous
(AV) Shunts Created for Dialysis (AV Grafts and AV Fistula).
Extensive new guidance has been created for arteriovenous dialysis access
to clarify correct coding for code 3 6 1 4 7. This language starts on page 196
of the CPT 2012 Professional Edition and page 139 of the Standard Edition
and provides detailed anatomical guidance on coding for interventions for
arteriovenous (AV) shunts created for dialysis (AV grafts and AV fistulae). This
guidance was created by a multispecialty panel to ensure that this
procedure is reported accurately.
• The two vessel segments of arteriovenous (AV) shunts are defined.
• Catheterization of the vena cava is not separately reportable when
performed through the same access as the AV fistula shunt.
• Central veins (e.g., subclavian, innominate and vena cava) are considered
separate venous vessel segment for coding AV dialysis access interventions.
2012
INTERVENTIONAL
PA G E
RADIOLOGY
14
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
C AT E G O RY I
• Additional venous catheterization of a side branch off the conduit
(accessory veins) are additionally reported with codes 3 6 0 1 1 or
3 6 0 1 2. If venous catheterization is performed for intervention such as
embolization, separate intervention codes 3 7 2 0 4 and 7 5 8 9 4 may also
be reported.
• Advancement of the catheter into the arterial anastomosis is included in
the work of 3 6 1 4 7.
• Advancement of the catheter beyond the arterial anastomosis is separately
reported with code 3 6 2 1 5.
• Percutaneous transluminal angioplasty (PTA) of a lesion at the arterial
anastomosis is coded with arterial angioplasty codes 3 5 4 7 5 and
7 5 9 6 2 , which would also include any venous outflow angioplasties, if
performed, in the peripheral venous segment (excluding central veins as
above).
L o w e r- e x t r e m i t y E n d o v a s c u l a r R e v a s c u l a r i z a t i o n
The guidelines for lower-extremity endovascular procedure codes
3 7 2 2 0 – 3 7 2 3 5 have been revised to specify that all closure services are
included. Pressure application, an arterial closure device or standard closure
of the puncture site by suture is not separately reportable.
These codes bundle everything required for the intervention into a single
code, including all imaging directly related to the intervention, accessing the
vessel and crossing the lesion by any method, embolic protection if used,
closure of the vessel by any method, moderate sedation, roadmapping and
pressure measurements.
Language to report services for extensive repair or replacement of an artery,
codes 3 5 2 2 6 or 3 5 2 8 6 , has also been added.
Note that a CPT erratum for 2012 has been posted to correct the
parenthetical following the lower-extremity revascularization codes. For
2012
INTERVENTIONAL
PA G E
RADIOLOGY
15
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
C AT E G O RY I
code 3 7 2 2 3, Revascularization, endovascular, open or percutaneous, iliac
artery, each additional ipsilateral iliac vessel; with transluminal stent
placement(s), includes angioplasty within the same vessel, when
performed), the parenthetical instructs the user to report code 3 7 2 2 3 in
conjunction with 3 7 2 2 1, 3 7 2 2 9, 3 7 2 3 1 :
(Code 3 7 2 2 3 may be reported in conjunction with code 3 7 2 2 1 )
Additionally, code 3 7 2 2 9 was added to the parenthetical under code
3 7 2 3 4 ; it now reads:
(Use 3 7 2 3 4 in conjunction with 3 7 2 2 9 , 3 7 2 3 0 , 3 7 2 3 1 )
Renal Angiography (New Codes for 2012)
For 2012, four new CPT codes describing diagnostic renal angiography have
been created. These codes bundle together the previous surgical and S&I
codes that were used to report this service. Therefore, CPT codes 7 5 7 2 2
and 7 5 7 2 4 have been deleted.
The new renal angiography codes, 3 6 2 5 1 – 3 6 2 5 4 , include moderate
sedation, arterial access and catheter placement, contrast injection(s),
fluoroscopy, flush aortogram, image postprocessing, permanent images
recording and radiological supervision and interpretation (RS&I). Therefore,
it is not appropriate to report these services separately.
3 6 2 5 1 Selective catheter placement (first-order), main renal artery and
any accessory renal artery(s) for renal angiography, including arterial
puncture and catheter placement(s), fluoroscopy, contrast injection(s),
image postprocessing, permanent recording of images, radiological
supervision and interpretation, including pressure gradient measurements
when performed, and flush aortogram when performed; unilateral
3 6 2 5 2 bilateral
2012
INTERVENTIONAL
PA G E
RADIOLOGY
16
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
C AT E G O RY I
3 6 2 5 3 Superselective catheter placement (one or more second order or
higher renal artery branches) renal artery and any accessory renal artery(s)
for renal angiography, including arterial puncture, catheterization,
fluoroscopy, contrast injection(s), image postprocessing, permanent
recording of images, and radiologic supervision and interpretation, including
pressure gradient measurements when performed, and flush aortogram
when performed; unilateral
3 6 2 5 4 bilateral
(Do not report 3 6 2 5 4 in conjunction with 3 6 2 5 2 )
Ve n a C a v a F i l t e r Pr o c e d u r e s ( N e w C o d e s f o r 2 0 1 2 )
Three new codes have been created for the reporting of intravascular vena
cava transcatheter procedures. Vascular access, vessel selection,
intraprocedural roadmapping, imaging guidance (including ultrasound and
fluoroscopy) and radiological supervision and interpretation are included in
the work of 3 7 1 9 1, 3 7 1 9 2, and 3 7 1 9 3, and should not be additionally
coded.
CPT codes 3 7 6 2 0 and 7 5 9 4 0 have been deleted. A new code, 3 7 6 1 9 ,
describing open ligation of the IVC, also has been created for 2012.
3 7 1 9 1 Insertion of intravascular vena cava filter, endovascular approach
including vascular access, vessel selection, and radiological supervision and
interpretation (RS&I), intraprocedural roadmapping, and imaging guidance
(ultrasound and fluoroscopy), when performed
(For open surgical interruption of the inferior vena cava through a
laparotomy or retroperitoneal exposure, use 3 7 6 1 9 )
3 7 1 9 2 Repositioning of intravascular vena cava filter, endovascular
approach including vascular access, vessel selection, and radiological
2012
INTERVENTIONAL
PA G E
RADIOLOGY
17
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
C AT E G O RY I
supervision and interpretation (RS&I), intraprocedural roadmapping, and
imaging guidance (ultrasound and fluoroscopy), when performed
(Do not report 3 7 1 9 2 in conjunction with 3 7 1 9 1 )
3 7 1 9 3 Retrieval (removal) of intravascular vena cava filter, endovascular
approach inclusive of vascular access, vessel selection, and all RS&I,
intraprocedural roadmapping, and imaging guidance (ultrasound and
fluoroscopy), when performed
(Do not report 3 7 1 9 3 in conjunction with 3 7 2 0 3, 7 5 9 6 1 )
A b d o m i n a l Pa r a c e n t e s i s ( N e w C o d e s f o r 2 0 1 2 )
New codes have been created to describe abdominal paracentesis
procedures, 4 9 0 8 2 without imaging guidance, 4 9 0 8 3 with imaging
guidance and 4 9 0 8 4 to describe a peritoneal lavage that includes imaging
guidance when performed. Therefore, codes 4 9 0 8 0 – 4 9 0 8 1 have been
deleted. Interventional radiologists primarily use code 4 9 0 8 3, which is
inclusive of imaging.
4 9 0 8 2 Abdominal paracentesis (diagnostic or therapeutic); without
imaging guidance
4 9 0 8 3 with imaging guidance
(Do not report 4 9 0 8 3 in conjunction with 7 6 9 4 2 , 7 7 0 0 2 , 7 7 0 1 2 ,
77021)
As part of the code set, a surgical code also has been created.
4 9 0 8 4 Peritoneal lavage, including imaging guidance, when performed.
77021)
2012
INTERVENTIONAL
PA G E
RADIOLOGY
18
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
DR CODES
NEW DIAGNOSTIC RADIOLOGY CODES FOR 2012
PA I N
MANAGMENT
C TA o f A b d o m e n a n d Pe l v i s ( N e w C o d e f o r 2 0 1 2 )
A new combined code, 7 4 1 7 4, has been created to describe computed
tomographic angiography (CTA) of the abdomen performed in conjunction
with a CTA of the pelvis.
7 5 6 3 5 , 7 6 3 7 6 , and 7 6 3 7 7 )
Code 7 4 1 7 5 will remain to report a CTA abdomen with and without
contrast study and 7 2 1 9 1 will remain to report a CTA pelvis with and
without contrast when studies are performed individually.
P A I N M A N A G E M E N T U P D AT E S
Fa c e t J o i n t N e r v e D e s t r u c t i o n b y N e u r o l y t i c
I n j e c t i o n Pe r N e r v e L e v e l
Four new codes 6 4 6 3 3 , 6 4 6 3 4 , 6 4 6 3 5 , and 6 4 6 3 6 have been
created to more accurately reflect the work and anatomical site involved in
the paravertebral facet joint nerve codes.
Codes 6 4 6 2 2 , 6 4 6 2 3 , 6 4 6 2 6 , and 6 4 6 2 7 have been deleted.
6 4 6 3 3 Destruction by neurolytic agent, paravertebral facet joint nerve(s)
with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet
joint
(For bilateral procedure, report 6 4 6 3 3 with modifier 5 0 )
6 4 6 3 4 cervical or thoracic, each additional facet joint (List separately in
addition to code for primary procedure)
(Use 6 4 6 3 4 in conjunction with 6 4 6 3 3 )
U P D AT E S
2012
INTERVENTIONAL
PA G E
RADIOLOGY
19
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
H O S P I TA L
6 4 6 3 5 lumbar or sacral, single facet joint
(For bilaterial procedure, report 6 4 6 3 5 with modifier 5 0 )
O U T PAT I E N T
PROSPECTIVE
PAY M E N T
SYSTEM
6 4 6 3 6 lumbar or sacral, each additional facet joint (List separately in
addition to code for primary procedure)
(Use 6 4 6 3 6 in conjunction with 6 4 6 3 5 )
(Do not report 6 4 6 3 3 – 6 4 6 3 6 with 7 7 0 0 3 , 7 7 0 1 2 )
Imaging guidance for fluoroscopy and CT, codes 7 7 0 0 3 and 7 7 0 1 2 ,
are not reported separately. Several revisions have been made to the
guidelines for reporting the paravertebral facet joint nerve codes.
Please review these in the CPT 2012 codebook. Code 7 7 0 0 3 has
been revised.
(Do not report 7 7 0 0 3 in conjunction with 2 7 0 9 6 , 6 4 4 7 9 –
64484,64490–64495,64633–64636)
Sacroiliac Joint Injection
Code 2 7 0 9 6 Injection procedure for sacroiliac joint was revised to
include imaging guidance when performed. Code 7 3 5 4 2 has been
deleted. In addition a parenthetical was added indicating to report 2 0 5 5 2
Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s), when
imaging is not performed.
H O S P I T A L O U T P AT I E N T P R O S P E C T I V E P AY M E N T S Y S T E M
As part of the 2012 CMS Final Rule on the Hospital Outpatient Prospective
Payment System (HOPPS), the new 2012 codes that pertain to interventional
radiology have been assigned to Ambulatory Payment Classification
categories. These payments are based on hospital charges. These are:
2012
INTERVENTIONAL
PA G E
RADIOLOGY
20
ONLINE SUPPLEMENT
NEW AND
REVISED
IR CODES
H O S P I TA L
O U T PAT I E N T
CODE &
DESCRIPTOR
49083 Abdominal
paracentesis with
imaging
TYPICAL
PRECEDESSOR
CODES
RINAL RULE APC
ASSIGNMENT
49080 or 49081 0070
with imaging
(Thoracentesis/
(76942 or 77012) Lavage
Procedures)
2012
PAYMENT
RATE
$385.52
PROSPECTIVE
STATUS
PAY M E N T
INDICATOR S Y S T E M
T
36251 Selective
36245 + 75722
catheter placement
for renal angiography,
unilateral
$2,020.94
0279 (Level II
Angiography and
Venography)
Q2
36252 Selective
36245 + 75724
catheter placement
for renal angiography,
bilateral
$2,020.94
0279 (Level II
Angiography and
Venography)
Q2
36253 Superselective catheter
placement for renal
angiography,
unilateral
(36246 or 36247
or 36248) +
75722
$2,020.94
0279 (Level II
Angiography and
Venography)
Q2
36254 Super(36246 or 36247
selective catheter
or 36248) +
placement for renal
75724
angiography, bilateral
$2,020.94
0279 (Level II
Angiography and
Venography)
Q2
37191 Insertion of
intravascular vena
cava filter
37620 + 75940 + 0091 (Level II
(76942 or 77002) Vascular
Ligation)
37192 Repositioning
of intravascular vena
cava filter
$2,125.03
37203 + 36010 + 0623 (Level III
75825 + 75961 + Vascular Access
76937
Procedures)
37193 Retrieval
(removal) of
intravascular vena
cava filter
$2,125.03
37203 + 36010 + 0623 (Level III
75825 + 75961 + Vascular Access
76937
Procedures)
$3,096.61
T
T
T
2012
INTERVENTIONAL
PA G E
RADIOLOGY
21
ONLINE SUPPLEMENT
FA Q S
Frequently Asked
Questions
FA Q 1 How do I report imaging and catheterization of a
horseshoe kidney?
