Download Facility Guide for Interventional Radiology

FIR.book Page 1 Tuesday,N ovem ber25,2008 11:29 A M
Facility Guide for
Interventional Radiology
2009
FIR.book Page i Tuesday,N ovem ber25,2008 11:29 A M
Contents
Introduction ......................................................1
Procedure Codes ..........................................2
Chapter 1: The Basics .......................................5
APC Basics–Why Is This Important? ..............5
CCI Edits–Why Is This Important? .................7
Coding Basics ..............................................8
General Coding Guidelines ..........................8
Modifiers for Outpatient Hospital Radiology
and Cardiology Procedures ....................9
Revenue Codes ..........................................10
General Interventional Radiology Coding
Guidelines for Selective and Nonselective
Catheter Placements ............................11
Catheter Placement Codes for Interventional
Radiology ............................................11
General Cardiac Interventional Coding
Guidelines ............................................12
Documentation ..........................................13
Supply Device Codes .................................13
Chapter 2: Diagnostic Angiography ..............15
Cerebral Angiography—Internal Carotid
and Vertebral .......................................15
Cerebral Angiography—External Carotid ....19
Aorta Angiography—Arch, Thoracic,
and Abdominal ....................................21
Internal Mammary and Spinal
Angiography ........................................24
Visceral Angiography—Celiac, Hepatic,
Splenic, Inferior Phrenic, Superior
and Inferior Mesenteric Arteries, and
Bronchial Arteries .................................27
Renal Angiography .....................................30
Adrenal Angiography .................................32
Extremity Angiography ..............................34
Pelvic Artery Angiography ..........................38
Pulmonary Artery Angiography ..................40
Chapter 3: Diagnostic Venography ................43
Cerebral Veins ............................................43
Central Veins—Superior and Inferior
Vena Cava ...........................................46
Renal and Adrenal Veins .............................48
Extremity Veins ..........................................50
Portal and Hepatic Veins and TIPS ..............52
Arteriovenous Fistula and Interventions ......56
Venous Sampling .......................................60
Chapter 4: Vascular Interventions ..................61
Percutaneous Embolization—Peripheral and
Visceral Vessels .....................................61
Percutaneous Embolization—Uterine
Fibroid ................................................ 64
Percutaneous Embolization—Cerebral
(Extracranial and Intracranial) ............. 65
Temporary Balloon Occlusion .................... 68
Transcatheter Thrombolysis and Infusion
Therapy .............................................. 70
Percutaneous Thrombectomy .................... 73
Percutaneous Transluminal Angioplasty ..... 76
Percutaneous Intracranial Angioplasty ...... 80
Percutaneous Transluminal Atherectomy ... 82
Percutaneous Vascular Filter Placement/
Removal .............................................. 86
Intravascular Ultrasound, Non-coronary .... 88
Transcatheter Vascular Stent
Placement—Peripheral and Visceral ..... 90
Transcatheter Vascular Stent
Placement—Cervical Carotid ............... 93
Transcatheter Vascular Stent
Placement—Intracranial ..................... 97
Transcatheter Vascular Stent
Placement—Extracranial Vertebral
or Intrathoracic Carotid Artery ............ 99
Transcatheter Biopsy ............................... 101
Chapter 5: Vascular Access Device Placement
and Therapy ................................................. 103
Non-Tunneled Vascular Access Device
Placement ......................................... 104
Tunneled Vascular Access Device
Placement ......................................... 107
Repair/Replacement/Removal of Vascular
Access Device .................................... 110
Maintenance of Vascular Access Device ... 114
Chapter 6: Minor Interventional Procedures 119
Arthrography .......................................... 119
Needle-Guided Interventional Procedures 122
Other Biopsy Procedures ......................... 125
Aspiration Procedures .............................. 127
Image Guided Drainage Procedures ........ 128
Endovenous Ablation Therapy ................. 129
Stab Phlebectomy ................................... 130
Chapter 7: Gastrointestinal Tract
Interventions ................................................ 131
Percutaneous Transhepatic
Cholangiography .............................. 131
Percutaneous Biliary Stone Removal ........ 132
Esophageal Dilation ................................. 134
Percutaneous Transhepatic Biliary Duct
Dilation and Stent Placement ............ 135
Percutaneous Gastrostomy Tube
Placement ......................................... 138
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FIR.book Page 27 Tuesday,N ovem ber25,2008 11:29 A M
Chapter 2: Diagnostic Angiography
Visceral Angiography—Celiac, Hepatic, Splenic, Inferior Phrenic, Superior and Inferior
Mesenteric Arteries, and Bronchial Arteries
Visceral angiography includes selective catheterization of
one of the arteries supplying blood to the viscera and
encompasses arteries within the thoracic and abdominal
viscera. CPT code 75726 is selective or superselective.
Arteries covered by this code include the celiac, hepatic,
splenic, gastric, inferior phrenic, superior and inferior
mesenteric arteries, and bronchial arteries, as well as other
branches. The code includes the performance of an
aortogram and as many injections and projections as
necessary to image each vessel. Imaging may be obtained
via traditional film methods and/or utilizing digital
techniques.
injected through the catheter and a series of x-rays or
fluoroscopic images taken to visualize the vessels and
evaluate any abnormalities such as blockages, narrowing,
or aneurysms. The catheter is removed and pressure
applied to the site. This code reports the radiological
supervision and interpretation. Use separately reportable
code for the catheterization.
75726
2.
