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Interventional Radiology
Coding Update
2 0 13
nineteenth edition
2013 Interventional Radiology Coding Update
Coding for Endovascular and Interventional Procedures and Services
Society of Interventional Radiology
American College of Radiology
Edition 2013
Copyright © 2013 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 © 2012
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 Update 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
11
The Basics of Coding and Reimbursement
19
Evaluation and Management (E&M) Codes
24
Revised Interventional Radiology Codes for 2013
24 Vertebral Body, Embolization or Injection
24 Respiratory System
27
New 2013 CPT Codes Common to Interventional Radiology
27 Thoracentesis
27 Cervicocerebral Angiography
30 Deleted RS&I Codes
31 Foreign Body Retrieval
31 Transcatheter Thrombolysis
33 Diagnostic Radiology (Diagnostic Imaging)
34 Endovascular Revascularization
39 Special Coding Note for 2013: Embolization Therapy for
Benign Prostatic Hyperplasia (BPH)
42
Frequently Asked Questions
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TA B L E O F
CONTENTS
45
Individual Coverage Request Sample Letters
45
Percutaneous Radiofrequency Ablation of Pulmonary Tumor(s)
50 Ovarian Vein Embolization (OVE) to Treat Pelvic Congestion
Syndrome (PCS)
56 MRI of the Pelvis for UFE
60
Sample 2013 Charge Sheets
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FOREWORD
foreword
The 2013 Interventional Radiology Coding Update provides coding
information to physicians, coders and administrators on what is new for 2013
in coding and reimbursement in the specialty of interventional radiology.
By providing specialized information, as well as presenting some common
coding scenarios, the intent is to supplement the Current Procedural
Terminology (CPT) manual. Readers should always consult the CPT
Professional manual as the definitive source of coding information. Other
AMA resources, such as the CPT Assistant series, also commonly cover
coding topics of interest to endovascular specialties.
In 2013, the trend of bundling existing codes continued. In response to
coding “screens” utilized by the Centers for Medicare and Medicaid Services
(CMS), and implemented by the American Medical Association’s Specialty
Society RVS Update Committee (RUC), specialty societies were instructed to
develop new CPT codes that combined the procedure codes with the
radiological supervision and interpretation (RS&I) code. New CPT codes
were established for foreign body retrieval, carotid angiography,
thrombolysis and chest tube procedures. These new codes are described in
this Update.
Coding of interventional radiology procedures can often seem a daunting
task. While the transition to bundled codes is ongoing, many codes that are
part of the component coding system remain in effect. This has resulted in
something of a hybrid coding system, with new bundled codes existing
alongside older component codes. Physicians and coders should exercise
care, as there are some scenarios where the two coding systems can be
utilized together. In this Update, we point out several of those scenarios.
Over the past years, the amount of volunteer time that SIR and ACR
members contribute to the coding and reimbursement process has
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FOREWORD
continued to grow. The efforts of the volunteer coders, physicians and
associates are gratefully acknowledged by the Society of Interventional
Radiology and American College of Radiology. Their work and insightful
comments have directly resulted in this 2013 Update.
Fairfax, Virginia
Reston, Virginia
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G L O S S A RY
glossary of acronyms
AAA
ABN
ABPTS
ACO
ACR
AMA
APC
ASC
AV
AVF
CAC
CF
CMD
CMS
CPT
DRG
E&M
GPCI
HCFA
HCPCS
HOPPS
ICD-CM
ICD-9-CM
IDE
IDTF
IVUS
LCD
MAC
MP
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
Conversion Factor
Carrier Medical Director
Centers for Medicare and Medicaid Services
Current Procedural Terminology
Diagnosis-related Group
Evaluation and Management
Geographic Practice Cost Index
Health Care Financing Administration
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 Ultrasound
Local Coverage Determination
Medicare Adminstrative Contractor
Malpractice
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G L O S S A RY
MPFS
MPPR
MUE
NCCI
NEC
NCHS
NOS
NP
PA
PE
PIN
POS
PTA
RAC
RAW
RBMA
RBRVS
RFA
RS&I
RS/IS&I
RUC
RVS
RVU
SIR
SOAP
TAA
Medicare Physician Fee Schedule
Multiple Procedure Payment Reduction
Medically Unlikely Edit
National Correct Coding Initiative
Not Elsewhere Classified
National Center for Health Statistics
Not Otherwise Specified
Nurse Practitioner
Physician’s Assistant
Practice Expense
Provider Identification Number
Place of Service
Percutaneous Transluminal Angioplasty
Recovery Audit Contractor
Relativity Assessment Workgroup
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
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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/about-cpt/category-iii-codes.shtml.
C AT E G O RY I I I
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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, including
G - C o d e s These are temporary codes issued by CMS to describe
procedures and professional services.
S - C o d e s These 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.
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THE BASICS
OF CODING
RBRVS
the basics of coding
and reimbursement
T H E R E L AT I V E VA L U E P AY M E N T S Y S T E M ( R B R V S )
In 1992, Medicare adopted a national system of payment using the
Resource-based Relative Value Scale (RBRVS). Under the RBRVS, procedures
are weighted and assigned a value on the basis of their difficulty, intensity,
time and resource utilization. In the RBRVS system, a procedure’s RVU total
is derived by summing the physician’s work (time and intensity), the
practice expense (PE) related to performing the service, and malpractice
costs associated with the procedure.
Additionally, in order to take into account regional cost variations, CMS folds
in what is termed the Geographic Practice Cost Index (GPCI). The GPCI
rates are reviewed annually by CMS for their relevancy and accuracy.
Finally, every year, CMS publishes in the Final Rule for the Physician Fee
Schedule a figure called the conversion factor (CF). For CY 2013, the CF is
$34.0230.
Determining how much a service is paid is not a straightforward task.
In recent years, most of the Medicare Administrative Contractors (MACs)
have published on their Web sites helpful tables that show the physician fee
schedule for the coming year for their covered region.
Depending on whether a provider practices in the nonfacility (i.e., physician
office) or facility (i.e., hospital) setting, the actual formula for provider
payment is as follows:
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CPT PROCESS
2013 Nonfacility Pricing Amount = [(Work RVU * Work GPCI) +
(Transitioned Nonfacility PE RVU * PE GPCI) + (MP (Malpractice) RVU *
MP GPCI)] * CF
2013 Facility Pricing Amount = [(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
On the member’s homepage of www.SIRweb.org, SIR has created tables that
display all of the RVU component values for the common interventional
radiology CPT codes.
CPT PROCESS
CPT codes are developed by the AMA CPT Editorial Panel in consultation
with CMS and the CPT Advisory Committee which includes representatives
from numerous specialty and subspecialty societies and allied medical
societies. CPT Advisory Committee membership is limited to those national
medical societies seated in the AMA House of Delegates.
Since the practice of medicine is dynamic, the need for new CPT codes to
reflect changes in practice often arises. Code change proposals are
submitted to the AMA through the medical specialty societies, or
individually, through a standard application process. Assessment of the
supporting scientific literature and informal survey by the societies of a
number of individuals performing the procedure in question helps assess
the need for the new procedural code, its validity and the language that will
be proposed to describe it. After a case can be made to support editing CPT
to include a new procedure, the application is heard by the CPT Editorial
Panel, which contains representatives of approximately 20 medical and
allied organizations.
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THE BASICS
OF CODING
RUC PROCESS
The AMA holds three CPT Editorial Panel meetings per year, most commonly
in February, May and October. To ensure release of the upcoming year’s
updated CPT manual each fall, all proposed additions or revisions to
Category I CPT codes for the upcoming calendar year must be heard by the
Panel by the preceding February meeting. For example, new Category I
codes approved by the Panel at the May 2011, October 2011 and February
2012 Panel meeting are reflected in the 2013 edition of CPT. The CPT cycle
has stringent deadlines for submission of proposals that are well in advance
of Panel meetings to ensure all advisers have an opportunity to review and
comment.
The general public is allowed to register for and attend AMA CPT Editorial
Panel meetings. Information regarding CPT submission deadlines and
Panel meetings can be found on the AMA Web site,
www.ama-assn.org/ama/pub/category/3113.html.
RUC PROCESS
When the CPT Editorial Panel approves a new Category I CPT code,
including newly bundled codes, the RUC process is initiated and a
recommended relative value is developed. This provides Medicare and other
payers a uniform scale on which to base payment. In the case of a revised
code, depending on the nature of the change, the code’s value may be
reevaluated through the RUC process. Category III codes are not referred to
the RUC for valuation; instead reimbursement levels are set directly by those
carriers electing to provide coverage for the performance of these
“emerging technologies.”
The RVS Update Committee (RUC) develops physician work RVU
recommendations for new and revised CPT codes. Specialties comprising
the RUC Advisory Committee designate their level of interest for developing
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THE BASICS
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RUC PROCESS
work RVU recommendations based on recent actions taken by the CPT
Editorial Panel. The supporting societies must survey members of their
organizations using a standardized survey tool for data on time, intensity and
risk of the procedure, including all the necessary pre- and postprocedural
work. Based on the amount of physician work involved, each individual
surveyed is asked to weigh the procedure in comparison to a defined
standard procedure with which they are familiar. These data are assimilated
and summarized for the valuation process. If more than one specialty is
involved, a consensus value must be reached.
Direct practice expenses including supplies, equipment and clinical staff
time are also examined for both in-facility(hospital) and nonfacility (office)
settings. For example, even for facility-based services there is often a direct
practice expense for clinical staff time spent on the completion of
preservice diagnostic/referral forms, coordination of presurgery services,
scheduling of facility space for a procedure, review of test and exam results,
follow-up phone calls and prescriptions. As with the physician work value,
these data are also summarized for consideration by the RUC and, if more
than one specialty is involved, consensus regarding these inputs must be
reached.
The proposed work value along with practice expense inputs for officebased procedures are submitted for consideration by the (RUC). After
debate, the RUC will recommend physician work and practice expense
values that serve as recommendations to the Centers for Medicare and
Medicaid Services (CMS), which is the final decision-maker regarding RVUs.
CMS’ final decision on RVUs and other payment policies usually appear each
November in the Federal Register. (A copy of the Physician Fee Schedule is
available to the general public for download via the CMS Web page,
www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp.)
Mandated “budget neutrality” may negatively impact the payment associated
with RVUs of existing codes when new codes are created. The extent of any
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THE BASICS
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CMS SCREENS
change is determined by the number of RVUs assigned to the procedure and
the number of times the procedure is performed annually. This provides a
clear incentive to societies with representatives on the RUC to assure that
all valuations are fair and accurate.
The Medicare RVS is designed to pay for services on the basis of the amount
of work involved without regard to the specialty of the provider(s)
performing the service. Since 1992, all physician specialty types use the
same code(s) to report the procedural component of an interventional
radiology service. Similarly, the supervision of imaging personnel and
interpretation of images obtained during the procedure is reported by the
use of radiological supervision and interpretation/imaging supervision and
interpretation (RS/IS&I) code(s) without regard to the specialty of the
physician who performs the service. If a single physician performs both
phases of the service, that single physician utilizes both codes (i.e.,
procedural and RS/IS&I). If several physicians perform portions of a service,
each reports only those codes reflecting the procedure that they performed.
CMS SCREENS AND HOW CODES ARE ASSIGNED
TO THE RUC PROCESS
In their rule-making process, CMS has identified groups of codes they feel
are misvalued using 12 different screens including: New Technology, High
Volume Growth, Fastest Growing Procedures and old Harvard-valued codes
with utilization over 30,000 procedures annually. For additional information
on the RUC screening process, see
www.ama-assn.org/resources/doc/rbrvs/five-year-progress.pdf.
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THE FIVE-YEAR
REVIEW
THE FIVE-YEAR REVIEW
Since the implementation of the Medicare Resource-based Relative Value
Scale (RBRVS) Physician Fee Schedule in January 1992, Congress (through
the Omnibus Budget Reconciliation Act of 1990) has required CMS to
review the physician’s work relative value units within the Medicare Fee
Schedule (MFS). CMS is required to conduct these reviews at least once
every five years. This process, known as the Five-year Review, is used to
identify, and reconsider the valuation of, potentially misvalued codes. The
results from the first Five-year Review were implemented on Jan. 1, 1997,
and subsequent reviews have been implemented every five years with the
most recent implementation in 2012. Currently, the review process focuses
only on the physician work RVU values. However, it is expected that future
reviews will include re-examination of the practice expense RVU values for
potentially misvalued codes as well.
THE RUC ROLLING FIVE-YEAR REVIEW
In 2006, prompted by concerns raised by MedPAC, legislators, CMS and
others, the AMA established the Five-year Review Identification Workgroup
as a subcommittee under the RUC. The Five-Year Review Identification
Workgroup (now known as the Relativity Assessment Workgroup [RAW])
engages in a “rolling,” ongoing process to identify potentially misvalued
codes outside the traditional, formal Five-year Review process. Since its
inception, the Workgroup has targeted more than 320 codes for further
review by the RUC including many radiology and interventional radiology
codes.