The horseshoe kidney is two kidneys that have fused. There may be five or
more renal arteries in this situation.
For coding purposes, if both the right and left halves are studied, a
horseshoe kidney is coded using the bilateral code 3 6 2 5 2. The unilateral
code 3 6 2 5 1 would be reported if only the right or the left half is studied.
FA Q 2 How do I code a vena cava filter retrieval when multiple
venous access sites are utilized? For example, attempts to retrieve
the filter are performed via the right internal jugular vein; however,
the apex of the filter cannot be snared secondary to tilt. Therefore,
the right common femoral vein is accessed, sheath placed, and
10mm balloon is placed to realign the filter in order to successfully
snare the filter from the right internal jugular access.
Report CPT code 3 7 1 9 3 for an intravascular vena cava (IVC) filter
retrieval when multiple venous access sites are utilized. This is similar to the
repositioning required at the time of the initial placement when only CPT
3 7 1 9 1 is reported. The repositioning code, 3 7 1 9 2, is intended for the
purpose of repositioning in a setting separate from filter placement or
removal.
2012
INTERVENTIONAL
PA G E
RADIOLOGY
22
ONLINE SUPPLEMENT
FA Q S
FA Q 3 How are selective catheterizations of the renal veins to
further detail anatomy for appropriate IVC filter placement coded?
Selective catheterizations of the renal veins to further detail anatomy for
appropriate intravascular vena cava filter placement is reported using CPT
code 3 7 1 9 1. Vascular access and vessel selection are included in code
3 7 1 9 1.
FA Q 4 What code should be reported to describe the placement
of IVC filters when placed in a duplicated inferior vena cava?
Report code CPT 3 7 1 9 1 twice to describe the placement of two vena
cava filters in a duplicate inferior vena cava system. Use modifier 5 9 with
the second code to denote to the payer this is a separate and distinct study
and to ensure appropriate reimbursement.
FA Q 5 Patient presented with hypotension and hematuria status
postpercutaneous kidney biopsy for bilateral solid mass lesions.
Bilateral main renal artery selective catheterizations were
performed, which revealed an arteriovenous fistula (AVF) in a
superior pole branch of the right renal artery. Superselective
catheterization of the superior pole branch was performed followed
by embolization of this branch. What code(s) should be reported to
describe the catheterization of bilateral renal arteries when only
one side was superselective?
Codes 3 6 2 5 1 and 3 6 2 5 3 should be reported to describe the bilateral
catheterization of the renal arteries, when only one kidney is superselective
catheterized as well as CPT codes 3 7 2 0 4 , 7 5 8 9 4 , 7 5 8 9 8 for the
transcatheter embolization.
2012
INTERVENTIONAL
PA G E
RADIOLOGY
23
ONLINE SUPPLEMENT
FA Q S
FA Q 6 A patient presents with poor right upper arm dialysis
graft function. Accesses towards the arterial and venous
anastomoses are obtained and an arteriovenous fistulogram is
performed. To further examine arterial inflow, a 5-French angleglide catheter is advanced beyond the arterial anastomosis and
angiogram is performed of the arterial inflow. Is the catheterization
of the native artery considered a part of the initial access code
36147?
In this scenario, because the catheter is advanced beyond the arterial
anastomosis, the selective catheterization of the native artery is reported
separately. It is appropriate to report code 3 6 2 1 5 for selective
catheterization of the upper extremity or 3 6 2 4 5 for selective
catheterization of the lower extremity in addition to CPT codes 3 6 1 4 7
and 3 6 1 4 8 .
FA Q 7 A patient presents with increased pulsatility of a right
upper arm arteriovenous fistula. Fistula access towards the venous
outflow is obtained and fistulogram is performed revealing superior
vena cava (SVC) stenosis. The size of the balloon needed to treat
this lesion requires a sheath too large to safely place into the
current fistula access. Subsequently, access into the right internal
jugular vein is achieved and superior vena cava angioplasty is
performed. How should this be coded?
It is appropriate to report CPT code 3 6 0 1 0 in addition to CPT 3 6 1 4 7
in this scenario to account for catheter or device placement into the SVC
since it is via a separate access site, as well as the CPT codes for venous
angioplasty, 3 5 4 7 6 and 7 5 9 7 8. A modifier may be necessary to indicate
to the payer that a distinct procedure was performed.
2012
INTERVENTIONAL
PA G E
RADIOLOGY
24
ONLINE SUPPLEMENT
FA Q S
FA Q 8 Through two separate arteriovenous fistula or graft
accesses, a physician diagnosed and treated two different
obstructions—one at the arterial anastomosis and one in the
subclavian vein. Is this reported with two percutaneous
transluminal angioplasties (PTAs)—one arterial and one venous—
or only a venous PTA? For coding purposes, where is the transition
between artery and vein in an arteriovenous dialysis access?
Extensive new guidance is provided in the CPT 2012 code book that
addresses diagnostic studies of arteriovenous (AV) shunts for dialysis. This
language is inserted prior to CPT code 3 6 1 4 7. This represents a change in
CPT coding advice and a changing definition for what is considered the
arterial anastomosis. CPT now recommends the use of arterial PTA codes for
treatment of a lesion that involves that segment of vessel immediately
proximal to, at and just distal to the arterial anastomosis.
For coding purposes, the arterial anastomosis and immediate perianastomotic region of a hemodialysis AV dialysis access are considered to be
the arterial portion of the fistula. Any lesion that involves the arterial
anastomosis is considered to be arterial, including those that extend into the
native artery and/or into the vein/graft. The region of the hemodialysis
fistula beyond the immediate peri-anastomotic arterial anastomosis through
the axillary/cephalic vein is defined as the venous portion of the AV dialysis
access. The subclavian vein, innominate vein and SVC are treated as a
separate venous segment for coding purposes.
For the purposes of AV access interventions, the AV access is divided into
two vessel segments. All balloon angioplasty of the AV dialysis access within
one of these two venous segments is coded with one set of angioplasty
codes, no matter how many focal stenoses are treated within the AV dialysis
circuit. The majority of the time, this is a venous angioplasty code and would
2012
INTERVENTIONAL
PA G E
RADIOLOGY
25
ONLINE SUPPLEMENT
FA Q S
be reported using 3 5 4 7 6 and 7 5 9 7 8. However, as in this case, if the
stenosis in the AV fistula or graft that is treated is at the arterial anastomosis,
it may be coded with arterial angioplasty codes 3 5 4 7 5 and 7 5 9 6 2. This
code would then apply to all other stenoses treated within the peripheral AV
shunt “vessel.” In other words, all angioplasty within the peripheral vessel
segment of the AV dialysis circuit (considered from the perianastomotic
vessels near the arterial anastomosis through the axillary vein) would be
coded with either 3 5 4 7 5 and 7 5 9 6 2 or 3 5 4 7 6 and 7 5 9 7 8 . The
appropriate code is chosen on the basis of whether a true arterial
anastomotic stenosis is treated.
Removal of the arterial “plug” occlusion is never coded as a PTA, as it is
considered to be part of the thrombectomy (coded 3 6 8 7 0 ), not as
treatment of an arterial stenosis with angioplasty. In addition, in this case,
the angioplasty of a separate subclavian vein stenosis is reported using CPT
codes 3 5 4 7 6 and 7 5 9 7 8. All lesions treated in the central veins beyond
the axillary venous segment would be coded as a single venous angioplasty,
irrespective of how many focal lesions are treated. For therapeutic
purposes, the fistula or graft “vessel” is defined as being from the arterial
anastomosis through the venous anastomosis, as well as the outflow vein,
but not including the subclavian vein. Therefore, venous angioplasty of a
central vessel (e.g subclavian vein) is appropriately reported in addition to
the angioplasty of the fistula or graft itself. The clinical indication for
treatment of these lesions should be clearly documented in the medical
record.
Please note that there are National Correct Coding Initiative (NCCI) edits for
the reporting of CPT codes 3 5 4 7 5 and 3 5 4 7 6 for procedures
performed on the same day of service. A modifier (e.g., 5 9 ) must be used to
ensure appropriate reimbursement.
2012
INTERVENTIONAL
PA G E
RADIOLOGY
26
ONLINE SUPPLEMENT
SAMPLE
LETTERS
individual coverage
request sample letters
The following are examples of a few common coverage request letters.
The examples include letters for coverage for radiofrequency ablation of
pulmonary tumor(s), ovarian vein embolization for pelvic congestion
syndrome and MRI imaging of the uterus prior to uterine fibroid
embolization. These templates include data, arguments for need and benefit
and can save you considerable work
P E R C U TA N E O U S R A D I O F R E Q U E N C Y
A B L AT I O N O F P U L M O N A R Y T U M O R ( S )
[DATE ]
[CARRIER MEDICAL DIRECTOR ]
[COVERAGE RECONSIDERATION DEPARTMENT ]
[CARRIER NAME ]
[CARRIER ADDRESS ]
[CARRIER CITY, STATE ZIP ]
RE: [PATIENT NAME ]
[PATIENT ID ]
Request for coverage for Percutaneous Radiofrequency Ablation (RFA) of
Pulmonary Tumor(s)
[CARRIER MEDICAL DIRECTOR ]:
On [INSERT DATE OF PRECERTIFICATION/COVERAGE REQUEST DENIAL ], notice
was received from your company that radiofrequency ablation (RFA) of
pulmonary tumor(s) is considered experimental and investigational, and,
2012
INTERVENTIONAL
PA G E
RADIOLOGY
27
ONLINE SUPPLEMENT
SAMPLE
LETTERS
therefore, a noncovered service. This is a formal request for individual
consideration to extend coverage for RFA of pulmonary tumor(s) for
[PATIENT NAME ], who has been diagnosed with [INSERT DIAGNOSIS: lung
cancer, lung metastases, lung malignancies, including stage ].
[PATIENT NAME ] has been seen and evaluated by a [SELECT REFERRING
PHYSICIAN TYPE: thoracic surgeon/oncologist/oncology physician team ] who
[is/are ] in agreement that pulmonary tumor RFA is the best treatment option
for [PATIENT NAME ] at this time.
[PATIENT NAME ] is not alone in suffering from [INSERT CONDITION: lung cancer,
lung metastases, lung malignancies, including stage ]. Lung cancer kills more
Americans than any other type of malignancy. The disease kills some
160,000 Americans a year—more than breast cancer, colon cancer and
prostate cancer combined.
Pulmonary Tumor RFA Is Safe and Effective
The Society of Interventional Radiology “finds that RFA of pulmonary
tumor(s) is a safe and effective treatment for a subset of patients with
metastases to the lung, and patients with primary lung malignancies who are
poor surgical candidates or refuse resection. In addition to tumor
eradication, radiofrequency ablation is used to ‘debulk’ or reduce lung
tumor increasing the effectiveness of adjunctive chemo- and/or radiation
therapy or as a stand-alone treatment after failed conventional therapy for
chest wall pain palliation.”
Pulmonary tumor RFA has been shown to be an effective palliative therapy
providing tumor control and pain relief. In order to provide an appropriate
framework in which to accurately evaluate the efficacy of pulmonary RFA,
we provide background information regarding traditional treatments.
2012
INTERVENTIONAL
PA G E
RADIOLOGY
28
ONLINE SUPPLEMENT
SAMPLE
LETTERS
Life Expectancy, Rate of Tumor Growth and Tumor Control, for Lung
Cancer Patients. Life expectancies for lung cancer patients vary according
to the stage and overall health of the patient. For patients with metastases to
the lung, nodule size typically doubles in 2–10 months. The rate of lung
cancer spread varies greatly with each individual and cell type. However,
tumor growth is typically seen over a few months and may result in the
patient’s demise. For stage IV NSCLC patients, those “who do not receive
any treatment live for an average of four months and approximately 5–10%
remain alive one year from diagnosis.” For those patient receiving
chemotherapy, the “average duration of patients’ survival was similar for all
four [chemotherapy] treatment regimens and was between seven and eight
months.”
http://patient.cancerconsultants.com/lung_cancer_treatment.aspx?id=805
Typically, the only cure for lung cancer is surgical removal of the tumor(s).
Typically, surgical intervention is only considered for stage I and II patients,
with stage III patients occasionally found to be viable candidates. Surgery is
rarely considered a treatment option for stage IV patients. The majority of
lung cancer patients are found to have advanced disease at the time of initial
diagnosis and are not considered viable surgical candidates. Even for those
treated surgically, recurrence rates are quite high. The American Cancer
Association does not present surgery as a definitive cure but rather advises
that surgery “may cure lung cancer.” Historically, the surgical options
offered are local wedge resection, lobectomy and pneumonectomy, several
of which have been in use for well over a century.
