Vascular embolization can prove challenging for many coders. Knowing the fundamentals of vascular embolization is important for successful CPT® coding. By gaining better comprehension of these services, healthcare coding and billing professionals can help ensure accurate coding while safeguarding full reimbursement. Let’s take a look at some of the details that define these codes when it comes to interventional radiology coding and billing. Here we explore 37241 and 37242.
How is code 37241 utilized?
Code 37241 is specific to venous embolization for clinical indications other than:
| 37241 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation,intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (e.g., congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) |
Make sure that code 37241 is not assigned for extremity incompetent veins or spider veins.
Examples of appropriate clinical indications for 37241 include:
Note that it would not be appropriate to report code 37241 for embolization of accessory (side) branches of an AV dialysis graft. Instead, see code 36909 for more information.
When is code 37242 reported?
Arterial embolization for reasons other than hemorrhage, tumor, organ ischemia or infarction is reported with code 37242.
| 37242 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation,intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (e.g., congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) |
As noted in the code description there are several correct clinical indications for this code including:
Understand that it is important not to assign this code for injection of thrombin into an extremity pseudoaneurysm as that is appropriately coded as 36002.
When hepatic chemoembolization or radioembolization (Y-90) is planned, other arteries such as the gastroduodenal or left gastric may be embolized to keep the chemotherapy or isotope from reaching other organs. If these arteries are embolized at the same session as the hepatic chemoembolization or radioembolization, only one embolization code (37243) would be assigned although additional vascular catheterization codes could be added. If these arteries are embolized at a session separate from the chemoembolization or radioembolization procedure, assign code 37242 (once) plus appropriate catheterization codes.
Patients with an abdominal aortic aneurysm (AAA) stent graft may be found to have an endoleak requiring embolization. An endoleak is not considered a hemorrhage but is rather a continued filling of the aneurysm either through accessory arteries or because the stent graft has become mispositioned. Embolization of the aneurysm or feeding vessel(s) resulting in the endoleak would be reported by 37242, not 37244. It may be necessary to approach the endoleak site by a translumbar injection, which would be coded 36160. However, understand that the NCCI Policy Manual for Medicare Services prohibits assigning a non-selective catheterization code such as 36160 with the embolization codes.
Interventional radiologists sometimes are asked to place balloon catheters within the internal iliac arteries prior to a C-section for a patient with placental issues and potential bleeding. If the balloons are placed but not inflated, report only catheter placements (i.e., 36245, 36246). If the IR physician is asked to inflate the balloons temporarily to prevent hemorrhage, report also 37242-52. Because both internal iliac arteries are in the same operative field, report 37242 only once.
As service volumes rebound, now more than ever it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with expert-infused insight. Our Upper Extremity Interventional Radiology Coding webcast is an essential training tool for both audio and visual learners.
Imagine receiving notice that your healthcare organization faces a potential multimillion-dollar repayment demand based on the review of just 100 claims. This scenario, playing out
Some of you may have read my article from last week kindly published as a special bulletin. For those who did not, let me recap.
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