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THE BASICS
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NCCI
N AT I O N A L C O R R E C T C O D I N G I N I T I AT I V E ( N C C I )
In order to prevent payment of perceived abuses in procedural reporting,
Congress authorized HCFA (now CMS) to begin the National Correct
Coding Initiative (NCCI) in 1996. The primary intent of the NCCI has been
to identify coding pairs that cannot or should not be performed at the same
time (so called "mutually exclusive" pairs), and to promote “correct coding”
of services reported together including the prevention of billing of inherent
procedures in conjunction with comprehensive procedures (commonly
referred to as “unbundling”).
NCCI edits are developed by CMS through a subcontract with Correct
Coding Solutions LLC (http://correctcodingsolutions.com/). Most proposed
new NCCI edits are distributed by the AMA to specialty societies for
comment, which may include critique of the appropriateness of the edits, as
well as applicable use of the NCCI modifier indicator. CMS and Correct
Coding Solutions review comments with follow-up communication when
necessary. Following the comment process, edits to be implemented go
forward as part of regular quarterly carrier system updates.
An NCCI modifier indicator of “0” indicates that NCCI-associated modifiers
cannot be used to bypass the edit. A modifier indicator of “1” indicates that
NCCI-associated modifiers can be used to bypass an edit under appropriate
circumstances. (Please see the Modifier chapter for additional information.)
NCCI edits including identification of the associated modifier indicator
status are available to the public free-of-charge and can be downloaded from
the CMS Web page,
www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage.
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MUES
Effective Jan. 1, 2013, two new NCCI-associated modifiers have been added:
modifiers - 2 4 and - 5 7 .
M o d i f i e r - 2 4 Unrelated evaluation and management service by the
same physician or other qualified health care professional during a
postoperative period
M o d i f i e r - 5 7 Decision for surgery
M E D I C A L LY U N L I K E LY E D I T S ( M U E S )
Beginning in January 2007 CMS began using national “medically unlikely
edits” (MUEs). These edits are commonly referred to as frequency unit edits;
they result in the limitation of the frequency (or number of units) that a
particular service can be reported by the same provider/provider group for
a given date of service.
ADD-ON CODE EDITS
Edits are also known to exist that limit the use of certain “add-on” codes
(those codes are identified with a “+ ” designation). These edits result in
rejection of the add-on code when reported in conjunction with a code not
on the approved list. CMS has asserted that these edits are determined at the
local level.
The SIR and ACR coding advisers carefully review all the proposed NCCI
edits, and the Society frequently comments and submits opinion letters
objecting to a proposed edit if clinical scenarios and typical patient care
practices indicate that the edit might be in error.
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evaluation and
management (E&M) codes
Several years ago, CMS eliminated payment for outpatient (9 9 2 4 1 to
9 9 2 4 5 ) and inpatient (9 9 2 5 1 to 9 9 2 5 5 ) consultation codes.
Consultations performed in an outpatient office are coded using the existing
codes for new (9 9 2 0 1 to 9 9 2 0 5 ) or established (9 9 2 1 1 to 9 9 2 1 5 )
patients. Consultations performed on inpatients are coded using the existing
codes for initial (9 9 2 2 1 to 9 9 2 2 3 ) or subsequent (9 9 2 3 1 to
9 9 2 3 3 ) hospital care visits. This does not mean that consultations should
not be performed on Medicare patients. The CPT codes for consultation
services have not been eliminated. When these services are provided to
Medicare patients, they will be billed with different codes as outlined above.
Elimination of payment for consultation codes has been evolving for several
years because of discrepancies between the CMS requirements for
consultations and the AMA interpretation of these requirements. This led to
a CMS finding that consultation services were often billed inappropriately
by not meeting the definition of a consultation or not having appropriate
documentation to support the use of consultation codes. Furthermore, the
documentation requirements for consultations, which were initially stricter
than for other types of E&M services, are now similar to these other services
and, therefore, do not warrant the higher payment that was associated with
consultation services.
The work relative value units (RVUs) for new and established office visits
have increased by approximately 6 percent to reflect the elimination of the
office consultation codes. The work RVUs for initial hospital and facility
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visits are increased by approximately 2 percent. This has increased the
payments for both of these services. In addition, the increased use of these
visits will be incorporated into PE and MP RVU calculations.
Finally, the incremental work RVUs for the E&M codes that are built into the
10-day and 90-day global surgical codes were increased as well.
Third-party payers have not released information about reporting
consultations. Payers may or may not choose to follow this policy. Therefore,
all physicians providing consultation services must be aware of the payment
policies from their local and regional providers to know which codes to
submit when rendering these services.
E&M CODING AND INTERVENTIONAL RADIOLOGISTS
Over the past several years, SIR has encountered a handful of instances in
which some hospital systems or payers deny payment for E&M claims
submitted by radiologists and interventional radiologists. SIR’s standing
position is that E&M services are allowable and can be appropriately
claimed by any provider performing the services, including radiologists and
interventional radiologists. Interventional radiologists perform total patient
care; it is fully appropriate for interventional radiologists to document such
care with E&M codes. We understand that some carriers have denied
payments for E&M services provided by all radiologists because they have
assumed that the services that were being reported were not true E&M
services but rather focused history and physicals to satisfy Joint Commission
(formerly Joint Commission on Accreditation of Healthcare Organizations)
requirements for current documentation on the chart for invasive
procedures.
Our Society has worked with several of these carriers to educate them on
the actual E&M work provided by clinical interventional radiologists and to
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differentiate these E&M services from the work that is already included in
invasive procedure valuations.
Many interventional radiology procedures require longitudinal care,
identical to many other fields of medicine. Patients are evaluated
preprocedure to determine their state of health, presenting illness and
underlying conditions. Appropriate testing is ordered to fully diagnose their
pathology. The patient is advised of all potential treatment options
including, but not limited to, options provided by interventional
radiologists. If the patient’s condition is deemed suitable for treatment by
the interventional radiologist, then he or she is scheduled for treatment and
the service is rendered. Follow-up care is given as appropriate, and patients
are often followed in a clinical office to monitor the effectiveness of the
therapy and the progress of the underlying condition. Additionally,
radiologists providing breast care, specifically mammography services, also
perform separate E&M services, advising patients on treatment options. This
is entirely analogous to services as provided by medical and surgical
specialists such as gastroenterologists, surgeons and cardiologists.
In another example of appropriate E&M, an interventional radiologist is
asked to provide his or her clinical opinion regarding the appropriateness of
a procedure for a given patient. When a patient is referred by another
physician, the specialist physician routinely documents his or her services
with an E&M code. For example, interventional radiologists see patients who
have been referred for possible procedures for spinal fractures
(vertebroplasty/kyphoplasty), peripheral arterial disease, uterine fibroids
and oncologic cases (e.g., ablation therapies and Y-90 spheres).
For inpatients, it is appropriate to perform and document consults. If the
consult is performed and fully documented on the same day as a procedure,
one should add modifier – 5 7 to the E&M code, designating that the consult
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led to a decision to treat and is a separate service. Inpatient rounds also lead
to frequent changes in patient management. For inpatient rounds, IR
physicians should follow the global period rules for billing.
As a result of these evaluations, many patients referred for a specific
procedure may ultimately have care that differs from the procedure named
on the request. A procedure may be cancelled or changed to a different
procedure and follow-up or additional imaging may be recommended rather
than a procedure. Hospitals may use different information systems, but it is
important to note that, when a physician orders a procedure from the
interventional radiology department, the interventional radiologist will still
be required to exercise his or her clinical evaluative skills and judgment
before performing the procedure. There are easily conceivable scenarios in
which a procedure is ordered but, after a review of all medical information,
the interventional radiologist decides that such a procedure is not
warranted. The interventional radiologist would communicate this decision
to the referring physician and would document and charge for his or her
consultation but not the procedure. If the procedure is indeed warranted
and performed by the IR, the IR will still have been required to evaluate the
patient.
For inpatient rounds, interventional radiologists should follow the global
period rules for billing. Inpatient rounds lead to frequent changes in patient
management. All of the above clinical actions are appropriately billed with
E&M codes. E&M coding is appropriate for IR clinical work and indicates
that a higher level of care is being offered to patients under the care of that
IR practice. SIR has always made a distinction between routine
preprocedure care and the more complex and time-consuming patient
interaction that takes place as part of a formal consult. To help clarify the
guidelines, SIR stated in 2006: “If you are asked to see a patient for input
into that patient’s management and you evaluate that patient to develop an
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assessment and plan and then document the encounter and your
recommendations appropriately, then you have performed the work of a
consultation and should bill the correct E&M code. However, if you are
seeing a patient before a previously arranged procedure and the purpose of
that visit is to confirm that the patient can go through that procedure and to
obtain informed consent for the procedure, then consider that encounter to
be bundled into the procedure itself and do not bill separately for that
encounter. Only you will know the reason for the encounter and therefore
only you can make that decision.” (“Coding for Consultations in
Interventional Radiology,” IR News, Nov./Dec. 2006, p. 14;
http://members.SIRweb.org/members/newsPDF/IRNewsNovDec2006.pdf).
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REVISED IR
CODES FOR
NEW AND REVISED
interventional radiology
codes for 2013
REVISED INTERVENTIONAL RADIOLOGY CODES FOR 2013
For 2013, a number of revisions and code clarifications were added to
several common codes used by interventional radiologists.
Ve r t e b r a l B o d y, E m b o l i z a t i o n o r I n j e c t i o n
The add-on code + 2 2 5 2 2 (each additional thoracic or lumbar vertebral
body [List separately in addition to code for primary procedure]) has been
revised to include moderate (conscious) sedation. The AMA CPT manual
denotes the inclusion with the bull’s eye symbol ☉.
Respiratory System
New codes for endoscopy procedures have been created for 2013.
Bronchoscopy
Codes 3 1 6 2 2 – 3 1 6 4 8 include fluoroscopic guidance, when performed.
☉3 1 6 2 2 Bronchoscopy, rigid or flexible, including fluoroscopic
guidance, when performed, diagnostic, with cell washing, when performed
(separate procedure)
☉31623
with brushing or protected brushings
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☉31624
with bronchial alveolar lavage
☉31625
with bronchial or endobronchial biopsy(s), single and
multiple sites
☉31626
with placement of fiducial markers, single or multiple
☉31627
with computer-assisted, image-guided navigation (list
separately in addition to code for primary procedure(s)
☉31628
with transbronchial lung biopsy(s), single lobe
☉31629
with transbronchial needle aspiration biopsy(s), trachea,
main stem and/or lobar bronchus(i)
☉31634
with balloon occlusion, assessment of air leak, with
administration of occlusive substance (e.g., fibrin glue) if
performed
(Do not report 3 1 6 3 4 in conjunction with 3 1 6 4 7 ,
3 1 6 5 1 at the same session.)
☉31635
with removal of foreign body
(For removal of implanted bronchial valves
see 3 1 6 4 8 – 3 1 6 4 9 .)
☉31647
with balloon occlusion, when performed, assessment of air
leak, airway sizing and insertion of bronchial valve(s), initial
lobe
☉31648
with removal of bronchial valve(s), initial lobe removal
and insertion of bronchial valve at the same session,
see 3 1 6 4 7 , 3 1 6 4 8 and 3 1 6 5 1 )
(3 1 6 5 6 has been deleted. To report, see code 3 1 8 9 9 .)
CODES FOR
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Bronchial Thermoplasty
CODES FOR
2013
☉ 3 1 6 6 0 Bronchoscopy, rigid or flexible, including fluoroscopic
guidance, when performed; with bronchial thermoplasty, 1 lobe
☉31661
with bronchial thermoplasty, 2 or more lobes
(3 1 7 1 5 has been deleted. To report, use code 3 1 8 9 9 .)
Lungs and Pleura
(3 2 4 2 0 has been deleted. To report, use 3 2 4 0 5 .)
(3 2 4 2 1 and 3 2 4 2 2 have been deleted. To report, see codes 3 2 5 5 4 ,
3 2 5 5 5 .)
(3 2 5 5 1 has been revised for tube thoracostomy to indicate that this code
is now used for reporting an open procedure.)
☉ 3 2 5 5 3 Placement of an interstitial device(s), for radiation therapy
guidance (e.g., fiducial markers, dosimeter), percutaneous, intrathoracic,
single or multiple
(Report supply of device separately.)
For 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, report ☉ 4 9 4 1 1 .
Imaging guidance codes (7 6 9 4 2 , 7 7 0 0 2 , 7 7 0 1 2 or 7 7 0 2 1 ) and
device codes (e.g., A 4 6 4 8 tissue marker, A 4 6 5 0 implantable radiation
dosimeter or A 4 6 4 9 surgical supply) are reported separately in
conjunction with the percutaneous placement procedure codes.
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NEW 2013 CPT CODES COMMON TO
INTERVENTIONAL RADIOLOGY
Thoracentesis
Four new codes have been created describing thoracentesis and pleural
drainage. Codes 3 2 5 5 4 – 3 2 5 5 7 are NOT to be reported in conjunction
with codes 3 2 5 5 0 , 3 2 5 5 1 , 7 6 9 4 2 , 7 7 0 0 2 , 7 7 0 1 2 , 7 7 0 2 1 ,
75989.
3 2 5 5 4 Thoracentesis, needle or catheter, aspiration of the pleural space;
without imaging guidance
32555
with imaging guidance
3 2 5 5 6 Pleural drainage, percutaneous, with insertion of indwelling
catheter; without imaging guidance
32557
with imaging guidance
To report insertion of indwelling tunneled pleural catheter with cuff, see
code 3 2 5 5 0 .