According to the National Cancer Institute (NCI), the efficacy of traditional
surgical treatments for lung cancer is equivalent to the odds associated with
tossing a coin: according to one study, recurrence rates are as high as 50%
for stage I patients treated with wedge or segment resection. Per the NCI,
the mortality rate for lobectomy is 3–5% and according to the Southern
2012
INTERVENTIONAL
PA G E
RADIOLOGY
29
ONLINE SUPPLEMENT
SAMPLE
LETTERS
Illinois University Division of Cardiothoracic Surgery, a provider of these
services, a thoracotomy incision is considered to be “one of the more
painful incisions.” Recovery time after these invasive surgical treatments is
substantial with at least a two-day stay in the Intensive Care Unit (ICU), and
a total hospital stay of 5–10 days after lung resection. Chemotherapy and
radiation can be considered as adjunctive therapies to surgical intervention.
These techniques cannot be given earlier than 8 weeks after surgery since
they may interfere with the body’s ability to heal.
At this time, just as with traditional invasive surgical treatments, it is not
known whether pulmonary RFA is a definitive “cure” for lung cancer.
However, as adeptly stated by the Radiological Society of North America,
“RFA is a relatively quick procedure that does not require general
anesthesia. Recovery is rapid so that chemotherapy may be resumed almost
immediately. Even when RFA does not remove all of a tumor, a reduction in
the total amount of tumor may extend life for a significant time.”
Control and Comfort
It is generally accepted that tumor control results in increased life
expectancy for patients with lung cancer. The FDA defines an “effective”
drug [treatment] as one that achieves a 50% or more reduction in tumor size
for 28 days. At this time, the focus of RFA is tumor control and at this time
there are numerous studies that support that RFA is effective in tumor
control. Tumor control is also commonly associated with relief of symptoms,
providing patients with an increased quality of life.
Body of Scientific Literature Supporting RFA of Pulmonary Tumor(s)
As an Effective Treatment
Studies show that patients who have pulmonary tumor(s) treated with RFA
experience reduction and, in many instances, complete eradication of
2012
INTERVENTIONAL
PA G E
RADIOLOGY
30
ONLINE SUPPLEMENT
SAMPLE
LETTERS
tumor(s). This is believed to extend life expectancy and/or result in
increased comfort. Please see “Attachment A” for a list of supporting
scientific literature for radiofrequency ablation of pulmonary tumor(s). Also,
enclosed is a table (see Attachment B) summarizing the scientific articles
available supporting RFA as an effective treatment.
Proposed Treatment Plan for [INSERT PATIENT NAME ]
In this procedure, the interventional radiologist guides a small needle
through the skin into the tumor. Radiofrequency energy is transmitted to the
tip of the needle, where it produces heat in the tissues. The tumor tissue
shrinks and slowly forms a scar. It is ideal for nonsurgical candidates and
those with smaller tumors.
Once a patient such as [PATIENT NAME ] has been diagnosed with [INSERT
CONDITION—lung cancer, lung metastases, lung malignancies—including stage ], it is
imperative to implement treatment as quickly as possible. Depending on the
size of the tumor, RFA can reduce the size and often completely eradicate
the tumor. By decreasing the size of a large mass, or treating new tumors in
the lung as they arise, the pain and other debilitating symptoms caused by
the tumors are often relieved. While the tumors themselves may not be
painful, they can cause mass affect on nerves or vital organs, eliciting pain.
I respectfully request that you extend coverage to [PATIENT NAME ] for
pulmonary tumor RFA. I hope you have found this information helpful in
support of [reversing the previous denial authorizing coverage] for this
procedure. Please feel free to contact me if you require any further
information.
Sincerely,
[SIR/ACR MEMBER NAME ], MD
CC: [PATIENT NAME ]
[STATE INSURANCE COMMISSIONER ]
2012
INTERVENTIONAL
PA G E
RADIOLOGY
31
ONLINE SUPPLEMENT
SAMPLE
LETTERS
O VA R I A N V E I N E M B O L I Z AT I O N ( O V E ) T O T R E AT
P E LV I C C O N G E S T I O N S Y N D R O M E ( P C S )
[DATE ]
[CARRIER MEDICAL DIRECTOR ]
[COVERAGE RECONSIDERATION DEPARTMENT ]
[CARRIER NAME ]
[CARRIER ADDRESS ]
[CARRIER CITY, STATE ZIP ]
RE: [PATIENT NAME ]
[PATIENT ID ]
Request for coverage for Ovarian Vein Embolization (OVE) to treat Pelvic
Congestion Syndrome (PCS)
[CARRIER MEDICAL DIRECTOR ]:
On [INSERT DATE OF PRECERTIFICATION/COVERAGE REQUEST DENIAL ], notice
was received from your company that ovarian vein embolization (OVE) is
considered experimental and investigational and therefore, a noncovered
service. This is a formal request for individual consideration to extend
coverage for OVE for [PATIENT NAME ], who is believed to be suffering from
pelvic congestion syndrome (PCS).
[PATIENT NAME ] has presented with symptoms consistent with pelvic
congestion syndrome, which is a well defined condition. She has been seen
by a vascular medicine physician, [VASCULAR MEDICINE PHYSICIAN NAME ],
MD. Both Dr. [VASCULAR MEDICINE PHYSICIAN NAME ] and my findings are
consistent; confirming that [PATIENT NAME ] has had recurrent varicose veins
in the lower extremity(ies). Additionally, [LIST RELEVANT DIAGNOSTIC
STUDY(IES). FOR EXAMPLE: an MR venogram of the pelvis shows large ovarian and
2012
INTERVENTIONAL
PA G E
RADIOLOGY
32
ONLINE SUPPLEMENT
SAMPLE
LETTERS
pelvic veins, and an ultrasound of the pelvis has been performed, which
demonstrated enlarged pelvic varicosities, more prominent on the left than the right.
Reflux was noted in the left greater saphenous vein as well ]
supporting a
diagnosis of PCS for this patient. OVE has been found to be an effective
minimally invasive procedure to treat the symptoms of PCS and is
recommended for this patient.
PCS Symptoms
[PATIENT NAME ] is not alone in suffering with the symptoms of PCS. It has
been estimated that almost 40% of all women will experience chronic pelvic
pain during their lifetime and that 15% of all women between the ages of
18–50 experience chronic pelvic pain. Of note, 15% of all hysterectomies
and 35% of all diagnostic laparoscopies are performed due to chronic pelvic
pain. Ovarian vein incompetence has been shown to occur in approximately
10% of women. This phenomenon can lead to PCS and its associated
symptoms in 60% of these patients. Despite this incidence, PCS is
significantly under-diagnosed. It typically results in pelvic pain that is often
described as dull and aching. The pain is typically worse in an upright
position and becomes more severe with walking and postural changes. It
may be associated with dyspareunia or a postcoital ache.
These symptoms of pelvic congestion syndrome (PCS) are typically caused
by the development of varicosities in the infundibulopelvic and broad
ligaments within the pelvis. The exact reason why these varicosities develop
is unknown, but one important factor is the absence or incompetence of
valves in the ovarian veins. It is felt that there is an anatomic component to
this as well, since reflux occurs more often on the left than the right. This
may be due to the fact that veins are absent more often on the left than the
right, but is also likely due to the fact that the left ovarian vein drains into
the left renal vein before draining into the inferior vena cava, while the right
ovarian vein drains directly into the inferior vena cava. This is why
2012
INTERVENTIONAL
PA G E
RADIOLOGY
33
ONLINE SUPPLEMENT
SAMPLE
LETTERS
symptoms are often more common or more severe on the left side than the
right, which is what we are seeing with [PATIENT NAME ]. A hormonal
component is also felt to contribute to the development of PCS as well
since it mainly affects premenopausal women. The pain associated with PCS
has been directly attributed to the presence of these dilated veins within
the pelvis.
OVE Treatment Plan for PCS
Once a patient such as [PATIENT NAME ] has been diagnosed with PCS, it is
important to direct treatment towards eliminating retrograde flow in the
abnormal ovarian vein(s). This reduces pressure in the pelvic veins which
eliminates the development of these varicosities and the pain that they
cause. This can all be accomplished with the use of ovarian vein
embolization (OVE), which is a percutaneous, catheter-based procedure that
results in occlusion of the abnormal ovarian vein(s). For the past 15 years,
this treatment has been associated with good clinical outcomes in most
women suffering from the symptoms of PCS. Currently, this procedure is
technically successful in almost 100% of patients. Symptomatic
improvement tends to be seen in >80% of patients undergoing OVE. Specific
data includes that reported in 2006 by Kim, et al who found an 83% success
rate in 127 patients treated with OVE. This particular study reported results
after 4-year follow-up. Kwon, et al also reported data in 2007 that described
symptomatic improvement in 82% of 67 patients treated with OVE. In 2002,
Venbrux, et al reported symptomatic improvement in 96% of the 56 patients
12 months after being treated with OVE. Other reports by Mowatt, et al,
Capasso, et al, Sichlar, et al, Tarazov, et al, Maleux, et al, and Cordts, et al have
reported similar data to the studies outlined above.
The OVE treatment plan includes an ovarian venogram to confirm that
retrograde flow is present in the ovarian veins. If reflux and retrograde flow
is identified within the left and/or right ovarian vein, then one would
2012
INTERVENTIONAL
PA G E
RADIOLOGY
34
ONLINE SUPPLEMENT
SAMPLE
LETTERS
proceed with embolization of the abnormal vein to eliminate this reflux and
reduce the pressure within these pelvic varicosities. This procedure would
be performed on an [OUTPATIENT/INPATIENT ] basis.
Patient’s Medical History Consistent With Varicose Veins of the
Lower Extremity(ies)/Pelvis Otherwise Known As “PCS”
A review of [PATIENT NAME ]’s medical history finds that she had [LIST
RELEVANT FINDINGS SPECIFIC TO THE PATIENT’S HISTORY. FOR EXAMPLE: recurrent
varicose veins following a vein stripping of her right leg. She had also developed
labial varicosities with her first pregnancy and then with her second pregnancy the
labial varicosities had markedly increased. She has also had increasing right varicose
veins. ]
Patient’s Current Symptoms Are Typical of Pelvic Congestion
Syndrome
[PATIENT NAME ]’s current symptoms are typical of PCS. The patient is
experiencing extreme heaviness and discomfort in her pelvis with standing
and also following sexual intercourse. Her pelvic discomfort is least in the
morning and worsens during the day as she is standing. Her symptoms are
very typical for ovarian vein reflux or potentially reflux into the internal
iliac veins. PCS is initially caused by reflux into the ovarian vein, which then
causes increased flow and pressure in the pelvic veins and causes severe
pain in the pelvis. This is exactly the same as with varicoceles that are found
in men.
Body of Scientific Literature Supporting OVE As an Effective
Treatment for PCS
Attached is a comprehensive listing of the scientific literature available that
supports OVE as an effective treatment for PCS (see Attachment A). Also
2012
INTERVENTIONAL
PA G E
RADIOLOGY
35
ONLINE SUPPLEMENT
SAMPLE
LETTERS
enclosed is a table (see Attachment B) summarizing the scientific articles
available supporting ovarian vein embolization as an effective treatment for
PCS; many of these articles support that in many patients embolization of
other pelvic veins may be required in addition to the OVE.
To deny the existence of PCS contradicts these multiple articles. Tubal
ovarian varices were described in the 1950s. The association between pelvic
pain and varicosities was first described in 1928 and again in 1949. The
association of these pelvic varicosities with PCS was described in 1964. In a
1984 study of laparoscopic and venographic studies in woman with
unexplained chronic pelvic pain, 91% of them were found to have marked
pelvic venous congestion. In 2002, a study examining incompetent ovarian
veins demonstrated that with ligation of these veins 54% of them had
resolution of their pelvic pain with improvement in 23%. There has been
increasing recognition of this problem with multiple articles including a
study from Korea where patients with documented pelvic congestion
syndrome were randomized to hysterectomy (with either oopherectomy of
ovary on the side of an incomplete gondal vein or bilateral oopherectomy)
and OVE. OVE demonstrated significantly better results than surgery.To deny
the existence of PCS contradicts these multiple articles. Tubal ovarian
varices were described in the 1950s. The association between pelvic pain
and varicosities was first described in 1928 and again in 1949. The
association of these pelvic varicosities with PCS was described in 1964. In a
1984 study of laparoscopic and venographic studies in woman with
unexplained chronic pelvic pain, 91% of them were found to have marked
pelvic venous congestion. In 2002, a study examining incompetent ovarian
veins demonstrated that with ligation of these veins 54% of them had
resolution of their pelvic pain with improvement in 23%. There has been
increasing recognition of this problem with multiple articles including a
study from Korea where patients with documented pelvic congestion
syndrome were randomized to hysterectomy (with either oopherectomy of
2012
INTERVENTIONAL
PA G E
RADIOLOGY
36
ONLINE SUPPLEMENT
SAMPLE
LETTERS
ovary on the side of an incomplete gondal vein or bilateral oopherectomy)
and OVE. OVE demonstrated significantly better results than surgery.