Moderate sedation is NOT inherent to procedure codes 3 2 5 5 4 – 3 2 5 5 7
and should be reported separately when these services are provided.
Cervicocerebral Angiography
Eight new cervicocerebral angiography codes have been created to report
nonselective and selective arterial catheter placement and diagnostic
imaging of the aortic arch, carotid and vertebral arteries, 3 6 2 2 1 – 3 6 2 2 8 .
Accompanying the new codes is extensive introductory language describing
the new codes and reporting instructions. This new section starts on p. 207
of the CPT 2013, Professional Edition code book.
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These codes describe arterial contrast injections with arterial, capillary and
venous-phase imaging, when performed. Accessing the vessel, placement of
catheter(s), contrast injection(s), fluoroscopy, RS&I and the closure of the
arteriotomy by pressure or by application of an arterial closure device is
inherent in codes 3 6 2 2 1 – 3 6 2 2 6 and not separately reportable.
Moderate sedation is included in the new codes, and is not separately
reportable.
Codes 3 6 2 2 1 – 3 6 2 2 6 progress up a hierarchy in which the lesser
intensive services are included in the higher intensity code—i.e., use the
code of the most intensive service provided. For example, 3 6 2 2 1 is
reported for nonselective catheter placement, thoracic aorta, with
angiography of the aortic arch and great vessel origins. Do not report
3 6 2 2 1 in conjunction with 3 6 2 2 2 – 3 6 2 2 6 selective codes, as these
include the work of 3 6 2 2 1 when performed.
☉ 3 6 2 2 1 Nonselective catheter placement, thoracic aorta, with
angiography of the extracranial carotid, vertebral, and/or intracranial vessels,
unilateral or bilateral, and all associated radiological supervision and
interpretation, includes angiography of the cervicocerebral arch, when
performed.
(Do not report 3 6 2 2 1 with 3 6 2 2 2 – 3 6 2 2 6 .)
☉ 3 6 2 2 2 Selective catheter placement, common carotid or innominate
artery, unilateral, any approach, with angiography of the ipsilateral
extracranial carotid circulation and all associated radiological supervision
and interpretation, includes angiography of the cervicocerebral arch, when
performed.
☉ 3 6 2 2 3 Selective catheter placement, common carotid or innominate
artery, unilateral, any approach, with angiography of the ipsilateral
intracranial carotid circulation and all associated radiological supervision
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and interpretation, includes angiography of the extracranial carotid and
cervicocerebral arch, when performed.
☉ 3 6 2 2 4 Selective catheter placement, internal carotid artery, unilateral,
with angiography of the ipsilateral intracranial carotid circulation and all
associated radiological supervision and interpretation, includes angiography
of the extracranial carotid and cervicocerebral arch, when performed.
Do not report 3 6 2 2 2 , 3 6 2 2 3 or 3 6 2 2 4 together for ipsilateral
angiography. Select the most comprehensive service following the hierarchy
of complexity.
☉ 3 6 2 2 5 Selective catheter placement, subclavian or innominate artery,
unilateral, with angiography of the ipsilateral vertebral circulation and all
associated radiological supervision and interpretation, includes angiography
of the cervicocerebral arch, when performed.
☉ 3 6 2 2 6 Selective catheter placement, vertebral artery, unilateral, with
angiography of the ipsilateral vertebral circulation and all associated
radiological supervision and interpretation, includes angiography of the
cervicocerebral arch, when performed.
Do not report 3 6 2 2 5 with 3 6 2 2 6 for ipsilateral angiography. Select the
most comprehensive service following the hierarchy of complexity.
☉ + 3 6 2 2 7 Selective catheter placement, external carotid artery,
unilateral, with angiography of the ipsilateral external carotid circulation
and all associated radiological supervision and interpretation (List separately
in addition to code for primary procedure.)
(Use 3 6 2 2 7 in conjunction with 3 6 2 2 2 , 3 6 2 2 3 or 3 6 2 2 4 .)
☉ + 3 6 2 2 8 Selective catheter placement, each intracranial branch of the
internal carotid or vertebral arteries, unilateral, with angiography of the
selected vessel circulation and all associated radiological supervision and
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interpretation (e.g., middle cerebral artery, posterior inferior cerebellar
artery). (List separately in addition to code for primary procedure.)
(Use 3 6 2 2 8 in conjunction with 3 6 2 2 4 or 3 6 2 2 6 .)
(Do not report 3 6 2 2 8 more than twice per side.)
Add modifier – 5 0 to codes 3 6 2 2 2 – 3 6 2 2 8 if the same procedure is
performed on both sides. Modifier – 5 9 may be used to indicate when
different carotid and/or vertebral arteries are being studied in the same
session.
Report 7 6 3 7 6 or 7 6 3 7 7 for 3D rendering when performed in
conjunction with 3 6 2 2 1 – 3 6 2 2 8 .
Report 7 6 9 3 7 for ultrasound guidance for vascular access, when
performed in conjunction with 3 6 2 2 1 – 3 6 2 2 8 .
Deleted RS&I Codes
As part of the new bundled cervicocerebral angiography codes, several
angiography supervision and interpretation codes have been deleted. These
are in the radiology section of CPT, under the subheading Vascular
System—Aorta and Arteries RS&I.
7 5 6 5 0 To report see codes 3 6 2 2 1 – 3 6 2 2 6 .
7 5 6 6 0 To report see code 3 6 2 2 7 .
7 5 6 6 2 To report use code 3 6 2 2 7 and append modifier – 5 0 .
7 5 6 6 5 To report see codes 3 6 2 2 3 , 3 6 2 2 4 .
7 5 6 7 1 To report see codes 3 6 2 2 3 and 3 6 2 2 4 and append modifier
– 5 0 as appropriate.
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7 5 6 7 6 To report see codes 3 6 2 2 2 – 3 6 2 2 4 .
7 5 6 8 0 To report see codes 3 6 2 2 2 – 3 6 2 2 4 and append modifier – 5 0
as appropriate.
7 5 6 8 5 To report see codes 3 6 2 2 5 – 3 6 2 2 6 .
Fo r e i g n B o d y R e t r i e v a l
For 2013, a new bundled CPT code has been created that bundles the
procedure with the radiological supervision and interpretation. The previous
CPT code for foreign body retrieval, 3 7 2 0 3 , has been deleted, along with
the RS&I code, 7 5 9 6 1 .
☉ 3 7 1 9 7 Transcatheter retrieval, percutaneous, of intravascular foreign
body (e.g., fractured venous or arterial catheter), includes radiological
supervision and interpretation, and imaging guidance (ultrasound or
fluoroscopy), when performed
(7 5 9 6 1 has been deleted. To report, use code 3 7 1 9 7 .)
(For percutaneous retrieval of a vena cava filter, use 3 7 1 9 3 .)
Tr a n s c a t h e t e r T h r o m b o l y s i s
Four new codes have been created to report transcatheter thrombolytic
arterial or venous infusion. These new codes cover the entire therapeutic
period of time. Critical guidance on these new codes is shown on p. 218 of
the CPT 2013 Professional Edition printed code book.
Codes 3 7 2 1 1 and 3 7 2 1 2 are used to report the initial day of
transcatheter thrombolytic infusion including follow-up
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arteriography/venography and catheter position change or exchange,
when performed. When initiation and completion of thrombolysis
occur on the same calendar day, report only 3 7 2 1 1 or 3 7 2 1 2 .
Catheter placement(s), diagnostic studies and other percutaneous
interventions may be reported separately.
Codes 3 7 2 1 1 – 3 7 2 1 4 include fluoroscopic guidance and associated
RS&I. Ultrasound guidance for vascular access—see code 7 6 9 3 7 —may be
reported separately when all required elements are performed.
Bilateral thrombolytic infusion through separate access site(s) may be
reported with modifier – 5 0 in conjunction with 3 7 2 1 1 , 3 7 2 1 2 .
Radiological supervision and interpretation codes 7 5 8 9 6 and 7 5 8 9 8
have been revised and are not to be reported in conjunction with
3 7 2 1 1 – 3 7 2 1 4 for thrombolysis infusion management.
 3 7 2 1 1 Transcatheter therapy, arterial infusion for thrombolysis other
than coronary, any method, including radiological supervision and
interpretation, initial treatment day.
 3 7 2 1 2 Transcatheter therapy, venous infusion for thrombolysis, any
method, including radiological supervision and interpretation, initial
treatment day.
 3 7 2 1 3 Transcatheter therapy, arterial or venous infusion for
thrombolysis other than coronary, any method, including radiological
supervision and interpretation, continued treatment on subsequent day,
during course of thrombolytic therapy, including follow-up catheter contrast
injection, position change, or exchange, when performed
37214
cessation of thrombolysis including removal of catheter and
vessel closure by any method
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The previous code for thrombolysis, 3 7 2 0 1 , has been deleted—see codes
37211–37214.
Code 7 5 9 0 0 has been deleted; see codes 3 7 2 2 1 – 3 7 2 1 4 for reporting
exchange of a previously placed intravascular catheter during thrombolytic
therapy.
Diagnostic Radiology (Diagnostic Imaging)
Chest
7 1 0 4 0 , 7 1 0 6 0 have been deleted. To report, use 7 6 4 9 9 .
Spine and Pelvis
7 2 0 4 0 Radiologic examination, spine, cervical; 3 views or less
72050
4 or 5 views
72052
6 or more views
7 2 2 7 5 Epidurography, radiological supervision and interpretation
(7 2 2 7 5 includes 7 7 0 0 3 )
(For injection procedure, see 6 2 2 8 0 – 6 2 2 8 2 , 6 2 3 1 0 – 6 2 3 1 9 ,
6 4 4 7 9 – 6 4 4 8 4 .)
(Use 7 2 2 7 5 only when an epidurogram is performed, images documented,
and a formal radiologic report is issued.)
(Do not report 7 2 2 7 5 in conjunction with 2 2 5 8 6 , 0 1 9 5 T , 0 1 9 6 T ,
0 3 0 9 T .)
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R a d i o l o g y G u i d e l i n e s , Va s c u l a r P r o c e d u r e s —
Aorta and Arteries
Parenthetical revisions have been added for aortography codes 7 5 6 0 0 ,
7 5 6 0 5 and 7 5 6 3 5 and angiography, pulmonary codes 7 5 7 4 6 , 7 5 7 5 6
and 7 5 7 7 4 . Providers may review these changes in the CPT® 2013
codebook.
E N D O VA S C U L A R R E VA S C U L A R I Z AT I O N
Guidelines have been updated for lower-extremity endovascular procedures
for 2013 to inform users of specific types of closure procedures that are
inherent to these procedures, and which specify services that are separately
reportable.
When treating multiple vessels within a territory, report each additional
vessel using an add-on code, as applicable. Select the base code that
represents the most complex service using the following hierarchy of
complexity (in descending order of complexity): atherectomy and stent>
atherectomy >stent >angioplasty. When treating multiple lesions within the
same vessel, report one service that reflects the combined procedures,
whether done on one lesion or different lesions, using the same hierarchy.
These codes take into account that multiple techniques may be needed in
order to open areas of disease in some vessels, and that these interventions
may take place in different vascular territories. In general, the codes for
interventions progress up a hierarchy of intensity with the work of the lessintense intervention included in the higher intensity code. For example,
angioplasty prior to a stent placement would be a progression up this
hierarchy and only the stent code would be reported. Each of these codes
includes the work of accessing the artery, selecting the vessel, crossing the
lesion, interpreting the images, performing therapeutic intervention(s) in
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the entire vessel segment, using any embolic protection device, performing
final image interpretation and closing the arteriotomy by any method. If
angioplasty is performed in addition to facilitate a more advanced
procedure, such as atherectomy, or stenting, it is included in the code for the
more advanced procedure. Moderate sedation is also included in each of
these codes. Mechanical thrombectomy and thrombolysis are not included
in the work of codes 3 7 2 2 0 – 3 7 2 3 5 and can be reported additionally
with the appropriate component codes when these techniques are used in
combination with PTA/stenting/atherectomy to restore flow to areas of
occlusive disease. As in the past, thrombolysis used as part of mechanical
thrombectomy is not separately reportable. When a thrombolytic infusion is
performed either subsequent or prior to mechanical thrombectomy, it is
separately reported. The codes apply to the procedure if performed
percutaneously or open.
Revascularization procedures are grouped into three vascular territories
based on the anatomy and are specific to the procedures of angioplasty,
stenting or atherectomy. (PTA is considered an inherent part of stenting or
atherectomy procedures and is not separately reportable.) Each code
applies to a single extremity.
1 Iliac territory: subdivided into common, internal and external iliac artery
a 37220–37223
b Single code used for a single vessel
c Add-on codes used for additional iliac vessels that are treated
(common, internal or external)
2 Femoral/popliteal territory: this entire territory is considered a single
vessel
a 37224–37227
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b Includes the common, deep and superficial femoral as well as
popliteal
c Since it is a single vessel, only a single code may be reported,
even if multiple lesions are treated
d If two procedures are performed in different areas of the vessel
territory, report the code that includes all therapies provided in that
region.
3 Tibial/peroneal territory: subdivided into anterior tibial, posterior tibial
and peroneal
a 37228–37235
b Report the initial vessel treated as the primary code for the highest
level of service provided within the tibial-peroneal territory with addon codes for additional vessels treated (not additional lesions or
procedures in the same vessel)
c The tibioperoneal trunk is not considered a separate vessel
If a lesion extends across the margin of a territory, but is opened with a
single therapy, report with only a single code. For example, if a distal
popliteal artery stenosis extends into the tibioperoneal trunk and the lesion
is treated with a single angioplasty spanning both lesions, only code a single
vessel treatment.
If both legs are treated at the same time, use modifier – 5 9 to indicate
separate and distinct services performed on the same day.
A “+ ” sign indicates an add-on code that must be used after the appropriate
code for the initial vessel treated.
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Iliac Artery Revascularization
 3 7 2 2 0 Revascularization, endovascular, open or percutaneous, iliac
artery, unilateral, initial vessel; with transluminal angioplast
37221
with transluminal stent placement(s), includes angioplasty
within same vessel when performed.)
 + 3 7 2 2 2 Revascularization, endovascular, open or percutaneous, iliac
artery, each additional ipsilateral iliac vessel; with transluminal angioplasty
(List separately in addition to code for primary procedure)
(Used in conjunction with 3 7 2 2 0 , 3 7 2 2 1 for additional iliac segment
PTA.)
+37223
with transluminal stent placement(s), includes angioplasty
within the same vessel, when performed (List separately in
addition to code for primary procedure)
(Used in conjunction with 3 7 2 2 1 for additional iliac
segment stent placement)
Femoral/Popliteal Artery Revascularization
 3 7 2 2 4 Revascularization, endovascular, open or percutaneous, femoral,
popliteal artery(s), unilateral; with transluminal angioplasty
37225
with atherectomy, includes angioplasty within the same
vessel, when performed
37226
with transluminal stent placement(s), includes angioplasty
within the same vessel, when performed
37227
with transluminal stent placement(s) and atherectomy,
includes angioplasty within the same vessel, when
performed
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Ti b i a l / P e r o n e a l A r t e r y R e v a s c u l a r i z a t i o n
 3 7 2 2 8 Revascularization, endovascular, open or percutaneous, tibial,
peroneal artery, unilateral, initial vessel; with transluminal angioplasty
37229
with atherectomy, includes angioplasty within the same
vessel, when performed
37230
with transluminal stent placement(s), includes angioplasty
within the same vessel, when performed
37231
with transluminal stent placement(s) and atherectomy,
includes angioplasty within the same vessel, when
performed
 + 3 7 2 3 2 Revascularization, endovascular, open or percutaneous,
tibial/peroneal artery, unilateral, each additional vessel; with transluminal
angioplasty (List separately in addition to code for primary procedure.)
(Used in conjunction with 3 7 2 2 8 – 3 7 2 3 1 .)
+37233
with atherectomy, includes angioplasty within the same
vessel, when performed. (List separately in addition to code
for primary procedure.)
(Used in conjunction with 3 7 2 2 9 , 3 7 2 3 1 .)
+37234
with transluminal stent placement(s), includes angioplasty
within the same vessel, when performed. (List separately in
addition to code for primary procedure.)
(Used in conjunction with 3 7 2 2 9 – 3 7 2 3 1 .)
+37235
with transluminal stent placement(s) and atherectomy,
includes angioplasty within the same vessel, when
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BENIGN
performed. (List separately in addition to code for primary
procedure.)
(Used in conjunction with 3 7 2 3 1 .)
S P E C I A L C O D I N G N O T E F O R 2 0 1 3 : E M B O L I Z AT I O N
T H E R A P Y F O R B E N I G N P R O S T AT I C H Y P E R P L A S I A ( B P H )
Benign prostatic hyperplasia (BPH) is a common ailment affecting many
men as they age. Symptomatic patients often suffer considerable lowerurinary-tract discomfort, and decreased quality of life is often associated
with BPH symptoms.
Embolization of the prostatic arteries is a procedure that has shown some
promise as a method to treat BPH in early small research studies, mostly
done in Europe and South America. Further clinical research and trials are
expected to commence in 2013 in the United States. SIR supports research
on this procedure and will be supporting and closely following these trials
to assess the early data and outcomes.
In terms of coding and reimbursement, given the experimental nature of the
procedure, SIR’s position is that physicians should discuss any proposed
prostatic embolization procedure with their patients’ relevant Carrier
Medical Directors. Since embolization for BPH is clearly an investigational
procedure at this time, physicians should check with the insurance carrier
prior to performing the procedure to determine if the procedure will be
covered and how the procedure should be coded. The carriers could request
that the procedure be coded with CPT code 3 7 7 9 9 (Unlisted Procedure,
vascular surgery) to indicate its investigational nature. If component coding
is allowed, the appropriate codes could include:
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BENIGN
• 3 7 2 0 4 (x1) (Transcatheter occlusion or embolization (e.g., for tumor
destruction, to achieve hemostasis, to occlude a vascular malformation),
percutaneous, any method, noncentral nervous system, non-head or neck),
• 7 5 8 9 4 (x1) (Transcatheter therapy, embolization any method,
radiological supervision and interpretation)
• 3 6 2 4 7 (Up to maximum of 2 times) (Selective catheter placement,
arterial system; initial third order or more selective abdominal, pelvic or
lower-extremity artery branch, within a vascular family)
• 3 6 2 4 8 catheter placement, arterial system; additional second order,
third order, and beyond, abdominal, pelvic, or lower extremity artery branch,
within a vascular family). 3 6 2 4 8 may be used if 2 branches have to be
catheterized for study and/or embolization on the same side
• 7 5 8 9 8 (x1) (Angiography through existing catheter for follow-up study
for transcatheter therapy, embolization or infusion, other than for
thrombolysis)
Diagnostic angiography would, in most cases, not be additionally reported
since the imaging of the pelvic vessels done prior to the embolization
would be done for roadmapping purposes rather than diagnosis of BPH.
However, if an interventional radiologist is performing the embolization as
part of a clinical trial site, the physician should likewise discuss the trial and
get pre-approval from the carrier prior to enrolling patients. There should be
agreement with the carrier prior to enrolling patients as to how the
procedures will be coded and paid. Some FDA IDE trials will allow use of
existing CPT codes while others may designate that existing CPT codes are
not applicable.
In 2013, SIR will draft a new Category III CPT code to describe prostatic
artery embolization for presentation to the American Medical Association’s
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REVISED
IR CODES
BENIGN
CPT Editorial Panel. Category III codes describe emerging technologies
or investigational procedures and also allow for data collection. If the
new code is approved, SIR will inform members promptly through its
outreach and educational venues, and it is anticipated that most carriers
will require use of the new Category III code for reporting prostatic artery
embolization to treat BPH.
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FA Q S
frequently asked questions
FA Q 1 How do I code for internal iliac artery embolizations at
the time of EVAR?
Embolization performed at the time of an endovascular repair of an
aneurysm (thoracic endovascular aortic repair [TEVAR] and endovascular
aneurysm repair [EVAR]), including embolization of a hypogastric artery, is
separately billable. Codes 3 7 2 0 4 , 7 5 8 9 4 , 7 5 8 9 8 and typically 3 6 2 4 5
are all appropriate to report this procedure. Use of a selective catheter
placement code for embolization obviates the use of the 3 6 2 0 0 for
placing a catheter in the aorta under coding convention rules.
FA Q 2 What are the appropriate codes to report for
sclerotherapy of nonvascular structures, such as seromas, cysts,
lymphoceles or abscesses?
The following CPT codes are reported for all nonvascular sclerosis
procedures (e.g., seroma, cyst, lymphocele, abscess):
2 0 5 0 0 (Injection of sinus tract; therapeutic [separate procedure])
7 6 0 8 0 (Radiologic examination, abscess, fistula or sinus tract study,
radiological supervision and interpretation)
The use of different agents (e.g., alcohol, tetracycline, betadine) does not
limit or alter the reporting of these codes.
Moderate sedation is not inherent to code 2 0 5 0 0 and is separately
reportable.
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9 9 1 4 4 Age 5 years or older, first 30 minutes intra-service time
+99145
Each additional 15 minutes intra-service time
Note that this is an add-on code (+ ) and must be used in
conjunction with 9 9 1 4 4 .
If the patient is being seen for new or worsening symptoms and E&M
services provided by the interventionalist to evaluate those symptoms, those
E&M services should be separately documented and coded. This E&M
service may need to be reported with the use of appropriate modifiers
(e.g., – 2 4 , – 2 5 ) as the patient’s recent operative history demands.
FA Q 3 What are the appropriate codes to use when microwave
ablation is the energy source used for liver, lung or renal lesions?
The existing CPT codes for tumor ablation are defined for radiofrequency
ablation. This definition has led to some confusion, occasionally resulting in
the use of unlisted procedure codes for microwave ablation.
SIR does not recommend the use of unlisted procedure codes for
microwave ablation of kidney, lung or liver tumors.
Microwave is part of the radiofrequency spectrum and uses a different part
of the radiofrequency spectrum to generate heat energy to destroy
abnormal soft tissue. Microwave ablation equipment is substantially
comparable to operate in practice, which is also reflected in the U.S. Food
and Drug Administration (FDA) approval of microwave devices under the
510(K) clearance process as equivalent to radiofrequency.
As such, SIR recommends that CPT codes 4 7 3 8 2 , 3 2 9 9 8 and 5 0 5 9 2
be used for both microwave and radiofrequency ablation in their respective
anatomic locations, in conjunction with the appropriate imaging guidance
code:
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4 7 3 8 2 Ablation, 1 or more liver tumor(s) percutaneous, radiofrequency;
with appropriate image guidance code: 7 7 0 1 3 (CT), 7 6 9 4 0 (US),
7 7 0 2 2 (MRI)
3 2 9 9 8 Ablation therapy for reduction or eradication of 1 or more
pulmonary tumor(s) including pleura or chest wall when involved by tumor
extension, percutaneous, radiofrequency, unilateral; with appropriate image
guidance code: 7 7 0 1 3 (CT), 7 6 9 4 0 (US), 7 7 0 2 2 (MRI)
5 0 5 9 2 Ablation, 1 or more renal tumor(s), percutaneous, unilateral,
radiofrequency; with appropriate image guidance code: 7 7 0 1 3 (CT),
7 6 9 4 0 (US), 7 7 0 2 2 (MRI)
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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,
therefore, a noncovered service. This is a formal request for individual
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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.
Life Expectancy, Rate of Tumor Growth and Tumor Control, for Lung
Cancer Patients. Life expectancies for lung cancer patients vary according
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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
Illinois University Division of Cardiothoracic Surgery, a provider of these
services, a thoracotomy incision is considered to be “one of the more
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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
tumor(s). This is believed to extend life expectancy and/or result in
increased comfort. Please see “Attachment A” for a list of supporting
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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 ]
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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
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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
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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
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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
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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
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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 ]
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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
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2002; 13:1149–1153) evaluated the importance of imaging prior to UAE and
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,
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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
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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.
2013
INTERVENTIONAL
PA G E
RADIOLOGY
60
C O D I N G U P D AT E
ONLINE SUPPLEMENT
SAMPLE
CHARGE
SHEETS
sample 2013
charge sheets
Find the updated 2013 interventional radiology coding charge sheets at
http://members.SIRweb.org/members/coding/chargeSheets.cfm
www.acr.org/codingpubs.
VASCULAR INTERVENTIONAL CHARGE SHEET
DATE:
REFERRING PHYSICIAN:
INTERVENTIONAL RADIOLOGIST:
Catheterization and Imaging Separately Reportable Unless Specifically Noted Otherwise for ALL Therapeutic Procedures
MCS-Moderate Conscious Sedation Indicator @: Do NOT additionally report Moderate Conscious Sedation codes in conjunction with these
Valuation for codes with @ in the MCS indicator column includes the physician work for conscious sedation.
Procedure
S&I
Procedure S&I
(x) MCS code
Code
(x) MCS Code
Code
THROMBOLYSIS AND INFUSION THERAPY
DIALYSIS ACCESS INTERVENTIONS
Transcatheter therapy, arterial infusion for thrombolysis other
than coronary
37211
Clot removal any method
@
36870
N/A
Venous infusion for thrombolysis
37212
Dialysis Fistulagram
@
36147
N/A
37213
Add'l puncture (document in dictation)
@
36148
N/A
Continued thrombolytic infusions(s) on subsequent day(s)
37214
PTA, A-V fistula arterial
35475
75962
Thrombolytic infusion(s) Final Day of therapy
37202
75896
PTA, A-V fistula venous
35476
75978
Infusion, Non-Thrombolytic
Infusion for Thrombolysis, cerebral
37195
75970
Fistulogram with needles in
N/A
75791
Intravascular stent
37205
75960
Angio thru exist cath F/U embo/other than for thrombolysis
49418
N/A
N/A
75898
Insertion of tunneled intraperitoneal catheter (eg, dialysis)
N/A
MECHANICAL THROMBECTOMY includes imaging guidance
Insertion of tunneled intraperitoneal catheter w/ subcutaneous po 49419
Primary Arterial Mech Thromb - initial vessel
@
Peritoneal dialysis catheter placement open
49421
N/A
37184
49422
N/A
Removal of tunneled intraperitoneal catheter
Primary Arterial Mech Thromb @
37185
Peritoneogram (Air &/or contrast)
49400
74190
2nd/and all subsequent vessel(s)
Secondary Mech Thromb- "rescue", suction, snare basket
@
37186
TRANSCATHETER THERAPY MISC.