Equitable Coverage Sought for Equivalent Treatments for
Comparable Syndromes Found in Men and Women
Varicose veins in the testicle of men is called varicoceles. Varicose veins of
the uterus and pelvis of women is called pelvic congestion syndrome. These
are comparable syndromes suffered by men and women. Your company will
authorize coverage for testicular vein embolization to treat varicoceles in
men. Yet, you are currently denying coverage for the equivalent treatment
for the comparable syndrome (ovarian vein embolization for pelvic
congestion syndrome) found in women. It is incomprehensible that men are
allowed to undergo a procedure to cure their problem and that this same
procedure, used to treat an equivalent syndrome, is denied for women. Your
reversal of this inappropriate determination is respectfully requested. Please
extend coverage [PATIENT NAME ] for ovarian vein embolization to treat
pelvic congestion syndrome.
I hope that you will find this information helpful in reversing the previous
denial [FOR PREAUTHORIZATION/OF COVERAGE ]. Please feel free to contact me
if you require any further information.
Sincerely,
[SIR/ACR MEMBER NAME ], MD
[SIR/ACR MEMBER TITLE ]
CC: [PATIENT NAME ]
[STATE INSURANCE COMMISSIONER ]
2012
INTERVENTIONAL
PA G E
RADIOLOGY
37
ONLINE SUPPLEMENT
SAMPLE
LETTERS
M R I O F T H E P E LV I S F O R U F E
To Whom It May Concern:
I am writing this letter to appeal your decision to deny coverage for an MRI
of the pelvis for [PATIENT NAME ], (DOB: [INSERT DATE OF BIRTH ]; [PATIENT ID ])
prior to a uterine artery embolization (UAE) procedure to treat symptomatic
uterine fibroids.
As you know, UAE is a uterine-sparing procedure that effectively treats the
symptoms associated with uterine fibroids and reduces both uterine and
fibroid volume due to fibroid infarction. Prior to UAE, the interventional
radiologist performing the procedure needs to be certain that the procedure
is being performed for an appropriate indication. When fibroids were
treated exclusively with hysterectomy, pre-procedure imaging was not
critical to gynecologists because the uterus, in its entirety, was being
removed. As a result, a pathologic evaluation performed on the uterus after
surgery was the primary means of determining the etiology of the
presenting symptoms. Uterine artery embolization is different. Since the
uterus is remaining in its anatomic position and the fibroids are not being
removed, it becomes incumbent upon the physician responsible for
performing this procedure to obtain definitive imaging of the pelvis prior to
the procedure.
The standard imaging modality used to evaluate patients with suspected
uterine fibroids is ultrasound. In fact, almost all patients presenting in
consultation for UAE have been evaluated previously with a pelvic
ultrasound that has demonstrated fibroids. While ultrasound is certainly a
good test to evaluate patients for fibroids, it is an operator-dependent
imaging modality that has recognized limitations when it comes to
evaluating patients specifically for UAE. Omary, et al (J Vasc Interv Radiol
2002; 13:1149–1153) evaluated the importance of imaging prior to UAE and
2012
INTERVENTIONAL
PA G E
RADIOLOGY
38
ONLINE SUPPLEMENT
SAMPLE
LETTERS
recommended that MRI be considered in all patients prior to this
procedure. They did this by evaluating the diagnostic confidence and
anticipated treatment plan both before and after performance of a pelvic
MRI. They found that MRI significantly increased diagnostic confidence. In
addition, they found that MRI changed the initial diagnosis in 18% of
patients and the immediate clinical management in 22% of patients. Overall,
19% of women who were anticipated to undergo UAE prior MRI did not
undergo that procedure as a result of the findings on MRI, which most often
included abnormalities other than fibroids.
MRI has also been shown to potentially predict the response to UAE and can
therefore be helpful with patient selection for this procedure. An MRI can
accurately determine the location and size of fibroids within the uterus. As
described by Cura, et al (Acta Radiol 2006; 47:1105–1114), UAE may not be
the appropriate therapy if a patient’s symptoms do not correlate with the
size and location of their fibroids. For example, a small subserosal fibroid is
not likely to be responsible for abnormal bleeding so UAE may not be
indicated in this particular type of patient. In addition, MRI is helpful in
differentiating degenerated fibroids from cellular fibroids, which is
important since cellular fibroids typically have the best response to UAE.
Cellular fibroids have characteristic MRI findings with high signal intensity
on T2 weighted images and enhancement after contrast administration
(Yamashita, et al, Radiology 1993; 189:721–725) so fibroids with these
characteristics may be expected to respond best to UAE. This has been
supported by Burn, et al (Radiology 2000; 214:729–734), who reported on
the good response of fibroids with high signal intensity on T2-weighted
images, and by Jha, et al (Radiology 2000; 217:228–235), who reported that
hypervascular fibroids which enhanced after contrast administration had a
greater response to UAE. Therefore, an MRI can help determine which
patients are appropriate candidates for UAE on the basis of size, location,
2012
INTERVENTIONAL
PA G E
RADIOLOGY
39
ONLINE SUPPLEMENT
SAMPLE
LETTERS
signal characteristics and degree of enhancement after contrast
administration.
The findings on MRI can also help determine if vessels other than the
uterine arteries provide arterial supply to the fibroids. Kroencke, et al
(Radiology 2006; 241:181–189) determined that contrast-enhanced MRI can
help predict the presence of ovarian arterial supply to uterine fibroids. This
information is important to have prior to UAE because if these vessels are
not recognized, the ability of this procedure to induce infarction within the
treated fibroids becomes significantly limited. In addition, knowing that
ovarian arteries may need to be treated during a UAE procedure is
something that is important to discuss with a patient prior to UAE since
treating these vessels could increase the possibility of post-procedure
amenorrhea.
Finally, MRI is very helpful in determining if patients are potentially at risk
for complications after UAE. For example, pedunculated submucosal fibroids
are potentially at risk for transcervical expulsion or infection and
pedunculated subserosal fibroids can potentially separate from the uterus
and result in intraperitoneal complications. Pelvic MRI is able to define the
morphology of pedunculated fibroids far better than ultrasound and
therefore help determine which patients are potentially at risk for these
complications. This was well described by Verma, et al (AJR 2008;
190:1220–1226) who reported on the utility of MRI in defining the interface
between pedunculated submucosal fibroids and the endometrium. They
found that this helps define the risk of fibroid migration into the
endometrial cavity with subsequent transcervical expulsion after UAE.
In summary, an MRI of the pelvis provides the information that is necessary
for an interventional radiologist to determine if a patient with symptomatic
uterine fibroids is a suitable candidate for uterine artery embolization. It can
potentially provide information regarding the cellular morphology of
2012
INTERVENTIONAL
PA G E
RADIOLOGY
40
ONLINE SUPPLEMENT
SAMPLE
LETTERS
fibroids, the presence or absence of other pathology that could explain a
patient’s symptoms, the contribution of other blood vessels responsible for
the arterial supply of fibroids, and the potential risk of complications
associated with pedunculated fibroids. As a result, MRI has been shown to
potentially change the treatment plan in a significant number of patients,
underscoring its importance as a pre-procedure imaging test. It is my hope
that this information will help support a reversal of your decision to deny
coverage to [PATIENT NAME ] for an MRI of the pelvis prior to her planned
uterine artery embolization procedure.
2012
INTERVENTIONAL
PA G E
RADIOLOGY
41
ONLINE SUPPLEMENT
SAMPLE
CHARGE
SHEETS
sample 2012
charge sheets
Find the updated 2012 interventional radiology coding charge sheets at
http://members.SIRweb.org/members/coding/chargeSheets.cfm
www.acr.org/codingpubs.
PATIENT:
DATE:
PROCEDURE:
REFERRING PHYSICIAN:
INTERVENTIONAL RADIOLOGIST:
TRANSLUMINAL ANGIOPLASTY/STENT/ ATHERECTOMY CHARGE SHEET
MCS-Moderate Conscious Sedation Indicator @: Do NOT additionally report Moderate Conscious Sedation codes in conjunction with these services.
Valuation for codes with @ in the MCS indicator column includes the physician work for conscious sedation.
MCS
Procedure
code
S&I
Code
@
@
@
@
@
@
@
@
@
@
@
@
@
@
@
37220
37221
37222
37223
37224
37225
37226
37227
37228
37229
37230
37231
37232
37233
37234
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
@
37235
N/A
Renal artery
Visceral artery (except renal) each vessel
Abdominal aorta
Brachiociphalic trunk and branches, each vessel
Illicac artery, each vessel
0234T
0235T
0236T
0237T
0237T
N/A
N/A
N/A
N/A
N/A
Endovascular repair of iliac artery bifurcation using a bifurcated external and
internal iliac artery
0254T
0255T
Intravascular Stents Extracranial Vertebral/Intrathoracic Carotid
includes all ipsilateral selective cath, target vessel angiography
Intravascular Stent, perc; initial vessel
Intravascular Stent, perc; each addl. vessel
0075T
0076T
N/A
N/A
(x)
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY/STENT/ATHERECTOMY*
PTA, Iliac Artery, unilateral
Stent, Iliac, with PTA when performed, unilateral
PTA, each add'l illiac vessel, unilateral
Stent, Iliac, with PTA when performed, ea add'l vessel, unilateral
PTA, Femoral/Popliteal Arteries, unilateral
Atherectomy, Femoral/Popliteal, with PTA when performed, unilateral
Stent, Femoral/Popliteal, with PTA when performed, unilateral
Stent and Atherectomy, Femoral/Polpiteal, with PTA when performed, unilateral
PTA, Tibial/Peroneal Artery, unilateral
Atherectomy, Tibial/Peroneal, with PTA when performed, unilateral
Stent, Tibial /Peroneal, with PTA when performed, unilateral
Stent and Atherectomy, Tibial/Peroneal, with PTA when performed, unilateral
PTA, Tibial/Peroneal, each add'l vessel, unilateral
Atherectomy, Tibial/Peroneal, with PTA when performed, each add'l vessel, unilateral
Stent, Tibial /Peroneal, with PTA when performed, each add'l vessel, unilateral
Stent and Atherectomy, Tibial/Peroneal, with PTA when performed, each add'l
vessel, unilateral
(x) MCS
Procedure
Code
Category III codes effective Jan 1, 2011 to describe transluminal
peripheral atherectomy above Inguinal ligaments percutaneously and/or
though open surgical exposure (includes RS&I)
PRESENTING PROBLEM(S)/DIAGNOSIS
Dx 1: __________________
Dx 2 :_________________
CPT Only copyright 2011 American Medical Association. All Rights Reserved.
ICD-9: _____
ICD-9: _____
Copyright 2011, Society of Interventional Radiology. All Rights Reserved.
S&I
Code
PATIENT:
DATE:
PROCEDURE:
VASCULAR DIAGNOSTIC CHARGE SHEET
SELECTIVE VASCULAR CATHETERIZATIONS
ARTERIAL VASCULAR FAMILY
(X)
Rt Brachiocephalic (Right Carotid/Subclavian)
Left Carotid
Left Subclavian
Other Thoracic Aorta Vascular Family
Celiac
SMA
IMA
Renal, Unilateral
Renal, Bilateral
IIiac, Ipsilateral
Common IIiac, Contralateral
Common Femoral, Ipsilateral
Common Femoral, Contralateral
Other Abdominal Aorta Vascular Family
Right Heart or Pulmonary Trunk Only
Left Pulmonary (includes pressures)
Right Pulmonary (includes pressures)
@
@
@
@
@
@
@
@
@
@
Each Add'l 2nd
1st
Order
(X)
36215
36215
36215
36215
36245
36245
36245
36251
36252
36245
36245
36245
N/A
36245
36013
N/A
N/A
2nd
Order*
36216
36216
36216
36216
36246
36246
36246
36253
36254
36246
36246
36246
36246
36246
N/A
36014
36014
VENOUS VASCULAR FAMILY
(X)
Right Renal
Left Renal
Jugular
Left Adrenal
Right Adrenal
Selective Organ Blood Sampling (x #)
Other Venous Vascular Family
Portal Venogram
1st & 2nd
(X) Order*
36011
36011
36011
NA
36011
36500 x __
36011 x __
36481
3r
Order*
(X)
36217
36217
36217
36217
36247
36247
36247
36253
36254
36247
36247
36247
36247
36247
N/A
36015
36015
or 3rd Order*
# of Vessels
36218 x __
36218 x __
36218 x __
36218 x __
36248 x __
36248 x __
36248 x __
36248 x __
36248 x __
36248 x __
36248 x __
36248 x __
N/A
36015 x __
36015 x __
75605
75625
75630
75650
75658
75660
75662
75665
75671
75676
75680
75685
75685 x 2
75705 x __
75710
75716
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012 x __
36012 x __
36012 x __
Adrenal, Bilateral
Pelvic, Each Vessel, Sel.