Venous Mech Throm - Day 1
@
37187
Foreign Body Retrieval
@
37197
N/A
IVC Filter Insertion
@
37191
Venous Mech Throm - repeat mech thrombectomy on
subsequent day during a course of therapy
IVC Filter Respositioning
@
37192
@ 37188 x __
IVC Filter Retrieval (Removal)
@
37193
EMBOLIZATION (per surgical field)
INTRAVASCULAR ULTRASOUND*
Embolization (Non-Neuro, Non-UFE)*
37204
75894
imaging and catheterization(s)
37210
IVUS initial vessel
37250
75945
@
Each additional vessel IVUS
37251
75946
Cerebral Balloon Occlusion Test (BOT) includes
61623
imaging and catheterization of target vessel
PERCUTANEOUS ANGIOPLASTY
PTA, Renal or Visceral Artery
@
35471
75966
Embolization (CNS)* permanent
61624
75894
61626
75894
PTA, Aorta
@
35472
75966
Embolization (non-CNS) Head or Neck
F/U Angio study for transcatheter therapy,
embolization or infusion, other than for thrombolysis
PTA, Brachiocephalic Arteries
@
35475
75962
N/A
75898
PTA, Venous
@
35476
75978
Add'l agent -prescribing, handling, and bolus administration
chemotherapeutic agent
96420
PTA, Each add'l visceral vessel
@ 35471 x __ 75968 x __
PTA, Each add'l brachiocephalic vessel
@ 35475 x __ 75964 x __
79445
radioactive agent
TIPS (includes catheterization and associated imaging)
PTA, Each additional venous
@ 35476 x __ 75978 x __
INTRA-OPERATIVE (OPEN) ANGIOPLASTY
TIPS
37182
PTA, Renal or Visceral Artery
35450
75966
TIPS Revision
@
37183
PTA, Aorta
35452
75966
36011 or
75894
PTA, Brachiocephalic vessels
35458
75962
Embolization of varix*
36012
+ 75898
PTA, Venous
35460
75978
+ 37204
*Note: Report selective catheterization codes in addition to embolization.
INTRACRANIAL DILATION, ANGIOPLASTY, STENT
MODERATE (CONSCIOUS) SEDATION
includes selective catheterization and all imaging of target vessel
Intracranial angioplasty
61630
provided by same physician performing the Dx-Tx service
61635
Intracranial angioplasty with stent
Intraservice
Start Time: __________
End Time:___________
61640
99144
Dilation of intracranial vasospam, initial vessel
Conscious Sedation AGE 5 or OLDER first 30 min
61641
99145 x __
each add vessel same vascular family
each additional 15 minutes
61642
99143
each add vessel different vascular family
Conscious Sedation UNDER 5 first 30 min
99145 x __
each additional 15 minutes
INTRAVASCULAR STENTS
Intravascular Stents Non-Coronary/Non-Carotid/Non-Vertebral/Non-Intracranial
OTHER
Intravascular Stent, perc., initial
37205
75960
Pseudoaneurysm TX Injection (Thrombin)
36002 Specific
Imaging Guidance for Needle Plcmnt (circle one) US-76942 fluoro-77002 CT-77012 MR-77021
Intrasvascular Stent, perc., each add'l vessel
37206
75960
Intravascular Stent, open, initial
37207
75960
Closure Device
G0269
Intrasvascular Stent, open, each add'l vessel
37208
75960
CT, limited or localized follow-up
76380
Intravascular Stents Cervical Carotid
US Guidance for Vascular Access
76937
includes all ipsilateral selective cath, ipsilateral cervical/cerebral angiography
(required documentation on file)
Intravascular Stent w/ distal embolic protection
@
37215
N/A
UNLISTED IMAGING CODES
Intravascular Stent w/out distal embolic protection
@
37216
N/A
Unlisted, Fluoroscopic procedure
76496
Intravascular Stents Extracranial Vertebral/Intrathoracic Carotid
Unlisted, CT procedure
76497
includes all ipsilateral selective cath, target vessel angiography
Unlisted, MR procedure
76498
Intravascular Stent, perc; initial vessel
0075T
N/A
Unlisted, US procedure
76999
Intravascular Stent, perc; each addl. vessel
0076T
N/A
UNLISTED VASCULAR PROCEDURE
Unlisted, vascular surgery
37799
Append Clinical Trial Modifier
PRESENTING PROBLEM(S)/DIAGNOSIS
ICD-9: _____
Dx 1: __________________
Service provided within FDA approved clinical trial
PATIENT:
PROCEDURE:
ATTACH REPORT
(and device approved for use in the trial at the time the service was
rendered.)
IDE #
-Q0
CPT Only copyright 2012 American Medical Association. All Rights Reserved.
Dx 2 :_________________
ICD-9: _____
Copyright 2012, Society of Interventional Radiology. All Rights Reserved.
VASCULAR INTERVENTIONAL CHARGE SHEET
PATIENT:
2
DATE:
REFERRING PHYSICIAN
INTERVENTIONAL RADIOLOGIST
PROCEDURE:
X MCS
ENDOVASCULAR VARICOSE VEIN TREATMENT includes imaging guidance
catheterization is considered inherent to EVAT
Radiofrequency - 1st vein treated.
RFA - 2nd & subs. vein(s)
Laser EVAT- includes imaging- 1st vein
Laser - 2nd & subs. vein(s)
OTHER VARICOSE VEIN TREATMENT
PROCEDURE CODE
36475
36476
36478
36479
Injections of sclerosing solutions (single/multiple), spider veins; limb or trunk
36468
Injections of sclerosing solutions (single/multiple), spider veins; face
Injection of sclerosing solution- single vein
Injection of sclerosing solution- multiple veins, same leg
36469
36470
36471
Stab phlebectomy of varicose veins,
one extremity, 10-20 incisions
37765
Stab phlebectomy of varicose veins,
one extremity, more than 20 incisions
37766
MODERATE (CONSCIOUS) SEDATION
provided by same physician performing the Dx-Tx service
Intraservice
Start Time: __________
End Time:___________
Conscious Sedation AGE 5 or OLDER first 30 min
each additional 15 minutes
Conscious Sedation UNDER 5 first 30 min
each additional 15 minutes
99144
99145 x __
99143
99145 x __
CPT Only copyright 2012 American Medical Association. All Rights Reserved. Copyright 2012 Society of Interventional Radiology All rights reserved
VASCULAR DIAGNOSTIC CHARGE SHEET
PATIENT:
DATE:
REFERRING PHYSICIAN:
PROCEDURE:
INTERVENTIONAL RADIOLOGIST:
*@ designates moderate conscioius sedation included
SELECTIVE VASCULAR CATHETERIZATIONS
ARTERIAL VASCULAR FAMILY
1st
(X) Order
Selective cath place thoracic or Brachiocephalic
Subclavian
initial 3rd oder of more selctive
Each Add'l 2nd
2nd
3rd
or 3rd Order*
(X) Order* (X) Order* (X) # of Vessels
For same session
RADIOLOGICAL S&I
ARTERIOGRAPHY
(X)
36215
36215
36215
36216
36216
36216
36217
36217
36217
336218 x __
36218 x __
36218 x __
Thoracic Aortogram
Abdominal Aortogram
Abd Aortogram w Run-Offs
@
36215
36245
36216
36246
36217
36247
36218x_
36248 x __
Brachial, Retrograde
Spinal, Selective, Each Vessel
SMA
@
36245
36246
36247
36248 x __
Extremity, Unilateral
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)
@
@
@
@
@
@
@
@
36245
36251
36252
36245
36245
36245
N/A
36245
36013
N/A
N/A
36246
36253
36254
36246
36246
36246
36246
36246
N/A
36014
36014
36248 x __
Extremity, Bilateral
Visceral w-w/o Flush, Each Vessel
Adrenal, Unilateral
Adrenal, Bilateral
Pelvic, Each Vessel, Sel.
Pulmonary, Unilateral
Pulmonary, Bilateral
Pulmonary, Nonselective
Internal Mammary
Each Add Vessel After Basic
AV Dialysis Shunt Existing Access
VENOGRAPHY
(X)
Extremity, Unilateral
Extremity, Bilateral
IVC
SVC
Renal, Unilateral
Renal, Bilateral
Adrenal, Unilateral
Adrenal, Bilateral
Sinus or Jugular
Superior Sagittal Sinus
Epidural
Orbital
Hepatic w Hemodynamic Eval
Hepatic wedge pressures
no
venogram
Additional 2nd/3rd
VENOUS VASCULAR FAMILY
(X)
1st
Order*
36011
36011
36011
NA
36011
36500 x __
36011 x __
36481
36247
36253
36254
36247
36247
36247
36247
36247
N/A
36015
36015
1st, 2nd
1st & 2nd
&
(X)
Order* (X) 3rd Order* (X)
36012
36012
36012
36012
36012
36012
36012
36012
36012
36012
36248 x __
36248 x __
36248 x __
36248 x __
36248 x __
N/A
36015 x __
36015 x __
Each Add'l
2nd or 3rd*
36012
36012
36012
36012
36012
Right Renal
Left Renal
Jugular
Left Adrenal
Right Adrenal
Selective Organ Blood Sampling (x #)
Other Venous Vascular Family
36012 x __
36012 x __
36012 x __
Portal Venogram
*CATHETERIZATION CODING CONVENTIONS
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
Cervicocerebral Arch Angiography Bilateral
bilat diff territory Append -59
Non-selective cath thoracic/ aorta
36221
@
bilat/unil w/ imaging
-59
-50
Selective unil carotid/innominate w/ipsil
@
extracranial imaging
-59
36222
-50
Selective unil carotid/innominate w/ipsil
intracranial/extracranial imaging
DX and TX RS&I
Append -59
75605
75625
75630
-59
-59
-59
75658
75705 x __
-59
-59
75710
-59
75716
75726 x __
75731
75733
75736 x __
75741
75743
75746
75756
75774 x __
75791
CODE
75820
75822
75825
75827
75831
75833
75840
75842
75860
75870
75872
75880
75889
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
-59
75889-52
-59
Hepatic w/o Hemodynamic Eval
75891
-59
Venous Sampling (E.G. renins)
75893 x __
-59
@
Selective unil internal carotid w/ipsil
@
intra/exracranial imaging
Selective unil subclavian/innom w/ipsil
@
vertebral imaging
Selective unil vertebral w/ipsil vertebral
@
imaging
Selective unil external carotid w/ipsil ext
@
carotid imaging
Selective internal carotid or vertebral,
@
ea branch w/ imaging
NON-SELECTIVE VASCULAR CATHETERIZATIONS
36223
-50
-59
LYMPHANGIOGRAPHY
36224
-50
-59
Extremity only, unilateral
75801
-59
36225
-50
-59
Extremity only, bilateral
75803
-59
36226
-50
-59
Pelvic/abdominal, unilateral
75805
-59
36227
-50
-59
Pelvic/abdominal, bilateral
75807
-59
36228
-59
-50
(X)
@
CODE
36200
36140
36620
36147
Aorta, Catheter (Femoral, Brachial, Axillary)
Extremity Artery, Needle/Intracatheter, Unilateral
Radial artery catheter for pressures/monitoring
Arteriovenous Dialysis Shunt including RS&I
@
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
provided by same physician performing the Dx-Tx service
(X)
Intraservice
Start Time: __________
End Time:___________
Conscious Sedation AGE 5 or OLDER first 30 min
99144
each additional 15 minutes
99145 x __
Conscious Sedation UNDER 5 first 30 min
99143
each additional 15 minutes
99145 x __
MISCELLANEOUS
CODE
* (MAX 2X PER SIDE)
(X)
OTHER
(X)
Splenoportogram
UNLISTED IMAGING CODES
CODE
CODE
75810
-59
(X)
Unlisted, Fluoroscopic procedure
Unlisted, CT procedure
Unlisted, MR procedure
Unlisted, US procedure
Attach Report
Attach Report
Attach Report
Attach Report
PRESENTING PROBLEM(S)/DIAGNOSIS
Dx 1: __________________
ICD-9: _____
Dx 2 :_________________
ICD-9: _____
(X)
Closure Device
G0269
CT, limited or localized follow-up
US Guidance for Vascular Access
(Required documentation on file)
76937
76380
CPT Only copyright 2012 American Medical Association, All Rights Reserve Copyright 2012, Society of Interventional Radiology. All Rights Reserved.
PATIENT:
DATE:
PROCEDURE:
REFERRING PHYSICIAN:
INTERVENTIONAL RADIOLOGIST:
NONVASCULAR INTERVENTIONAL 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.
S&I
(X) MCS Procedure
S&I
DRAINAGE PROCEDURES
GASTROINTESTINAL TRACT
(X)MCS Procedure
Perc. Transhepatic Cholangiogram
47500
74320
20501
76080
Fistula or Sinus Tract Study
Perc. Biliary Drainage (External)
Thoracentesis needle or cath, w/out imaging
47510
75980
32554
N/A
Thoracentesis needle or cath, with imaging
47511
75982
32555
N/A
Perc. Biliary Drainage (Int. and Ext.)