Pulmonary, Unilateral
Pulmonary, Bilateral
Pulmonary, Nonselective
Internal Mammary
Each Add Vessel After Basic
AV Dialysis Shunt Existing Access
75733
75736 x __
75741
75743
75746
75756
75774 x __
75791
-59
-59
-59
-59
-59
-59
-59
-59
CODE
75820
75822
75825
-59
-59
-59
75827
-59
VENOGRAPHY
Extremity, Unilateral
Extremity, Bilateral
IVC
(X)
SVC
@
36200
36598
Renal, Unilateral
Renal, Bilateral
Adrenal, Unilateral
Adrenal, Bilateral
Sinus or Jugular
Superior Sagittal Sinus
Epidural
Orbital
Hepatic w Hemodynamic Eval
36140
36620
Arteriovenous Dialysis Shunt including RS&I
@
36147
AV dialysis shunt additional access for therapeutic intervention
@
36148
Extremity Vein, Needle/Intracath, Uni (Including contrast Inj)
36005
Aorta, Translumbar
36160
Carotid/Vertebral, direct puncture
36100
Retrograde Brachial
36120
Superior or Inferior Vena Cava, Catheter
36010
MODERATE (CONSCIOUS) SEDATION
Hepatic wedge pressures
venogram
(X)
99144
99145 x __
each additional 15 minutes
LYMPHANGIOGRAPHY
99143
99145 x __
Conscious Sedation UNDER 5 first 30 min
OTHER
Splenoportogram
G0269
76380
CT, limited or localized follow-up
US Guidance for Vascular Access
(Required documentation on file)
(X)
Extremity only, unilateral
Extremity only, bilateral
Pelvic/abdominal, unilateral
Pelvic/abdominal, bilateral
(X)
Closure Device
no
Hepatic w/o Hemodynamic Eval
Venous Sampling (E.G. renins)
End Time:___________
Conscious Sedation AGE 5 or OLDER first 30 min
UNLISTED IMAGING CODES
Thoracic Aortogram
Abdominal Aortogram
Abd Aortogram w Run-Offs
Cervicocerebral (Arch)
Brachial, Retrograde
Carotid, External, Unilateral
Carotid, External, Bilateral
Carotid, Cerebral, Unilateral
Carotid, Cerebral, Bilateral
Carotid, Cervical, Unilateral
Carotid, Cervical, Bilateral
Vertebral, Unilateral
Vertebral, Bilateral
Spinal, Selective, Each Vessel
Extremity, Unilateral
Extremity, Bilateral
-59
-59
CODE
Radial artery catheter for pressures/monitoring
MISCELLANEOUS
Append -59
75726 x __
75731
(X)
Extremity Artery, Needle/Intracatheter, Unilateral
Start Time: __________
CODE
Visceral w-w/o Flush, Each Vessel
Adrenal, Unilateral
NON-SELECTIVE VASCULAR CATHETERIZATIONS
Intraservice
(X)
Each Add'l
2nd or 3rd*
1) Code multiple catheterizations in the same vascular family to the highest order 2) Use the "Each Additional" code for each additional
second or third order vessel within the same vascular family 3) Code catheterizations of different vascular families separately
provided by same physician performing the Dx-Tx service
DX and TX RS&I
ARTERIOGRAPHY
&
(X) 3rd Order* (X)
*CATHETERIZATION CODING CONVENTIONS
Aorta, Catheter (Femoral, Brachial, Axillary)
For same session
1st, 2nd
*@ designates moderate conscious sedation included.
1st
Order*
(X)
RADIOLOGICAL S&I
(X)
75831
75833
75840
75842
75860
75870
75872
75880
75889
-59
-59
-59
-59
-59
-59
-59
-59
-59
75889-52
-59
-59
75891
75893 x __
-59
-59
CODE
75801
75803
75805
75807
-59
-59
-59
-59
CODE
75810
-59
76937
(X)
Unlisted, Fluoroscopic procedure
76496
ATTACH REPORT
Unlisted, CT procedure
76497
ATTACH REPORT
Unlisted, MR procedure
76498
ATTACH REPORT
Unlisted, US procedure
76999
ATTACH REPORT
Dx 1: __________________
ICD-9: _____
Dx 2 :_________________
ICD-9: _____
Co pyright 2011 S
ety of Interventional Radiology. All Rights Reserved.
311
PATIENT:
DATE:
PROCEDURE:
VASCULAR INTERVENTIONAL CHARGE SHEET
Catheterization and Imaging Separately Reportable Unless Specifically Noted Otherwise for ALL Therapeutic Procedures
(x) MCS
THROMBOLYSIS AND INFUSION THERAPY
Infusion for Thrombolysis
Infusion, Non-Thrombolytic
Infusion for Thrombolysis, cerebral
Exch/Manip exist cath during thrombolysis
Angio thru exist cath F/U embo/thrombolysis
MECHANICAL THROMBECTOMY includes imaging guidance
Primary Arterial Mech Thromb - initial vessel
@
Primary Arterial Mech Thromb 2nd/subsequent vessel(s)
Secondary Mech Thromb- "rescue", suction, snare basket
Venous Mech Throm - Day 1
Venous Mech Throm - repeat mech thrombectomy on
subsequent day during a course of therapy
Procedure
code
S&I
Code
37201
37202
37195
37209
N/A
75896
75896
75970
75900
75898
37184
@
37185
@
@
37186
37187
@
37188 x __
INTRAVASCULAR ULTRASOUND*
IVUS initial vessel
Each additional vessel IVUS
PERCUTANEOUS *
PTA, Renal or Visceral Artery
PTA, Aorta
@
@
37250
37251
75945
75946
35471
35472
75966
75966
PTA, Brachiocephalic Arteries
@
35475
75962
PTA, Venous
@
35476
75978
PTA, Each add'l visceral vessel
@
35471 x __ 75968 x __
PTA, Each add'l brachiocephalic vessel
@
35475 x __ 75964 x __
PTA, Each additional venous
@
35476 x __ 75978 x __
INTRA-OPERATIVE (OPEN) ANGIOPLASTY
PTA, Renal or Visceral Artery
35450
75966
PTA, Aorta
35452
75966
PTA, Brachiocephalic vessels
35458
75962
PTA, Venous
35460
75978
INTRACRANIAL DILATION, ANGIOPLASTY, STENT
includes selective catheterization and all imaging of target vessel
Intracranial angioplasty
61630
Intracranial angioplasty with stent
61635
Dilation of intracranial vasospam, initial vessel
61640
each add vessel different vascular family
61642
INTRAVASCULAR STENTS
Intravascular Stents Non-Coronary/Non-Carotid/Non-Vertebral/Non-Intracranial
Intravascular Stent, perc., initial
37205
75960
Intrasvascular Stent, perc., each add'l vessel
37206
75960
Intravascular Stent, open, initial
37207
75960
Intrasvascular Stent, open, each add'l vessel
37208
75960
Intravascular Stents Cervical Carotid
includes all ipsilateral selective cath, ipsilateral cervical/cerebral angiography
Intravascular Stent w/ distal embolic protection
@
37215
N/A
Intravascular Stent w/out distal embolic protection
@
37216
N/A
Intravascular Stents Extracranial Vertebral/Intrathoracic Carotid
includes all ipsilateral selective cath, target vessel angiography
Intravascular Stent, perc; initial vessel
0075T
N/A
Intravascular Stent, perc; each addl. vessel
0076T
N/A
Append Clinical Trial Modifier
Service provided within FDA approved clinical trial
(and device approved for use in the trial at the time the
service was rendered.)
IDE # _______
76496
76497
76498
76999
37799
Dx 1: __________________
ICD-9: _____
Dx 2 :_________________
ICD-9: _____
304
ATTACH REPORT
UNLISTED IMAGING CODES
Unlisted, Fluoroscopic procedure
Unlisted, CT procedure
Unlisted, MR procedure
Unlisted, US procedure
UNLISTED VASCULAR PROCEDURE
Unlisted, vascular surgery
-Q0
(x) MCS
DIALYSIS ACCESS INTERVENTIONS
Clot removal any method
@
Dialysis Fistulagram
@
Add'l puncture (document in dictation)
@
PTA, A-V fistula arterial
PTA, A-V fistula venous
Fistulogram with needles in
Intravascular stent
Insertion of tunneled intraperitoneal catheter (eg, dialysis)
Insertion of tunneled intraperitoneal catheter w/ subcutaneous port
Peritoneal dialysis catheter placement open
Removal of tunneled intraperitoneal catheter
Peritoneogram (Air &/or contrast)
TRANSCATHETER THERAPY MISC.
Foreign Body Retrieval
@
IVC Filter Insertion
@
IVC Filter Respositioning
@
IVC Filter Retrieval (Removal)
@
EMBOLIZATION (per surgical field)
Embolization (Non-Neuro, Non-UFE)*
Embolization to treat Uterine Fibroids includes imaging
and catheterization(s)
@
Cerebral Balloon Occlusion Test (BOT) includes imaging
and catheterization of target vessel
Embolization (CNS)* permanent
Embolization (non-CNS) Head or Neck
Procedure
Code
S&I
Code
36870
36147
36148
35475
35476
N/A
37205
49418
49419
49421
49422
49400
N/A
N/A
N/A
75962
75978
75791
75960
N/A
N/A
N/A
N/A
74190
37203
37191
37192
37193
75961
37204
75894
37210
61623
61624
61626
F/U Angio post Embo*
N/A
Add'l agent -prescribing, handling, and bolus administration
chemotherapeutic agent
radioactive agent
TIPS
includes catheterization and associated imaging
TIPS
TIPS Revision
@
Embolization of varix*
75894
75894
75898
96420
79445
37182
37183
36011 or 36012
+ 37204
*Note: Report selective catheterization codes in addition to embolization.