Abscess Drainage, Pleural (Empyema) w/out
imaging
47505
74305
32556
N/A
Injection, Cholangiography, Existing Cath., T-tube
Abscess Drainage, Pleural (Empyema) w/
imaging
Change of Biliary Drainage Catheter
@
47525
75984
32557
N/A
Revise/Reinsert Transhepatic tube
Abscess Drainage, Lung
47530
75984
@
32201
75989
Perc. Dil Biliary Stricture w/o Int. Stent
Insertion, Indwelling Tunneled Pleural Cath
47555
74363
@
32550
75989
Perc. Dil Biliary Stricture with Int. Stent
32552
N/A
47556
74363
Removal of Indwelling Tunneled Cath w/ cuff
47552
N/A
fibrinolysis via chest tube/catheter, agent initial
32561
N/A
Cholangioscopy, perc., w/ or w/o brushing or wash
32562
N/A
47553
N/A
fibrinolysis viacatheter, agent subs
Cholangioscopy, perc., with biopsy
47554
N/A
@
44901
75989
Cholangioscopy, perc., with calculus/calculi remova
Abscess Drainage, Appendiceal
47630
74327
@
47011
75989
Biliary Stone Removal via T-Tube
Abscess/Cyst Drainage, Liver
74300
@
48511
75989
Pancreatic Pseudocyst Drainage
Intraoperative Cholangiogram
74301
@
49021
75989
Intraoperative Cholangiogram Additional
Abscess Drainage, Peritoneal
@
49041
75989
Naso/oro gastric tube placement
43752
Abscess Drainage, Subdiaphragmatic
@
@
49061
75989
G-tube placement under fluoro guidance
49440
Abscess Drainage, Retroperitoneal
@
49082
Paracentesis, Abdominal wo imaging guidance
J-tube placement under fluoro guidance
49441
49083
Paracentesis, Abdominal w imaging guidance
duodenostomy tube placement under fluoro guidan @
49442
49423
75984
cecostomy/colonic tube placement under fluoro gu @
49442
Change of Abscess Drain (inc. injection)
@ 49440 + 49446
49424
76080
G-J tube placement under fluoro guidance
Abscessogram (Tube Check)
49446
Conversion of previously placed G-tube to G-J
@
@
58823
75989
Pelvic, transvaginal or transrectal
@
50021
75989
G-tube replacement under fluoro guidance
49450
Abscess Drainage, Renal or Perirenal
BIOPSIES
J-tube replacement under fluoro guidance
49451
20206
by modality*
49451
duodenostomy tube replacement under fluoro guid
Muscle, Percutaneous
G-J tube replacement under fluoro guidance
20220
by modality*
49452
Bone, Superficial, Percutaneous
Mechanical removal obstructive material G-, J-, G20225
by modality*
Bone Deep, Percutaneous
49460
J, C tube under fluoro guidance
32400
by modality*
Pleura, Percutaneous
Contrast Injection for G-, J-, G-J, C tube
@
32405
by modality*
Lung, Percutaneous
49465
Perc. Cholecystostomy complete
Lymph Nodes, Sup., Percut
47490
N/A
38505
by modality*
Pneumoperitoneum
49400
74190
Liver, Percutaneous, Separate
@
47000
by modality*
**
Liver, Percutaneous, w/ Other Procedure
@
47001
by modality*
ERCP
43260
@
**
ERCP w/ biopsy
43261
Pancreas, Percutaneous
48102
by modality*
@
43262
**
Abdomen/Retrop., Percutaneous
49180
by modality*
ERCP for Spincterotomy/Papillotomy
@
Renal, Percutaneous
ERCP calculus/calculi Removal
@
43264
**
@
50200
by modality*
Prostate
ERCP calculus/calculi Destruction
@
43265
**
55700
by modality*
Thyroid, Percutaneous
ERCP Insert Nasobiliary/Nasopancreatic tube
@
43267
**
60100
by modality*
ERCP Biliary/Pancreatic Stent
@
43268
**
62269
by modality*
Spinal Cord
ERCP Stent Removal or Change
@
43269
**
10021
N/A
Fine needle aspiration, w/out imaging guidance
43271
**
10022
by modality*
ERCP Balloon Dilation
@
Fine needle aspiration, w/ imaging guidance
Esophagus Dilation
@
43453
74360
*Imaging Guidance Modality Used (circle one)
Esophageal Plastic Tube or Stent
@
43219
**
US 76942
CT 77012
MR 77021
Fluoro
77002
**ERCP RS&I
S&I
74328
(X) MCS Procedure
OTHER
**ERCP Biliary Ducts RS&I
74329
Tracheal/Bronchial Stent
31631-62
N/A
**ERCP Pancreatic Ducts RS&I
S&I
74330
TRANSCATHETER BIOPSY
(X) MCS Procedure
**ERCP Pancreatic and Biliary Ducts RS&I
URINARY PROCEDURES
(X)
Procedure
S&I
37200/36011
75970
Transjugular liver biopsy
Perc Antegrade Pyelogram (thru needle)
50390
74425
ABLATION PROCEDURES
(X)
Procedure
S&I
Nephrostomy
50392
74475
Percutaneous RFA, Liver Tumor(s)
@
47382
by modality*
Nephrostogram (thru existing catheter)
50394
74425
Percutaneous Cryoablation, Liver Tumor(s)
47399
by modality*
Nephrostomy Tube Change
50398
75984
Percutaneous RFA, Renal Tumor(s)
@
50592
by modality*
74485
Dilation of Nephrostomy Tract/Pyelostomy
50395
Percutaneous Cryoablation, Renal Tumor(s)
@
50593
by modality*
Ureterography Through Existing Catheter
50684
74425
32998
by modality*
Percutaneous RFA Lung Tumor(s)
Percutaneous RFA Bone Tumor(s)
Ureteral Dilation
53899
74485
@
20982
URETERAL STENT
includes CT guidance
19499
by modality*
Percutaneous RFA Breast Tumor(s)
Internally Dwelling
Percutaneous injection of ablative agent (i.e.
Placement through renal pelvis
50393
74480
47399
by modality*
alcohol or acetic acid), liver
@
- exchange, perc. approach includes imaging
50382
@
47380**
76362
- removal, perc. approach includes imaging
50384
Open RFA, Liver Tumor(s) using U/S guidance
Transuretheral approach
@
xchange, transurtheral approach includes imaging
50385
Open Cryo, Renal Tumor(s)
50250**
@
- removal, transurtheral approach includes imaging
50386
includes US guidance
Externally Dwellling (externally accesible transnephric ureteral stent/
**Use modifier -62 when service is provided by co-surgeons.
*Imaging Guidance/Monitoring Modality Used for Ablation (circle one)
-exchange, includes imaging
@
50387
-removal, includes imaging
50389
US 76940
CT 77013
MR 77022
-removal NOT requiring imaging***
99XXX***
*** Considered inherent to E&M, report appropriate level of E&M provid
50688
Change ureterostomy tube/ureteral stent via ileal
Whitaker Test
50396
Nephrostolithotomy <2cm
Nephrostolithotomy >2cm
Aspiration, Renal Cyst by Needle
Contrast study of renal cyst
Ileoconduit Injection
Aspirate bladder (Diagnostic) by trocar/catheter
Suprapubic Catheter (incl. Bladder aspiration)
Cystogram
Urethrocystogram, Voiding
Cystography/VCU w/Chain
Urethrocystogram, Retrograde
Change Cystostomy Tube, Simple
Change Cystostomy Tube, Complex
**use 76001 in lieu of 76000 if > 1 hr fluoro
*Imaging Guidance Modality Used (circle one)
50080
50081
50390
50390
50690
51101
51102
51600
51600
51605
51610
51705
51710
US 76942
CT 77012
Fluoro 77002
75984
74425/74475
/74480
76000**
76000**
by modality*
74470
74425
by modality*
by modality*
74430
74455
74430
74450
75984
75984
Procedure
S&I
FALLOPIAN DILATATION
(X)
Hysterosalpingogram
58340
74740
Hysterosonography, w/ or w/o color flow
58340
76831
Fallopian Dilatation
58345
74742
MODERATE (CONSCIOUS) SEDATION
provided by same physician performing the Dx-Tx service
Intraservice
Start Time: __________
End Time:___________
Conscious Sedation AGE 5 or OLDER first 30 min
99144
each additional 15 minutes
99145 x ___
Conscious Sedation UNDER 5 first 30 min
99143
each additional 15 minutes
99145 x ___
PRESENTING PROBLEM(S)/DIAGNOSIS
Dx 1: __________________
ICD-9: _____
Dx 2 :_________________
ICD-9: _____
MR 77021
CPT Only copyright 2012 American Medical Association. All Rights Reserved. Copyright 2013 Society of Interventional Radiology. All rights reserved
TRANSLUMINAL ANGIOPLASTY/STENT/ ATHERECTOMY CHARGE SHEET
PATIENT:
DATE:
REFERRING PHYSICIAN
PROCEDURE:
INTERVENTIONAL RADIOLOGIST
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.
(x) MSC
Procedure
S&I
code
Code
N/A
(x)
MCS
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY/STENT/ATHERECTOMY*
PTA, Iliac Artery, unilateral
Stent, Iliac, with PTA when performed, unilateral
@
37220
@
37221
N/A
PTA, each add'l illiac vessel, unilateral
Stent, Iliac, with PTA when performed, each add'l vessel, unilateral
@
37222
N/A
@
37223
N/A
PTA, Femoral/Popliteal Arteries, unilateral
Atherectomy, Femoral/Popliteal, with PTA when performed, unilatera
Stent, Femoral/Popliteal, with PTA when performed, unilateral
unilateral
@
37224
N/A
@
37225
N/A
@
37226
N/A
@
37227
N/A
PTA, Tibial/Peroneal Artery, unilateral
Atherectomy, Tibial/Peroneal, with PTA when performed, unilateral
Stent, Tibial /Peroneal,y,with PTA when performed,
unilateral
,
p
,
unilateral
@
37228
N/A
@
37229
N/A
@
37230
N/A
@
37231
N/A
PTA, Tibial/Peroneal, each add'l vessel, unilateral
Atherectomy, Tibial/Peroneal, with PTA when performed, each add'l
vessel,
, unilateral
,
p
,
,
unilateral
Stent and Atherectomy, Tibial/Peroneal, with PTA when performed, each
add'l vessel, unilateral
@
37232
N/A
@
37233
N/A
@
37234
N/A
@
37235
N/A
Renal artery
Visceral artery (except renal) each vessel
Abdominal aorta
Brachiocephalic trunk and branches, each vessel
Illicac artery, each vessel
0234T
0235T
0236T
0237T
0238T
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 Stent, perc; initial vessel
0075T
N/A
Intravascular Stent, perc; each addl. vessel
0076T
N/A
Category III codes to describe transluminal atherectomy above Inguinal
ligaments percutaneously and/or though open surgical exposure (includes RS&I)
Intravascular Stents Extracranial Vertebral/Intrathoracic Carotid
includes all ipsilateral selective cath, target vessel angiography
PRESENTING PROBLEM(S)/DIAGNOSIS
Dx 1: __________________
Dx 2 :_________________
CPT Only copyright 2012 American Medical Association. All Rights Reserved.
ICD-9: _____
ICD-9: _____
Copyright 2012 Society of Interventional Radiology
Procedure
S&I
Code
Code
PATIENT:
DOB
IDENTIFICATION NUMBER:
DATE:
AAA-TA-IA ENDOVASCULAR REPAIR CHARGE SHEET
Procedure
Code
EXPOSURE FOR ENDOPROSTHESIS
Femoral Cutdown
34812
Bilat
Fem-fem graft
34813
Iliac Retroperitoneal Exposure
34820
Bilat
CATHETERIZATION: NON-SELECTIVE *Report cath codes in addition to exposure
Aorta, Catheter (Femoral, Brachial, Axillary)
36200
Bilat
Iliac, nonselective
36140
Bilat
CATHETERIZATION: SELECTIVE --Circle code(s)-1st
1st & 2nd
Arterial Vascular Family****
Order
Order
IIiac, Ipsilateral
36245
36246
Common IIiac, Contralateral
36245
36246
Common Femoral, Ipsilateral
36245
36246
Common Femoral, Contralateral
N/A
36246
Common Iliac or Femoral, Axillary or Brachial Approach
36245
36246
Other Abdominal Aorta Vascular Family
36245
36246
Code
AAA ENDOPROTHESIS DEPLOYMENT
75952
AAA endo repr w/ aorto-aortic tube device
34800
AAA endo repr w/ modular bifurcated device (1-limb)
34802
75952
AAA endo repr w/ modular bifurcated device (2-limb)
34803
75952
AAA endo repr w/ unibody bifurcated device
34804
75952
AAA endo repair, aorto-uni-iliac/aorto-unifemoral device
34805
75952
AAA endo repair w/ visceral branches using prosthesis
0080T
0078T
AAA EXTENSIONS/CUFFS DEPLOYMENT*** Imaging code 75953 billed per vesse
75953
initial vessel
34825
34826
75953
each additional vessel
visceral extension prosthesis, ea visceral branch
0079T
0081T
Code
TA ENDOPROTHESIS DEPLOYMENT
75956
TA endo repair w/ coverage of subclavian origin
33880
TA endo repair w/out coverage of subclavian origin
33881
75957
Open subclavian to carotid artery transposition performed in
33889
conjunction with TA endo repair, neck incision
Graft with other than vein, transcervical retropharyngeal carotid33891
carotid performed in conjuncition with TAA
Procedure
Code
34812-50
Physician #1
34820-50
Physician #2
36200-50
36140-50
1st, 2nd & or 3rd Orde
3rd Order # of Vessels Modifier(s)
36247
X36248
36247
X36248
36247
X36248
36247
X36248
36247
X36248
36247
X36248
Modifier(s)
- 62 / -26
- 62 / -26
- 62 / -26
- 62 / -26
- 62 / -26
- 62 / -26
/
-26
/
-26
/
-26
Modifier(s)
- 62 / -26
- 62 / -26
TA EXTENSIONS/CUFFS DEPLOYMENT
Proximal - initial
33883
75958
/
75958
/
33886 75959
REFERRING PHYSICIAN:
-26
-26
/
MODIFIER DEFINITIONS
-22 Extended Services
-26 Professional Component
-50 Bilateral Procedure
-51 Multiple Procedures
-52 Reduced Service
-53 Discountinued Service
-58 Staged/Related Procedure
-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 Globa
-79 Unrelated Procedure,
-80 Assistant Surgeon
-RT Right-side
-LT Left-side
-Q0 FDA Approved IDE#______________
-GA Advanced Beneficiary Notice (ABN) on File
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.