ENDOVASCULAR VARICOSE VEIN TREATMENT includes imaging guidance
catheterization is considered inherent to EVAT
Radiofrequency EVAT- includes imaging- 1st vein
RFA - 2nd & subs. vein(s)
Laser EVAT- includes imaging- 1st vein
Laser - 2nd & subs. vein(s)
OTHER VARICOSE VEIN TREATMENT
Injections of sclerosing solutions (single/multiple), spider
veins; limb or trunk
Injection of sclerosing solution- single vein
Injection of sclerosing solution- multiple veins, same leg
Stab phlebectomy of varicose veins,
one extremity, 10-20 incisions
Stab phlebectomy of varicose veins,
one extremity, more than 20 incisions
Intraservice
End Time:___________
OTHER
75894
+ 75898
36475
36476
36478
36479
36468
36470
36471
37765
37766
99144
99145 x __
99143
99145 x __
modality
Specific
Pseudoaneurysm TX Injection (Thrombin)
36002
Imaging Guidance for Needle Plcmnt (circle one) US-76942 fluoro-77002 CT-77012 MR-77021
Closure Device
G0269
76380
76937
(required documentation on file)
PATIENT:
DOB:
IDENTIFICATION NUMBER:
AAA-TA-IA ENDOVASCULAR REPAIR CHARGE SHEET
Procedure
Procedure
Code
EXPOSURE FOR ENDOPROSTHESIS
Femoral Cutdown
34812
Fem-fem graft
34813
Iliac Retroperitoneal Exposure
34820
CATHETERIZATION: NON-SELECTIVE *Report cath codes in addition to exposure
Aorta, Catheter (Femoral, Brachial, Axillary)
Iliac, nonselective
CATHETERIZATION: SELECTIVE --Circle code(s)-Arterial Vascular Family****
IIiac, Ipsilateral
Common IIiac, Contralateral
Common Femoral, Ipsilateral
Common Femoral, Contralateral
Common Iliac or Femoral, Axillary or Brachial Approach
Other Abdominal Aorta Vascular Family
AAA ENDOPROTHESIS DEPLOYMENT
AAA endo repr w/ aorto-aortic tube device
AAA endo repr w/ modular bifurcated device (1-limb)
Bilat
34812-50
Bilat
34820-50
36200
36140
Bilat
Bilat
36200-50
36140-50
Physician #1
Physician #2
1st
1st & 2nd
1st, 2nd &
or 3rd Order
Order
Order
3rd Order
# of Vessels
36245
36245
36245
N/A
36245
36245
36246
36246
36246
36246
36246
36246
36247
36247
36247
36247
36247
36247
RS&I Code
Modifier(s)
- 62 / -26
AAA endo repr w/ unibody bifurcated device
75952
75952
75952
AAA endo repair, aorto-uni-iliac/aorto-unifemoral device
34805
75952
- 62 / -26
AAA endo repair w/ visceral branches using prosthesis
0078T
0080T
- 62 / -26
AAA EXTENSIONS/CUFFS DEPLOYMENT*** Imaging code 75953 billed per vessel
34825
initial vessel
each additional vessel
TA ENDOPROTHESIS DEPLOYMENT
TA endo repair w/ coverage of subclavian origin
TA endo repair w/out coverage of subclavian origin
Open subclavian to carotid artery transposition performed in conjunction
with TA endo repair, neck incision
Graft with other than vein, transcervical retropharyngeal carotid-carotid
performed in conjuncition with TAA
- 62 / -26
- 62 / -26
- 62 / -26
34826
75953
0081T
/
RS&I Code
75956
33880
33881
75957
33889
33891
-26
TA EXTENSIONS/CUFFS DEPLOYMENT
Proximal - initial
-22 Extended Services
-26 Professional Component
-50 Bilateral Procedure
-51 Multiple Procedures
-52 Reduced Service
-53 Discountinued Service
-58 Staged/Related Procedure During Global
Distinct
S -59 Ph
i i Procedural Service
/
-26
-62 Two Surgeons (Co-Surgeons)
/
-27
-76 Repeat Procedure, Same Physician
Modifier(s)
-77 Repeat Procedure, Different Physician
- 62 / -26
-78 Return for Related Procedure During Global
- 62 / -26
-79 Unrelated Procedure, Same Physician
-80 Assistant Surgeon
-RT Right-side
-LT Left-side
IDE#______________
-Q0 FDA Approved Trial
75953
0079T
Modifier(s)
X36248
X36248
X36248
X36248
X36248
X36248
MODIFIER DEFINITIONS
34800
34802
34803
34804
visceral extension prosthesis
Code
75952
AAA endo repr w/ modular bifurcated device (2-limb)
DATE:
-GA Advanced Beneficiary Notice (ABN) on File
33883
75958
Delayed distal (not at time of initial repair)
33886
IA ENDOPROSTHESIS DEPLOYMENT
Endovasc iliac aneuryem repr
34900
OCCLUSION DEVICE
Endovasc iliac occlusion device
34808
OPEN CONVERSION
34830
Open aortic tube prosth repr
34831
Open aortoiliac prosth repr
Open aortofemor prosth repr
34832
Code
OTHER CONCOMMITANT SERVICES
ANGIOPLASTY**
@-Conscious Sedation included in codes marked @
Perc TA, Renal or Visceral Artery @
35471
Open TA, Renal or Visceral Artery
35450
Perc TA, Aorta (within treatment zone NOT reportable) @
35472
Open TA, Aorta (within treatment zone NOT reportable)
35452
Perc TA, Brachiocephalic Arteries @
35475
Open TA, Brachiocephalic vessels
35458
Perc TA, Venous @
35476
Open TA, Venous
35460
Perc TA, Each add'l visceral vessel @
35471 x
Open TA, Each add'l visceral vessel
35450 x
Perc TA, Each add'l brachiocephalic vessel @
35475 x
Open TA, Each add'l brachiocephalic vessel
35458 x
INTRAVASCULAR ULTRASOUND
IVUS initial vessel
37250
Each additional vessel IVUS
37251
INTRAVASCULAR STENTS*
Intravascular Stent, perc., initial
37205
Intrasvascular Stent, perc., each add'l vessel
37206
Intravascular Stent, open, initial
37207
Intrasvascular Stent, open, each add'l vessel
37208
EMBOLIZATION *for embolization, follow up completion angio (75898) is separately reportable
Embolization (Non-Neuro)
OTHER *Required documentation on file
US for Vascular Access*
Placement of wireless sensor in sac during endo repair
Noninvasive physiological study of implanted wireless sensor
Additional Services--(please describe)
Category III codes effective Jan 1, 2011
Endovascular repair of iliac artery bifurcation using a bifurcated external
and internal iliac artery
37204
/
-26
75959
/
-26
75954
/
-26
RS&I Code
75968 x
75968 x
75964 x
75964 x
75966
75966
75966
75966
75962
75962
75978
75978
Modifier(s)
/
/
/
/
/
/
/
/
/
/
/
/
-26
-26
-26
-26
-26
-26
-26
-26
-26
-26
-26
-26
75945 /
75946 /
-26
-26
75960
75960
75960
75960
/
/
/
/
-26
-26
-26
-26
/
/
-26
-26
76937 /
76380 /
-26
-26
75894
+75898
CODING GUIDELINES:
* Stents placed inside the endoprosthesis treatment zone are
not separately billable.
** Balloon dilatation of endoprosthesis is not separately billable.
*** Multiple cuffs in the same vessel are not reportable beyond the first.
****Code caths of different vascular families separately per
standard catheter coding conventions.
**** Code Multiple Caths in the Same Vascular Family to the Highest Order.
**** Use the "Each Additional" Code for Each Add/l 2nd or 3rd Order Vessel.
93982
0254T
Not typically
billable at the
0255T
(x)
by
#1
by
#2
Procedure
Code
Modifier(s)
BYPASS
Fempop with vein
35556
Fempop non vein
35655
THROMBOENDARTERECTOMY
Iliofemoral
35355
Femoral, common
35371
Femoral, deep
35372
EMBOLECTOMY THROMBECTOMY
Fempop
34201
Popliteal-tibio-peroneal
34203
ARTERIAL REPAIR
Lower extremity, direct
35226
Lower extremity, vein graft
35256
Lower extremity, non vein graft
35286
Dx CODES
Inclusion of a DX code is not meant to imply that payors have approved coverage. Please check with local
payors for a list of approved DX codes for these services.
405.01
440.21
440.22
440.23
440.24
441.02
441.3
441.4
442.2
34086
(x)
442.82
444.22
585
747.64
747.69
901.1
902.0
902.53
902.54
998.2
Malignant secondary renovascular hypertension
Artherosclerosis, extremity w/ claud.
Artherosclerosis, extremity w/ rst pain
Artherosclerosis, extremity w/ ulcer
Artherosclerosis, extremity w/ gangrene
Dissection of abdominal aorta
Abdominal aneurysm, ruptured
Abdominal aneurysm without mention of rupture
Iliac artery aneurysm or pseudoaneurysm
Aneurysm or pseudoaneurysm of subclavian artery
Lower extremity arterial embolism/thrombosis
Chronic renal failure
Iliac arteriovenous fistula
Aortic arteriovenous fistula
Injury subclavian artery
Aortic injury/trauma
Injury iliac artery
Injury iliac vein
Iatrogenic rupture of vessel
Other (please specify) ____________________________
Copyright 2011 Society of Interventional Radiology. All Rights Reserved
305
PATIENT:
DATE:
PROCEDURE:
VENOUS ACCESS PROCEDURES CHARGE SHEET
\Valuation for codes with @ in the MCS indicator column includes the physician work for conscious sedation.
CENTRALLY INSERTED DEVICE
PERIPHERALLY INSERTED DEVICE
Procedure
(x) MCS
Procedure
Code
(x) MCS
Placement Peripherally Inserted
Placement Centrally Inserted
Non Tunneled child <5
Code
@
Non Tunneled ( 5+ older)
36555
Non Tunneled PICC child <5
36556
Non Tunneled PICC ( 5+ older)
@
36568
36569
Tunneled child <5 no port, no pump
@
36557
PICC w/ port child <5
@
36570
Tunneled (5+ older) no port, no pump
@
36558
PICC w/ port (5+ older)
@
36571
Tunneled port child <5
@
36560
Tunneled port (5+ older)
@
36561
Repair PICC
Tunneled pump
@
36563
PICC no port, no pump
2 tunneled cath, 2 access sites (no port, no pump) (e.g.Tesio
@
36565
PICC w/ port
Two tunneled cath, two access sites, w/ port
@
36566
36575
@
36576
@
36578
Partial Replacement (Cath Only)
Repair
PICC w/ port
Non Tunneled no port, no pump, cent or periph
36575
Tunneled no port, no pump, cent or periph
36575
Complete Replacement thru same vein access
Tunneled port, cent or periph
@
36576
PICC
Tunneled pump, cent or periph
@
36576
PICC w/ port
@
36585
36575 (X2)*
Two tunneled cath, two access sites (no port, no pump)
36584
@
Removal
36576 (X2)*
Non Tunneled no port, no pump
Partial Replacement (Cath Only)
99XXX**
@
PICC w/ port
Port, cent or periph
@
36578
Pump, cent or periph
@
36578
@
36578 (X2)*
CENTRAL/PERIPHERAL CVA DEVICE MAINTENANCE
Reposition central venous catheter
36597
76000
Thrombolytic declotting of vascular access
36593
N/A
36580
CVA maintenance fibrin stripping (sep access)
36595
75901
CVA maintenance through lumen (brushing)
36596
75902
Complete Replacement thru same venous access
Non Tunneled
36590
Tunneled, no port no pump
@
36581
Tunneled port
Tunneled pump
@
@
@
36582
36583
36581 (X2)*
@
36582 (X2)*
Non-Selective Catheter Plcmnt- superior/inferior vena
Selective Catheter Plcmnt- venous 1st order
Selective Catheter Plcmnt- venous 2nd order
36010
36011
36012
Removal
99XXX**
Non Tunneled no port, no pump
Tunneled no port, no pump
Intraservice
@
36590
Tunneled pump
@
36590
Two tunneled cath, two access sites port
36589 (X2)
@
Fluoro guidance placement
Fluoro guidance replacement, partial or complete
Fluoro guidance removal
US guidance for vascular access
End Time:___________
99144
99145 x ___
99143
99145 x ___
* For multi-catheter devices use the appropriate repair, partial replacement,
complete replacement, or removal code describing the service with a
frequency of two.
(x) Code ** Removal of a non-tunneled device is considered inherent to E&M, report
appropriate level of E&M provided.
77001
77001
77001
76937
Fluoro only - no archived image
76380
76000
Radiological Catheter Evaluation
(separate service only)
36598
SVC gram
75827
IVC gram
75825
Extremity venogram
75820
36590 (X2)
IMAGING for Central/Peripheral Device Procedures
314
36589
Tunneled port
(Do NOT report withcodes marked with @)
Copyright © 2011, Society of Interventional Radiology. All Rights Reserved.
PATIENT:
PROCEDURE:
DATE:
NONVASCULAR INTERVENTIONAL CHARGE SHEET
GASTROINTESTINAL TRACT
Perc. Transhepatic Cholangiogram
Perc. Biliary Drainage (External)
Perc. Biliary Drainage (Int. and Ext.)
Injection, Cholangiography, Existing Cath., T-tube
Change of Biliary Drainage Catheter
Revise/Reinsert Transhepatic tube
Perc. Dil Biliary Stricture w/o Int. Stent
Perc. Dil Biliary Stricture with Int. Stent
Cholangioscopy, perc., w/ or w/o brushing or washing
Cholangioscopy, perc., with biopsy
Cholangioscopy, perc., with calculus/calculi removal
Biliary Stone Removal via T-Tube
Intraoperative Cholangiogram
Intraoperative Cholangiogram Additional
Naso/oro gastric tube placement
G-tube placement under fluoro guidance
J-tube placement under fluoro guidance
duodenostomy tube placement under fluoro guidance
cecostomy/colonic tube placement under fluoro guidance
G-J tube placement under fluoro guidance
Conversion of previously placed G-tube to G-J tube under fluoro
G-tube replacement under fluoro guidance
J-tube replacement under fluoro guidance
(X)
MCS
@
Procedure
47500
47510
47511
47505
47525
47530
47555
47556
47552
47553
47554
47630
S&I
74320
75980
75982
74305
75984
75984
74363
74363
N/A
N/A
N/A
74327
74300
74301
43752
49440
49441
49442
49442
49440 + 49446
49446
49450
49451
@
@
@
@
@
@
duodenostomy tube replacement under fluoro guidance
49451
G-J tube replacement under fluoro guidance
49452
Mechanical removal obstructive material G-, J-, G-J, C tube under
49460
fluoro guidance
Contrast Injection for G-, J-, G-J, C tube radiological evaluation
49465
Perc. Cholecystostomy complete
47490
N/A
Pneumoperitoneum
49400
74190
**
ERCP
@
43260
**
ERCP w/ biopsy
@
43261
ERCP for Spincterotomy/Papillotomy
@
43262
**
ERCP calculus/calculi Removal
@
43264
**
ERCP calculus/calculi Destruction
@
43265
**
ERCP Insert Nasobiliary/Nasopancreatic tube
@
43267
**
ERCP Biliary/Pancreatic Stent
@
43268
**
ERCP Stent Removal or Change
@
43269
**
ERCP Balloon Dilation
@
43271
**
Esophagus Dilation
@
43453
74360
Esophageal Plastic Tube or Stent
@
43219
**
**ERCP RS&I
**ERCP Biliary Ducts RS&I
74328
**ERCP Pancreatic Ducts RS&I
74329
**ERCP Pancreatic and Biliary Ducts RS&I
74330
URINARY PROCEDURES
(X)
Procedure
S&I
Perc Antegrade Pyelogram (thru needle)
50390
74425
Nephrostomy
50392
74475
Nephrostogram (thru existing catheter)
50394
74425
Nephrostomy Tube Change
50398
75984
74485
Dilation of Nephrostomy Tract/Pyelostomy
50395
Ureterography Through Existing Catheter
50684
74425
Ureteral Dilation
53899
74485
URETERAL STENT
Internally Dwelling
Placement through renal pelvis
50393
74480
- exchange, perc. approach includes imaging
@
50382
- removal, perc. approach includes imaging
50384
@
Transuretheral approach
- exchange, transurtheral approach includes imaging
50385
@
- removal, transurtheral approach includes imaging
@
50386
Externally Dwellling (externally accesible transnephric ureteral stent/ external-internal stent)