-26
Delayed distal (not at time of initial repair)
IA ENDOPROSTHESIS DEPLOYMENT
34900 75954
/
-26
Endovasc iliac aneuryem repr
OCCLUSION DEVICE
(x)
(x)
Procedure
Endovasc iliac occlusion device
34808
by
by
Code
Modifier(s)
OPEN CONVERSION
BYPASS
#1
#2
34830
Fempop with vein
Open aortic tube prosth repr
35556
34831
Fempop non vein
35655
Open aortoiliac prosth repr
Open aortofemor prosth repr
34832
THROMBOENDARTERECTOMY
Code
Code
Modifier(s) Iliofemoral
OTHER CONCOMMITANT SERVICES
35355
ANGIOPLASTY**
@-Conscious Sedation included in codes marked @
Femoral, common
35371
Perc TA, Renal or Visceral Artery @
35471
75966 /
-26
Femoral, deep
35372
35450
75966 /
-26
Open TA, Renal or Visceral Artery
EMBOLECTOMY THROMBECTOMY
Perc TA, Aorta (within treatment zone NOT reportable) @
35472
75966 /
-26
Fempop
34201
Open TA, Aorta (within treatment zone NOT reportable)
35452
75966 /
-26
Popliteal-tibio-peroneal
34203
Perc TA, Brachiocephalic Arteries @
35475
75962 /
-26
ARTERIAL REPAIR
Open TA, Brachiocephalic vessels
35458
75962 /
-26
Lower extremity, direct
35226
35476
75978 /
-26
Lower extremity, vein graft
35256
Perc TA, Venous @
35460
75978 /
-26
Lower extremity, non vein graft
35286
Open TA, Venous
Perc TA, Each add'l visceral vessel @
35471 x 75968 x /
-26
Dx CODES
Open TA, Each add'l visceral vessel
35450 x 75968 x /
-26
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.
Perc TA, Each add'l brachiocephalic vessel @
35475 x 75964 x /
-26
Open TA, Each add'l brachiocephalic vessel
35458 x 75964 x /
-26
405.01 Malignant secondary renovascular hypertension
INTRAVASCULAR ULTRASOUND
440.21 Artherosclerosis, extremity w/ claud.
IVUS initial vessel
37250
75945 /
-26
440.22 Artherosclerosis, extremity w/ rst pain
37251
75946 /
-26
440.23 Artherosclerosis, extremity w/ ulcer
Each additional vessel IVUS
440.24 Artherosclerosis, extremity w/ gangrene
INTRAVASCULAR STENTS*
Intravascular Stent, perc., initial
37205
75960 /
-26
441.02 Dissection of abdominal aorta
Intrasvascular Stent, perc., each add'l vessel
37206
75960 /
-26
441.3 Abdominal aneurysm, ruptured
Intravascular Stent, open, initial
37207
75960 /
-26
441.4 Abdominal aneurysm without mention of rupture
37208
75960 /
-26
442.2 Iliac artery aneurysm or pseudoaneurysm
Intrasvascular Stent, open, each add'l vessel
EMBOLIZATION *for embolization, follow up completion angio (75898) is separately reportable
442.82 Aneurysm or pseudoaneurysm of subclavian artery
75894 /
-26
444.22 Lower extremity arterial embolism/thrombosis
-26
585
Embolization (Non-Neuro)
37204
+75898 /
Chronic renal failure
747.64 Iliac arteriovenous fistula
OTHER *Required documentation on file
US for Vascular Access*
76937 /
-26
747.69 Aortic arteriovenous fistula
CT, limited or localized follow-up
76380 /
-26
901.1 Injury subclavian artery
Placement of wireless sensor in sac during endo repair
34806
902.0 Aortic injury/trauma
902.53 Injury iliac artery
Noninvasive physiological study of implanted wireless sensor
93982 Not typically billable at the
Additional Services--(please describe)
902.54 Injury iliac vein
998.2 Iatrogenic rupture of vessel
Category III codes effective Jan 1, 2011
Endovascular repair of iliac artery bifurcation using a bifurcated
external and internal iliac artery
0254T 0255T
Other (please specify) ____________________________
CPT Only copyright 2012 American Medical Association. All Rights Reserved.
Copyright 2012 Society of Interventional Radiology. All Rights Reserved
PATIENT:
DATE:
PROCEDURE:
REFERRING PHYSICIAN:
VENOUS ACCESS PROCEDURES 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.
CENTRALLY INSERTED DEVICE
Procedure
(x)MCS
Code
Placement Centrally Inserted
Non Tunneled child <5
Non Tunneled ( 5+ older)
Tunneled child <5 no port, no pump
Tunneled (5+ older) no port, no pump
Tunneled port child <5
Tunneled port (5+ older)
Tunneled pump
2 tunneled cath, 2 access sites (no port, no p
Two tunneled cath, two access sites, w/ port
Repair
Non Tunneled no port, no pump, cent or per
Tunneled no port, no pump, cent or periph
Tunneled port, cent or periph
Tunneled pump, cent or periph
Two tunneled cath, two access sites (no port
Two tunneled cath, two access sites, w/ port
Partial Replacement (Cath Only)
Port, cent or periph
Pump, cent or periph
Two tunneled cath, two access sites, w/ port
@
@
@
@
@
@
@
@
36555
36556
36557
36558
36560
36561
36563
36565
36566
36575
36575
@
36576
@
36576
36575 (X2)*
@ 36576 (X2)*
@
36578
@
36578
@ 36578 (X2)*
Complete Replacement thru same venous access
Non Tunneled
36580
Tunneled, no port no pump
@
36581
Tunneled port
@
36582
Tunneled pump
@
36583
Two tunneled cath, two access sites (no port
@ 36581 (X2)*
@ 36582 (X2)*
Two tunneled cath, two access sites, w/ port
Removal
Non Tunneled no port, no pump
Tunneled no port, no pump
Tunneled port
Tunneled pump
Two tunneled cath, two access sites (no port
Two tunneled cath, two access sites port
@
@
@
99XXX**
36589
36590
36590
36589 (X2)
36590 (X2)
IMAGING for Central/Peripheral Device Procedures
Fluoro guidance replacement, partial or complete
77001
Fluoro guidance removal
77001
US guidance for vascular access
76937
(required documentation on file)
76380
CT, limited or localized follow-up
76000
Fluoro only - no archived image
SVC gram
75827
IVC gram
75825
Extremity venogram
75820
CPT Only copyright 2012 American Medical Association. All Rights Reserved.
PERIPHERALLY INSERTED DEVICE
Procedure
(x)MCS Code
Placement Peripherally Inserted
36568
Non Tunneled PICC child <5
@
36569
Non Tunneled PICC ( 5+ older)
36570
PICC w/ port child <5
@
PICC w/ port (5+ older)
36571
@
Repair PICC
PICC no port, no pump
PICC w/ port
@
36575
36576
Partial Replacement (Cath Only)
PICC w/ port
@
36578
Complete Replacement thru same vein access
PICC
36584
@
PICC w/ port
36585
Removal
Non Tunneled no port, no pump
PICC w/ port
@
99XXX**
36590
CENTRAL/PERIPHERAL CVA DEVICE MAINTENANCE
76000
Reposition central venous catheter
36597
N/A
Thrombolytic declotting of vascular access
36593
75901
CVA maintenance fibrin stripping (sep access)
36595
75902
CVA maintenance through lumen (brus
36596
Non-Selective Catheter Plcmnt- superio
36010
Selective Catheter Plcmnt- venous 1st
36011
Selective Catheter Plcmnt- venous 2nd
36012
Radiological Catheter Evaluation
36598
MODERATE (CONSCIOUS) SEDATION
provided by same physician performing the Dx-Tx service
(Do NOT report withcodes marked with @)
Intraservice
Start Time: __________
End Time:_________
Conscious Sedation AGE 5 or OLDER first 30 min 99144
each additional 15 minutes
99145 x ___
Conscious Sedation UNDER 5 first 30 min
99143
each additional 15 minutes
99145 x ___
* For multi-catheter devices use the appropriate repair,
** Removal of a non-tunneled device is considered inherent to E&M, report
Copyright © 2012, Society of Interventional Radiology. All Rights Reserved.
PATIENT:
DATE:
PROCEDURE:
REFERRING PHYSICIAN:
INTERVENTIONAL RADIOLOGIST
NONVASCULAR INTERVENTIONAL CHARGE SHEET 2
BREAST
Aspiration Breast Cyst
each additional cyst
Fine Needle Aspiration, w/ imaging guidance
(X)
CS
Procedure
19000
19001 x ___
10022
S&I
by modality*
by modality*
by modality*
Breast, Perc. Core Bx, Image Guided
19102 x ___
by modality*
(per 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)
see above ablation procedures
RFA Breast Tumor(s)
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 ___
MISCELLANEOUS
Closure Device
CT, limited or localized follow-up
US Guidance for Vascular Access
(required documentation on file)
PRESENTING PROBLEM(S)/DIAGNOSIS
(X)
G0269
76380
76937
Dx 1: __________________
ICD-9: _____
Dx 2 :_________________
ICD-9: _____
CPT Only copyright 2012 American Medical Association. All Rights ReservCopyright 2012 Society of Interventional Radiology. All Rights Reserved
PATIENT:
DATE:
PROCEDURE:
REFERRING PHYSICIAN:
INTERVENTIONAL RADIOLOGIST:
CT/MR Angiography - Cardiac MRI Charge Sheet
MR ANGIOGRAPHY
MRA Head w/out contrast
MRA Head w/ contrast
MRA Head w/out & w/ contrast
MRA Neck w/out contrast
MRA Neck w/ contrast
MRA Neck w/out & w/ contrast
MRA Chest w/ or w/out contrast
MRA Spinal Canal w/ or w/out contrast
MRA Pelvis w/out & w/ contrast
MRA Upper Ext w/ or w/out contrast
MRA Lower Ext w/ or w/out contrast
MRA Abdomen w/ or w/out contrast
(X)
CODE
70544
70545
70546
70547
70548
70549
71555
72159
72198
73225
73725
74185
74185
MRA - Abdominal Aorta including iliacs
w/ bilateral runoff
73725-RT
MRA - Thoracic and Abdominal Aorta
including iliacs w/ bilateral runoff
71555
74185
73725-RT
73725-LT
73725-LT
MODERATE (CONSCIOUS) SEDATION*
provided by same physician performing the Dx-Tx service
(X)
Intraservice Time Start Time: _____
AGE 5 or OLDER - first 30 min
99144
each additional 15 minutes
99145 x __
UNDER 5 YRS of AGE- first 30 min
99143
each additional 15 minutes
99145 x __
*Requires midpoint of time be reached in order to
assign code.
OTHER
(X) CODE
US guidance for vascular access
CT ANGIOGRAPHY
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
70496
70498
71275
72191
73206
73706
74174
74175
75574
75635
CARDIAC MRI
(X) CODE
Cardiac MRI for morphology and function without contrast
75557
with stress imaging
75559
Cardiac MRI for morphology and function with and without contrast
75561
with stress imaging
75563
Cardiac MRI for velocity flow mapping
75565
3-D RENDERING with interpretation and report under concurrent supervision
use in addition to base imaging code
NOT requiring postprocessing on an independent workstation
(X) CODE
76376
76377
REQUIRING postprocessing on an independent workstation
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, 78012,
78013,78015-78999, 0159T.
INJECTION
(X) CODE
C1-C2 puncture with injection for DX/Treatment
61055
Lumbar puncture, for myelogram
(Valuation for code 62284 includes conscious sedationDo NOT additionally report 99141.)