-exchange, includes imaging
@
50387
-removal, includes imaging
50389
-removal NOT requiring imaging***
99XXX***
*** Considered inherent to E&M, report appropriate level of E&M provided.
50688
75984
Change ureterostomy tube/ureteral stent via ileal conduit
74425/74475
Whitaker Test
50396
/74480
Nephrostolithotomy <2cm
50080
76000**
Nephrostolithotomy >2cm
50081
76000**
Aspiration, Renal Cyst by Needle
50390
by modality*
Contrast study of renal cyst
50390
74470
Ileoconduit Injection
50690
74425
Aspirate bladder (Diagnostic) by trocar/catheter
51101
by modality*
Suprapubic Catheter (incl. Bladder aspiration)
51102
by modality*
Cystogram
51600
74430
Urethrocystogram, Voiding
51600
74455
Cystography/VCU w/Chain
51605
74430
Urethrocystogram, Retrograde
51610
74450
Change Cystostomy Tube, Simple
51705
75984
Change Cystostomy Tube, Complex
51710
75984
**use 76001 in lieu of 76000 if > 1 hr fluoro
*Imaging Guidance Modality Used (circle one)
US 76942
CT 77012
Fluoro 77002
FALLOPIAN DILATATION
(X)
Hysterosalpingogram
Hysterosonography, w/ or w/o color flow
Fallopian Dilatation
Intraservice
End Time:___________
MR 77021
Procedure
58340
58340
58345
99144
99145 x ___
99143
99145 x ___
S&I
74740
76831
74742
DRAINAGE PROCEDURES
Fistula or Sinus Tract Study
Thoracentesis needle only
Therapeutic Thoracentesis (w/ tube)
Chest tube for pneumothorax
Abscess Drainage, Pleural (Empyema)
Abscess Drainage, Lung
Insertion, Indwelling Tunneled Pleural Cath
Removal of Indwelling Tunneled Cath w/ cuff
fibrinolysis via chest tube/catheter, agent initial
fibrinolysis via chest tube/cathecatheter, agent subs
Abscess Drainage, Appendiceal
Abscess/Cyst Drainage, Liver
Pancreatic Pseudocyst Drainage
Abscess Drainage, Peritoneal
Abscess Drainage, Subdiaphragmatic
Abscess Drainage, Retroperitoneal
Paracentesis, Abdominal wo imaging guidance
Paracentesis, Abdominal w imaging guidance
Change of Abscess Drain (inc. injection)
Abscessogram (Tube Check)
Pelvic, transvaginal or transrectal
Abscess Drainage, Renal or Perirenal
BIOPSIES
MCS
@
@
@
@
@
@
@
@
@
@
@
Procedure
20501
32421
32422
32422
32551
32201
32550
32552
32561
32562
44901
47011
48511
49021
49041
49061
49082
49083
49423
49424
58823
50021
S&I
76080
by modality*
by modality*
by modality*
75989
75989
75989
N/A
N/A
N/A
75989
75989
75989
75989
75989
75989
75984
76080
75989
75989
Muscle, Percutaneous
20206
Bone, Superficial, Percutaneous
20220
Bone Deep, Percutaneous
20225
Pleura, Percutaneous
32400
Lung, Percutaneous
@
32405
Lymph Nodes, Sup., Percut
38505
Liver, Percutaneous, Separate
@
47000
Liver, Percutaneous, w/ Other Procedure
@
47001
48102
Pancreas, Percutaneous
Abdomen/Retrop., Percutaneous
49180
Renal, Percutaneous
@
50200
Prostate
55700
Thyroid, Percutaneous
60100
Spinal Cord
62269
Fine needle aspiration, w/out imaging guidance
10021
Fine needle aspiration, w/ imaging guidance
10022
Fluoro 77002
US 76942
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
N/A
by modality*
CT 77012
OTHER
(X)
Tracheal/Bronchial Stent
TRANSCATHETER BIOPSY
(X)
Transjugular liver biopsy
ABLATION PROCEDURES
(X)
Percutaneous RFA, Liver Tumor(s)
Percutaneous Cryoablation, Liver Tumor(s)
Percutaneous RFA, Renal Tumor(s)
Percutaneous Cryoablation, Renal Tumor(s)
Percutaneous RFA Lung Tumor(s)
Percutaneous RFA Bone Tumor(s)
includes CT guidance
Percutaneous RFA Breast Tumor(s)
Percutaneous injection of ablative agent (i.e. alcohol or
acetic acid), liver
Open RFA, Liver Tumor(s) using U/S guidance
MCS
MCS
@
@
@
MR 77021
Procedure
31631-62
Procedure
37200/36011
Procedure
47382
47399
50592
50593
32998
@
S&I
N/A
S&I
75970
S&I
by modality*
by modality*
by modality*
by modality*
by modality*
20982
19499
by modality*
47399
by modality*
47380**
76362
Open Cryo, Renal Tumor(s)
50250**
includes US guidance
**Use modifier -62 when service is provided by co-surgeons.
*Imaging Guidance/Monitoring Modality Used for Ablation (circle one)
US 76940
CT 77013
MR 77022
Procedure
S&I
BREAST
(X)
CS
Aspiration Breast Cyst
19000
by modality*
each additional cyst
19001 x ___
by modality*
Fine Needle Aspiration, w/ imaging guidance
10022
by modality*
Breast, Perc. Core Bx, Image Guided
(per
by modality*
19102 x ___
lesion)
Breast, Perc Bx. vacuum assisted/rotating device (per
19103 x ___
by modality*
lesion)
Plcmnt each Localizing Clip
19295 x ___
by modality*
(use w/ 19102/19103)
RFA Breast Tumor(s)
see above ablation procedures
Breast Wire Localization
19290
77032
each additional localization
19291 x ___
77032 x ___
Galactogram, Single Duct
19030
77053
Galactogram, Multiple Ducts
19030 x ___
77054 x ___
Sentinel Node Injection
38792
by modality*
*Guidance Modalities for Breast Procedures
Stereotactic Guidance, each lesion
77031
x ___
Mammographic Guidance, each lesion
77032
x ___
Ultrasound Guidance for needle placement
76942
x ___
CT Guidance for needle placement
77012
x ___
Fluoroscopy Guidance needle placement
77002
x ___
MR Guidance for needle placement
77021
x ___
Specimen Services
(X)
Breast Specimen X-ray
76098 x ___
Cytohistologic study of specimen
88172
MISCELLANEOUS
Closure Device
Dx 1: __________________
Dx 2 :_________________
(X)
(X)
G0269
76380
76937
ICD-9: _____
ICD-9: _____
Copyright © 2011 Society of Interventional Radiology
306
PATIENT:
DATE:
PROCEDURE:
MUSCULOSKELETAL CHARGE SHEET
SPINE
(X)
Procedure
MYELOGRAM
Lumbar puncture, for myelogram
(Valuation for code 62284 includes moderate (conscious)
sedation - Do NOT separately report.)
62284
Cervical puncture, for myelogram
61055
Cervical Myelogram
Thoracic Myelogram
Lumbar Myelogram
Spinal Canal Myelogram two or more regions
DISKOGRAPHY
Diskography Lumbar (Each Level)
Diskography Cervical/Thoracic (Each Level)
PUNCTURE
Lumbar puncture, diagn, w/o injection
Lumbar puncture, Tx for drainage
Cervical puncture, w/o injection
Puncture Shunt Tubing
NEUROLYTIC INJECTION/INFUSION
Subarachnoid
Cervical or Thoracic Epidural
Lumbar, Single Epidural
NON-NEUROLYTIC INJECTION
Dx/Tx, Cerv or Thoracic, Epi/Subara.,
Dx/Tx., Lumb or Sac., Epi/Subara.,
Cont. Infusion, Cerv or Thoracic, Epi/Subara.
Cont. Infusion, Lumb or Sac., Epi/Subara
Injection, epidural, of blood or clot patch
FACET JOINT INJECTION per joint level
Inject Anesthesia, cervical or thoracic; single joint level
S & I*
see myelogram
codes
Thoracic one vertebral body w/bone bx
Lumbar one vertebral body w/bone bx
see myelogram
codes
sacroplasty unilat injection
sacroplasty bilat injection
(X)
Procedure
S&I
Each add'l T or L vertebral body
effective July 1, 2009
effective July 1, 2009
22520
22521
22522 x ___
0200T
0201T
by modality*
by modality*
by modality*
by modality*
by modality*
Each add'l T or L vertebral body
22523
22524
22525 x ___
by modality*
by modality*
by modality*
@
@
72240
72255
72265
72270
62290 x ___
62291 x ___
Cervical/thoracic, single nerve level w/guidance
cervical/thoracic, each additional nerve level
Lumbar/sacral, single nerve level w/guidance
lumbar/sacral, each additional nerve level
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zyg
72295
72285
62270
62272
61050
61070
77003
77003
77003
75809
62280
62281
62282
77003*
77003*
77003*
62310
62311
62318
62319
62273
77003*
77003*
77003*
77003*
77003*
64490
sec
64491
third and any additiona
64492
Inject Anesthesia Lumbar/Sacral, single joint level
64493
sec
64494
third and any additiona
64495
FACET JOINT NERVE DESTRUCTION BY NEUROLYTIC INJECTION per nerve level
64633
64634
64635
64636
0213T
0214T
0215T
0216T
0217T
0218T
N/A
N/A
N/A
N/A
N/A
N/A
US only
second [cervical/thoracic] level US only
third and any additional [cervical/thoracic] level(s)
US only
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zyg
US only
second [lumbar or sacral] level (s) US only
third and any additional [lumbar or sacral] level(s)
US only
ANESTHETIC/STEROID INJECTION TRANSFORMINAL EPIDURAL
Cervical/thoracic, single level
64479
N/A
cervical/thoracic, each additional level
64480 x ___
N/A
Lumbar, single level
64483
N/A
lumbar, each additional level
64484 x ___
N/A
*Use 72275 instead of 77003 if formal epidurography is also done. Report 72275 or 77003
ONCE per each spinal region
Codes 62275 OR 77003 are to be coded ONCE per
each spinal REGION.
MODIFIERS
21 Prolonged E/M Services
KYPHOPLASTY unilat or bilat injection(s)
Thoracic one vertebral body
Lumbar one vertebral body
*Guidance Modalities for Vertebroplasty/Kyphoplasty/Sacroplasty
BIOPSIES
Spinal Cord
Fluoroscopic guidance, per vertebral body
CT guidance, per vertebral body
*Bx Imaging Guidance Modality Used (circle one)
US 76942
Fluoro 77002
x ___
x ___
20220
20225
62269
by modality*
by modality*
by modality*
CT 77012
(Valuation for code 20982 includes moderate (conscious) sedation - Do NOT separately
report.)
OTHER
Perc. Aspiration of Nucleus Pulposus
Sinogram, Therapeutic
Sinogram, Diagnostic
Aspiration &/or Injection Small Joint
Arthrocentesis Medium Joint
Arthrocentesis Large Joint
Sacroiliac Joint Injection w/o imaging
ARTHROGRAPHY
(X)
Procedure
MR 77021
20982
(X)
Procedure
S&I Code
62287
20500
20501
20600
20605
20610
20552
77003
76080
76080
77002
by modality
by modality
Ci l
Radiographic S&I*
Arthrogram, TMJ
21116
70332
Arthrogram, Shoulder
23350
73040
Arthrogram, Elbow
24220
73085
Arthrogram, Wrist
25246
73115
27093
73525
27095
73525
Arthrogram, Hip
without anesthesia
Arthrogram, Hip
Arthrogram, Sacroiliac Joint (incl's imaging)
27096
Arthrogram, Knee
27370
73580
Arthrogram, Ankle
27648
73615
CT S&I**
Start Time: _______
Intraservice Time
73201 or
73222 or
73202
73201 or
73202
73201 or
73223
73222 or
73223
73222 or
73202
73223
73701 or
73702
73701 or
73702
73722 or
73723
73722 or
73723
73701 or
73702
73701 or
73702
73722 or
73723
73722 or
73723
End Time: ________
(X)
ICD-9: _____
ICD-9: _____
MISC
US Guidance for Vascular Access (documentation required on file)
NOTE: Reporting of associated RS&I/imaging guidance code72275/ 76005 has been limited to once per each spinal REGION.
99144
99145 x __
99143
99145 x __
Copyright 2011 Society of Interventional Radiology. All Rights Reserved
MR S&I**
70487
**Flouroscopic Guided Inj for CT/MR
77002
Arthography
*Do not additionally report 77002 in conjunction with radiographic arthrography S&I codes.