76937
(required documentation on file)
PRESENTING PROBLEM(S)/DIAGNOSIS
Dx 1: __________________
Dx 2 :_________________
ICD-9: _____
ICD-9: _____
CPT Only copyright 2013 American Medical Association. All Rights Reserved.
(X) CODE
Copyright 2012, Society of Interventional Radiology. All Rights Reserved.
62284
INTERVENTIONAL RADIOLOGY ONCOLOGY CHARGE SHEET
PATIENT:
DATE:
REFERRING PHYSICIAN:
INTERVENTIONAL RADIOLOGIST:
PROCEDURE:
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
Muscle, Percutaneous
Bone, Superficial, Percutaneous
Bone Deep, Percutaneous
Pleura, Percutaneous
Lung, Percutaneous
Lymph Nodes, Sup., Percut
Liver, Percutaneous, Separate
Liver, Percutaneous, w/ Other Procedure
Pancreas, Percutaneous
Abdomen/Retrop., Percutaneous
Renal, Percutaneous
Prostate
Thyroid, Percutaneous
Spinal Cord
Fine needle aspiration, w/out imaging
Fine needle aspiration, w/ imaging gu
(X)
MCS 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
(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
US 76942
CT 77012
Fluoro 77002
Percutaneous placement of an
interstitial device(s),fiducial marker
or
dosimeter for
radiationoftherapy
Percutaneous
placement
an
@
MISCELLANEOUS
Closure Device
CT, limited or localized follow-up
US Guidance Vascular Access
(required documentation on file)
32553
Start Time: __________
Conscious Sedation AGE 5 or OLDER first 30 min
each additional 15 minutes
Conscious Sedation UNDER 5 first 30 min
each additional 15 minutes
20982
19499
by modality*
47399
by modality*
47380**
CT 77013
MR 77022
HEPATIC EMBOLIZATION
@
Selective Catheterization 3rd order
@
Additional Selective Catheterization 2nd/3rd+
@
Selective Catheterization 2nd order
Selective Catheterization 1st order
@
Dx Angio- visceral selective (if indicated)
Dx Angio- selective add'l vessel beyond basic exam
36247
36248 x ___
36246
36245
75726
75774
Embolization (Non-Neuro)*
G0269
76380
37204
75894
REPORT ONLY ONCE PER SURGICA
F/U Angio study for transcatheter
therapy, embolization or infusion, other
75898
Add'l agent -prescribing, handling, and bolus administration
96420
chemotherapeutic agent
radioactive agent
79445
Yttirum-90
@
36247
Selective Catheterization 3rd order
@
36248 x ___
Additional Selective Catheterization 2nd/3rd+
76937
Selective Catheterization 2nd order
55876
(X)
MODERATE (CONSCIOUS) SEDATION - requires midpoint of time be reached in order
provided by same physician performing the Dx-Tx service
Intraservice
@
S&I
by modality*
by modality*
by modality*
by modality*
by modality*
MR 77021
49411
interstitial device(s), such as fiducial
marker or dosimeter for radiation
Placement of interstitial device(s) for
rad therapy guidance, prostate
Procedure
47382
47399
50592
50593
32998
76940
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
Procedure
S&I
37200/36011
75970
88172
(X)
@
@
Open RFA, Liver Tumor(s) using U/S guidance
*Imaging Guidance Modality Used (circle one)
TRANSCATHETER BIOPSY
Transjugular liver biopsy
Cytohistologic study of specimen
MCS
@
End Time:___________
99144
99145 x ___
99143
99145 x ___
@
@
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 SURGICA
F/U Angio study for transcatheter therapy, embolization or
infusion, other than for thrombolysis
36246
36245
75726
75774
37204
75894
75898
Yttirum- Radiopharmaceutical therapy, by intra-arterial particulate
90
administration
79445
77263
Radiation therapy planning
77300
Radiation therapy dose plan
77790
Radiation handling
PRESENTING PROBLEM(S)/DIAGNOSIS
Dx 1: __________________
ICD-9: _____
Dx 2 :_________________
ICD-9: _____
CPT Only copyright 2012 American Medical Association. All Ri Copyright 2012 Society of Interventional Radiology
PATIENT:
DATE:
PROCEDURE:
REFERRING PHYSICIAN:
INTERVENTIONAL RADIOLOGIST:
MUSCULOSKELETAL CHARGE SHEET
SPINE
MYELOGRAM
(X)
Procedure
S & I*
62284
see
myelogram
codes
VERTEBROPLASTY unilat or bilat procedur (X)
Thoracic one vertebral body w/bone bx
Lumbar puncture, for myelogram
(Valuation for code 62284 includes moderate
(conscious) sedation - Do NOT separately report.)
Cervical puncture, for myelogram
61055
Cervical Myelogram
Thoracic Myelogram
see
myelogram
codes
72240
72255
Lumbar Myelogram
Spinal Canal Myelogram two or more regions
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 OR Intermittent Cerv or Thoracic, Epi/Subara.
Cont. Infusion Lumb or Sac., Epi/Subara
62272
61050
61070
72265
72270
77003
77003
75809
62280
62281
62282
77003*
77003*
77003*
62310
62311
77003*
77003*
62318
62319
77003*
77003*
Injection, epidural, of blood or clot patch
62273
77003*
FACET JOINT INJECTION per joint level
Inject Anesthesia, cervical or thoracic; single joint level
64490
N/A
second level
64491
N/A
third and any additional level(s)
64492
N/A
Inject Anesthesia Lumbar/Sacral, single joint level
64493
N/A
second level
64494
N/A
third and any additional level(s)
64495
N/A
FACET JOINT NERVE DESTRUCTION BY NEUROLYTIC INJECTION per nerve level
Cervical/thoracic, single nerve level w/guidance
64633
cervical/thoracic, each additional nerve level
64634
Lumbar/sacral, single nerve level w/guidance
64635
lumbar/sacral, each additional nerve level
Injection(s), diagnostic or therapeutic agent, paravertebral
facet (zygapophyseal) joint (or nerves innervating that joint)
with ultrasound guidance, cervical or thoracic; single level second [cervical/thoracic] level third and any additional [cervical/thoracic] level(s)
@
Lumbar one vertebral
body w/bone bx
Procedure
22520
S&I
by modality*
by modality*
@
Each add'l T or L vertebral body @
sacroplasty unilat injection
sacroplasty bilat injection
KYPHOPLASTY unilat or bilat injection(s)
Thoracic one vertebral body
Lumbar one vertebral
body
Each add'l T or L vertebral body
*Guidance Modalities for Vertebroplasty
22521
22522 x ___
0200T
0201T
by modality*
by modality*
by modality*
22523
by modality*
22524
22525 x ___
by modality*
by modality*
72291
x ___
Fluoroscopic guidance, per vert. body
CT guidance, per vertebral body
72292
x ___
BIOPSIES
Bone, Superficial, Percutaneous
20220
by modality*
Bone Deep, Percutaneous
20225
by modality*
Spinal Cord
62269
by modality*
*Bx Imaging Guidance Modality Used (circle one)
Fluoro 77002
76942
CT 77012
MR 77021
RADIOFREQUENCY ABLATION
Percutaneous RFA Bone Tumor(s)
(Valuation for code 20982 includes
moderate (conscious) sedation - Do NOT
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)
20982
(X)
Procedure
62287
20500
20501
20600
20605
20610
20552
S&I Code
77003
76080
76080
77002
by modality
by modality
Procedure
Radiographic S&I*
CT S&I**
Arthrogram, TMJ
21116
70332
70487
Arthrogram, Shoulder
23350
73040
Arthrogram, Elbow
24220
73085
Arthrogram, Wrist
25246
73115
27093
73525
27095
73525
MR S&I**
64636
0213T
0214T
0215T
US only
US only
US only
Injection(s), diagnostic or therapeutic agent, paravertebral fac
0216T
US only
second [lumbar or sacral] level (s) 0217T
US only
third and any additional [lumbar or sacral] level(s)
0218T
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
22 Extended Services
24 Unrelated E/M During Global
25 Separate E/M Same Day of Procedure
26 Professional Component
50 Bilateral Procedure
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
Arthrogram, Hip
without anesthesia
Arthrogram, Hip
with anesthesia
Arthrogram, Sacroiliac
Joint (incl's imaging)
Arthrogram, Knee
73201 or
73202
73201 or
73222 or
73223
73222 or
73202
73201 or
73202
73701 or
73702
73701 or
73702
73223
73222 or
73223
73722 or
73723
73722 or
73723
73701 or
73722 or
73702
73701 or
73723
73722 or
27096
27370
73580
Arthrogram, Ankle
27648
73615
73702
73723
**Flouroscopic Guided
77002
77002
Inj for CT/MR
*Do not additionally report 77002 in conjunction with radiographic arthrography S&I codes.
MODERATE (CONSCIOUS) SEDATION
provided by same physician performing the Dx-Tx service
Intraservice Time
Start Time: _______
End Time: ________
(X)
99144
Conscious Sedation AGE 5 or OLDER first 3
each additional 15 minutes
99145 x __
Conscious Sedation UNDER 5 first 30 min
99143
each additional 15 minutes
99145 x __
(X)
MISC
76380
CT, limited or localized follow-up
US Guidance for Vascular Ac Access
76937
(require documentation in file)
LT Left-side
PRESENTING PROBLEM(S)/DIAGNOSIS
Dx 1: __________________
ICD-9: _____
Dx 2 :_________________
ICD-9: _____
CPT Only copyright 2012 American Medical Association. All Rights Reserved.
1. Codes 64622, 64623, 64626, 64627 are to be coded per NERVE LEVEL.
NOTE: Reporting of associated RS&I/imaging guidance code72275/ 76005 has been
limited to once per each spinal REGION.
Copyright 2012 Society of Interventional Radiology. All Rights Reserved
OFFICE WITH ULTRASOUND CAPABILITY CHARGE SHEET
PATIENT:
DATE:
EVALUATION & MANAGEMENT SERVICES
CONSULTATION Office/Outpatient
OFFICE VISIT
(x)
NEW
PATIENT
History and
Examinatio Complexity of Medical
n
Decision Making
NEW OR ESTABLISHED PATIENT
(x)
ESTABLISHED
PATIENT
Straightforward
99211
99241
Problem focused
Straightforward
99202
Problem
focused
Straightforward
99212
99242
Expanded
Straightforward
Expanded
Low
99243
99244
Low
Moderate
99213
99214
Detailed
Detailed
Comprehensive
Moderate
Comprehen
sive
High
99215
99245
Comprehensive
High
ENDOVASCULAR VARICOSE VEIN THERAPY
(x)
VARICOSE VEIN IMAGING DX/FOLLOW-UP
Non-invasive physiological study extremity veins, complete
93965
bilateral study (Doppler)
93970
Duplex scan of extremity veins - Bilat
93971
Duplex scan of extremity veins - unilat/limited study
ENDOVASCULAR VARICOSE VEIN TREATMENT
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)
OTHER VARICOSE VEIN TREATMENT
Injections of sclerosing solutions (single/multiple), spider
36468
veins; limb or trunk
Injections of sclerosing solutions (single/multiple), spider
36469
veins; face
36470
Injection of sclerosing solution- single vein
36471
Injection of sclerosing solution- multiple veins, same leg
Stab phlebectomy of varicose veins, one extremity, 10-20
37765
incisions
Stab phlebectomy of varicose veins, one extremity, more
37766
than 20 incisions
ULTRASOUND GUIDED BIOPSY
(x)
(x)
Complexity of Medical
Decision Making
Problem
focused
99205
(x)
History and Examination
99201
99203
99204
(x)
(x)
BIOPSY
20206
Muscle, Percutaneous
32400
Pleura, Percutaneous
32405 @ Lung, Percutaneous
38505
Lymph Nodes, Sup., Percut
47000 @ Liver, Percutaneous, Separate
47001 @ Liver, Percutaneous, w/ Other Procedure
48102
Pancreas, Percutaneous
49180
Abdomen/Retrop., Percutaneous
55700
Prostate
60100
Thyroid, Percutaneous
10021
Fine needle aspiration, w/out imaging guidance
10022
Fine needle aspiration, w/ imaging guidance
ULTRASOUND IMAGING GUIDANCE
76942
US guidance needle placement
Referring Physician: ____________________
Presenting Problem(s)/Diagnosis
Dx 1:
ICD-9:
_____________
Dx 2:
Dx 3:
ICD-9:
ICD-9:
_____________
_____________
Common Presenting Problem(s)/Diagnosis
Varicose Vein TX
454.0
454.1
454.2
454.8
454.9
459.81
453.8
451.0
Varicose vein of lower extremities with ulcer
Varicose vein of lower extremities with inflammation
Varicose vein of lower extremities with ulcer and inflammation
Varicose vein of lower extremities with other complications
Varicose vein of lower extremities asymptomatic varicose vein
Venous (peripheral) insufficiency, unspecified
Other venous embolism and thrombosis of other specified veins
Superficial thrombophlebitis
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
INTERVENTIONAL RADIOLOGIST:
_____________________________________________________________________
CPT Only copyright 2012 American Medical Association, All Rights Reserved.
Dx 1:
Dx 2:
for
ICD-9:
ICD-9:
Copyright 2012 Society of Interventional Radiology