1. Codes 64622, 64623, 64626, 64627 are to be coded per NERVE LEVEL.
316
72291
72292
RADIOFREQUENCY ABLATION
with anesthesia
22 Extended Services
24 Unrelated E/M During Global
25 Addition Consult Same Day of Procedure
26 Professional Component
51 Multiple Procedures
52 Reduced Service
53 Discountinued Service
57 Decision to Operate
58 Staged/Related Proc., During Global, Same MD
59 Distinct Procedural Service
62 Two Surgeons (Co-Surgeons)
76 Repeat Procedure, Same Physician
77 Repeat Procedure, Different Physician
78 Return for Related Procedure During Global
79 Unrelated Procedure, Same Physician During Global
99 Multiple Modifiers
RT Right-side
LT Left-side
Dx 1: __________________
Dx 2 :_________________
VERTEBROPLASTY unilat or bilat injection(s)
(X)
76380
76937
77002
PATIENT:
DATE:
PROCEDURE:
CT/MR Angiography - Cardiac MRI Charge Sheet
MR ANGIOGRAPHY
(X)
CT ANGIOGRAPHY
CODE
(X)
CTA Head w/out & w/ contrast
CTA Neck w/out & w/ contrast
CTA Chest w/out & w/ contrast
CTA Pelvis w/out & w/ contrast
CTA Upper Ext w/out & w/ contrast
CTA Lower Ext w/out & w/ contrast
CTA Abdomen/Pelvis w/contrast & wo/contrast when performed
CTA Abdomen w/out & w/ contrast
CTA Heart, coronary arteries & bypass grafts…w/contrast
CTA Aorta w/ Run-offs w/out & w/ contrast
CODE
70496
70498
71275
72191
73206
73706
74174
74175
75574
75635
MRA Head w/out contrast
70544
MRA Head w/ contrast
70545
MRA Head w/out & w/ contrast
70546
MRA Neck w/out contrast
70547
MRA Neck w/ contrast
70548
MRA Neck w/out & w/ contrast
70549
MRA Chest w/ or w/out contrast
71555
MRA Spinal Canal w/ or w/out contrast
72159
MRA Pelvis w/out & w/ contrast
72198
MRA Upper Ext w/ or w/out contrast
73225
MRA Lower Ext w/ or w/out contrast
73725
CARDIAC MRI
MRA Abdomen w/ or w/out contrast
74185
Cardiac MRI for morphology and function without contrast
75557
with stress imaging
Cardiac MRI for morphology and function with and without contrast
with stress imaging
75559
74185
MRA - Abdominal Aorta including iliacs w/ bilateral runoff
73725-RT
+ 3-D RENDERING with interpretation and report
use in addition to base imaging code
71555
74185
73725-RT
73725-LT
AGE 5 or OLDER - first 30 min
99144
99145 x __
UNDER 5 YRS of AGE- first 30 min
99143
INJECTION
99145 x __
C1-C2 puncture with injection for DX/Treatment
61055
Lumbar puncture, for myelogram
(Valuation for code 62284 includes conscious sedationDo NOT additionally report 99141.)
62284
*Requires midpoint of time be reached in order to assign code.
OTHER
(X)
US guidance for vascular access
CODE
76937
76377
Do NOT report 3-D rendering, 76376/76377 in conjunction with codes for which postprocessing
is considered inherent including: 31627, 70496, 70498, 70544-70549, 71275, 71555, 72159,
72191, 72198, 73206, 73225, 73706, 73725, 74174, 74175, 74185, 74261-74263, 75557, 75559,
75561, 75563, 75565, 75571-75574, 75635, 78000-78999, 0159T.
(X)
CODE
76376
REQUIRING postprocessing on an independent workstation
End Time:_____
(X)
NOT requiring postprocessing on an independent workstation
MODERATE (CONSCIOUS) SEDATION*
Intraservice Time Start Time: _____
CODE
75561
75563
75565
Cardiac MRI for velocity flow mapping
73725-LT
MRA - Thoracic and Abdominal Aorta including iliacs w/ bilateral runoff
(X)
(X)
CODE
Dx 1: __________________
Dx 2 :_________________
ICD-9: _____
ICD-9: _____
317
PATIENT:
DATE:
PROCEDURE:
INTERVENTIONAL RADIOLOGY ONCOLOGY CHARGE SHEET
MCS-Moderate Conscious Sedation Indicator @: Do NOT additionally report Moderate Conscious Sedation codes in conjunction with these services. Valuation for codes with @ in the MCS indicator column includes the physician work for
conscious sedation.
BIOPSY
Lung, Percutaneous
Liver, Percutaneous, Separate
Liver, Percutaneous, w/ Other Procedure
Renal, Percutaneous
Prostate
Spinal Cord
Percutaneous placement of an interstitial
device(s),fiducial marker or dosimeter, for radiation
therapy guidance thorax.
(X)
MCS
@
@
@
@
@
Percutaneous placement of an interstitial device(s),
such as fiducial marker or dosimeter, for radiation
therapy guidance within the abdomen, pelvis
(except prostate) and/or retroperitoneum.
Procedure
20206
20220
20225
32400
32405
38505
47000
47001
48102
49180
50200
55700
60100
62269
10021
10022
S&I
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
by modality*
N/A
by modality*
ABLATION PROCEDURES
Percutaneous RFA, Liver Tumor(s)
Percutaneous Cryoablation, Liver Tumor(s)
Percutaneous RFA, Renal Tumor(s)
Percutaneous Cryoablation, Renal Tumor(s)
Percutaneous RFA Lung Tumor(s)
Percutaneous RFA Breast Tumor(s)
(X) MCS
@
@
@
Procedure
47382
47399
50592
50593
32998
S&I
by modality*
by modality*
by modality*
by modality*
by modality*
@
20982
19499
by modality*
47399
by modality*
Percutaneous injection of ablative agent (i.e. alcohol or acetic acid), liver
Open RFA, Liver Tumor(s) using U/S guidance
47380**
76362
Open Cryo, Renal Tumor(s)
50250**
includes US guidance
**Use modifier -62 when service is provided by co-surgeons.
*Imaging Guidance/Monitoring Modality Used for Ablation (circle one)
32553
US 76940
CT 77013
MR 77022
49411
Placement of interstitial device(s) for rad therapy
guidance, prostate
55876
US 76942
CT 77012
TRANSCATHETER BIOPSY
Fluoro 77002
(X)
Transjugular liver biopsy
MR 77021
Procedure
S&I
37200/36011
75970
BREAST BIOPSY
(X)
Procedure
S&I
Fine Needle Aspiration, w/ imaging guidance
10022
by modality*
Breast, Perc. Core Bx, Image Guided
(per
19102 x ___
by modality*
lesion)
Breast, Perc Bx. vacuum assisted/rotating device (per
by modality*
19103 x ___
lesion)
Plcmnt each Localizing Clip
19295 x ___
by modality*
(use w/ 10022/19102/19103)
Breast Wire Localization
19290
77032
each additional localization
19291 x ___
77032 x ___
*Guidance Modalities for Breast Procedures
Stereotactic Guidance, each lesion
77031
x ___
Mammographic Guidance, each lesion
77032
x ___
Ultrasound Guidance for needle placement
76942
x ___
CT Guidance for needle placement
77012
x ___
Fluoroscopy Guidance needle placement
77002
x ___
MR Guidance for needle placement
77021
x ___
Specimen Services
(X)
Breast Specimen X-ray
76098 x ___
Cytohistologic study of specimen
88172
MODERATE (CONSCIOUS) SEDATION - requires midpoint of time be reached in order to assign code.
Intraservice
End Time:___________
99144
99145 x ___
99143
99145 x ___
Dx 1: __________________
Dx 2 :_________________
ICD-9: _____
ICD-9: _____
CPT Only copyright 2011 American Medical Association. All Rights Reserved
318
HEPATIC EMBOLIZATION
Selective Catheterization 3rd order
Additional Selective Catheterization 2nd/3rd+ order
Selective Catheterization 2nd order
Selective Catheterization 1st order
Dx Angio- visceral selective (if indicated)
Dx Angio- selective add'l vessel beyond basic exam
Embolization (Non-Neuro)*
REPORT ONLY ONCE PER SURGICAL FIELD
Add'l agent -prescribing, handling, and bolus administration
chemotherapeutic agent
radioactive agent
@
36247
@
@
@
36248 x ___
36246
36245
75726
75774
75898
96420
79445
Yttirum-90
@
Selective Catheterization 3rd order
@
Additional Selective Catheterization 2nd/3rd+ order
@
Selective Catheterization 2nd order
@
Selective Catheterization 1st order
Dx Angio- visceral selective (if indicated)
Dx Angio- selective add'l vessel beyond basic exam
Embolization (Non-Neuro)*
REPORT ONLY ONCE PER SURGICAL FIELD
Apply interstitial radiation complex
Yttirum-90 Authorized U Radiopharmaceutical therapy, by intra-arterial particulate administration
Radiation therapy planning
Radiation therapy dose plan
Radiation handling
MISCELLANEOUS
Closure Device
75894
37204
36247
36248 x ___
36246
36245
75726
75774
37204
75894
75898
77778
79445
77263
77300
77790
(X)
G0269
76380
76937
OFFICE WITH ULTRASOUND CAPABILITY CHARGE SHEET
PATIENT:
DATE:
EVALUATION & MANAGEMENT SERVICES
CONSULTATION Office/Outpatient
OFFICE VISIT
(x)
NEW OR ESTABLISHED PATIENT
ESTABLISHED
PATIENT
NEW PATIENT
History and Examination
Complexity of Medical
Decision Making
History and Examination
Complexity of Medical
Decision Making
99201
Problem focused
Straightforward
99211
99241
Problem focused
Straightforward
99202
Problem focused
Straightforward
99212
99242
Expanded
Straightforward
99203
Expanded
Low
99213
99243
Detailed
Low
99204
Detailed
Moderate
99214
99244
Comprehensive
Moderate
99205
Comprehensive
High
99215
99245
Comprehensive
High
(x)
(x)
Referring Physician: ____________________
ENDOVASCULAR VARICOSE VEIN THERAPY
(x) VARICOSE VEIN IMAGING DX/FOLLOW-UP
93965
Non-invasive physiological study extremity veins, complete bilateral study (Doppler)
93970
Duplex scan of extremity veins - Bilat
93971
Duplex scan of extremity veins - unilat/limited study
Presenting Problem(s)/Diagnosis
Dx 1:
ICD-9:
_____________
Dx 2:
ICD-9:
_____________
Dx 3:
ICD-9:
_____________
Common Presenting Problem(s)/Diagnosis
TX
for Varicose Vein
(x) ENDOVASCULAR VARICOSE VEIN TREATMENT
454.0
Varicose vein of lower extremities with ulcer
36475
Radiofrequency EVAT- includes imaging- 1st vein
36476
Radiofrequency - 2nd & subs. vein(s)
36478
Laser EVAT- includes imaging- 1st vein
36479
Laser - 2nd & subs. vein(s)
(x) OTHER VARICOSE VEIN TREATMENT
454.1
Varicose vein of lower extremities with inflammation
454.2
Varicose vein of lower extremities with ulcer and inflammation
454.8
Varicose vein of lower extremities with other complications
454.9
Varicose vein of lower extremities asymptomatic varicose vein
459.81
Venous (peripheral) insufficiency, unspecified
453.8
Other venous embolism and thrombosis of other specified veins
451.0
Superficial thrombophlebitis
36468
Injections of sclerosing solutions (single/multiple), spider veins; limb or trunk
36470
Injection of sclerosing solution- single vein
36471
Injection of sclerosing solution- multiple veins, same leg
37765
Stab phlebectomy of varicose veins, one extremity, 10-20 incisions
37766
Stab phlebectomy of varicose veins, one extremity, more than 20 incisions
ULTRASOUND GUIDED BIOPSY
(x) BIOPSY
20206
32400
32405 @ Lung, Percutaneous
38505
47000 @ Liver, Percutaneous, Separate
47001 @ Liver, Percutaneous, w/ Other Procedure
48102
49180
55700
Prostate
60100
10021
10022
(x) ULTRASOUND IMAGING GUIDANCE
US guidance needle placement
76942
_____________________________________________________________________
Presenting Problem(s)/Diagnosis Not Listed
Dx 1:
Dx 2:
ICD-9:
ICD-9:
Common Presenting Problem(s)/Diagnosis for BX
729.89
muscle (limb) lump
782.2
784.2
786.6
localized superficial swelling, mass, lump
789.3X
789.30
789.31
789.32
789.33
789.34
789.35
789.36
789.37
789.39
head and neck swelling, mass, lump
chest/lung swelling, mass, or lump
abdominal/pelvic swelling, mass, or lump
(5th digit required)
unspecified site
right upper quadrant
left upper quadrant
right lower quadrant
left lower quadrant
periumbilic
epigastric
generalized
other unspecified- multiple site
Presenting Problem(s)/Diagnosis Not Listed
Dx 1:
Dx 2:
Copyright
ICD-9:
ICD-9:
2011 Soc ciety of Interventional Radiology. All Rights Reserved.
319

Interventional Radiology Coding Update

Transcription

Similar documents

Interventional Radiology Coding Update

Radiology Services - St. Mary Medical Center

Product Information

Emeryville Advanced Imaging Referral Form Back

2003 Crownline 225 LPX - $ 19,900

The Heart

28` 6” Aquasport 1987 - Chapman School of Seamanship

Bond Movies Dr. Jonathan M Sackier As an Englishman of a certain

The Body is a Vessel

PDF Report

Interventional Informer - Association of Vascular and Interventional