Angiography, visceral, selective or
supraselective, (with or without flush
aortogram), radiological supervision and
interpretation
An artery supplying the organ of concern is examined
radiologically by injecting contrast material. A local
anesthetic is applied over the area of access, usually the
common femoral artery. The artery is percutaneously
punctured with a needle and a guidewire inserted and fed
through the artery to the point of study. A catheter is
threaded over the guidewire until it, too, reaches the point
of study and the guidewire is removed. Contrast medium is
Facility Coding Tips
1.
3.
Facilities report both components of the procedure:
the surgical component or catheter placement codes
and the technical radiology S&I codes.
If multiple vessels are studied during the same session,
CPT code 75774 is reported for each vessel after the
initial vessel. Catheter placement is coded for each
vascular family. Any of the arteries in the group listed
can be studied by themselves. CPT code 75726 and
one catheter placement code would be reported in this
situation. It is more common to study multiple vessels
during the same session.
Do not report CPT code 75625 in addition to 75726 if
the aorta is injected during the exam. The aorta is
included as part of this procedure.
Superior and Inferior Mesenteric Arteries and Branches
Transverse Branches of
Middle Colic artery
Superior
Mesenteric
artery
Inferior
Mesenteric
artery
Inferior Pancreaticoduodenal
artery
Middle
Colic
artery
Anterior & Posterior Branches of
Inferior Pancreaticoduodenal
Arcade
Left Colic Ascending
(Marginal) Branches
Right Colic Ascending
(Marginal) Branch
Right Colic
artery
Left Colic artery
Left Colic Descending
(Marginal) Branches
Right Colic Descending
(Marginal) Branch
Sigmoid Branches
Ileocolic artery
Ileal Branches
Superior Hemorrhoidal artery
Arcade Branches
Hemorrhoidal branches
© 2008 Ingenix
CPT only © 2008 American Medical Association. All Rights Reserved.
27
FIR.book Page 161 Tuesday,N ovem ber25,2008 11:29 A M
Chapter 9: Diagnostic Cardiac Catheterization
Left Heart Catheterization Combined Transseptal and Retrograde Approach
93524
Combined transseptal and retrograde left
heart catheterization
The physician threads a catheter to the heart
using combined retrograde and transseptal
techniques to evaluate left heart function. The
retrograde portion is performed through an
introducing sheath placed percutaneously into
the femoral, brachial, or axillary artery. The
catheter is then passed through the aortic valve
into the left ventricle. Transseptal catheterization
involves passing a catheter from the right femoral
vein to the right atrium. The interatrial wall or
septum is punctured and the catheter is passed
into the left atrium through the mitral valve and
into the left ventricle. Blood samples, pressure,
electrical recordings, and/or other measurements
are made.
Facility Coding Tips
1.
2.
3.
4.
5.
6.
CPT code 93524 does not include injection of contrast
media. Report the appropriate code from range
93539-93545.
Imaging supervision is reported separately with 93555
and 93556.
Fluoroscopy is considered to be part of cardiac catheterization and is not reported separately.
Pulse oximetry is not reported separately.
Report separately the placement of a flow directed
catheter (Swan-Ganz) for the purpose of hemodynamic monitoring when performed during cardiac
catheterization.
If angiography of the renal or iliac arteries is performed, for Medicare patients, report HCPCS Level II
code G0275 for unilateral or bilateral renal angiography and G0278 for iliac and/or femoral artery angiography. Refer to individual payer guidelines for nonMedicare patients.
Superior
Vena
Cava
Catheter may
enter through
brachiocephalic
branch
8.
9.
While physicians may not separately report the placement of a mechanical arterial sealing device after the
cardiac catheterization, hospitals should separately
report both the supply and the procedure. Medicare
has assigned a specific HCPCS Level II code for this
procedure (G0269). The corresponding supply code is
C1760 Closure device, vascular (implantable/ insertable). Other third-party payers will likely not accept
this code and hospitals should verify with each payer
on their policy regarding this service. Medicare does
not provide separate payment, but the costs and
charges should still be reported separately.
Do not report CPT codes from the 70000 series for test
angiograms done prior to placement of a vascular closure device. This is considered to be part of the cardiac
catheterization procedure.
Hospitals should separately report supplies and contrast used during cardiac catheterization procedures.
Facility HCPCS Coding
HCPCS Level II codes are used to report the supplies
provided during the procedure. Hospitals should separately
report supplies used during cardiac catheterization
procedures. Refer to chapter 1 for more information
regarding appropriate billing of supplies. Refer to the list of
current codes in appendix B.
Procedure HCPCS Codes
G0269 Placement of occlusive device into either a venous
or arterial access site, post surgical or
interventional procedure
G0275 Renal artery angiography (unilateral or bilateral)
performed at the time of cardiac catheterization,
includes catheter placement, injection of dye, flush
aortogram and radiologic supervision and
interpretation and production of images (List
separately in addition to primary procedure)
G0278 Iliac artery angiography performed at the same
time of cardiac catheterization, includes catheter
placement, injection of dye, radiologic supervision
and interpretation and production of images (List
separately in addition to primary procedure)
Aorta
ICD-9-CM Codes
Pulmonary
valve
Tricuspid
valve
7.
Left
ventricle
Right ventricle
The catheter crosses the aortic valve and enters
the left ventricle of the heart (retrograde).
Additionally, the catheter probes the septum
of the heart into the right side
© 2008 Ingenix
CPT only © 2008 American Medical Association. All Rights Reserved.
The application of this code is too broad to adequately
present ICD-9-CM diagnosis code links here. Refer to your
ICD-9-CM book.
CCI Edits
93524 0086T, 01920, 01924-01926, 33210, 3481234813, 35201-35206, 35226, 35261-35266,
35286, 36000, 36005-36010, 36013-36015,
36140, 36200, 36245, 36410, 36500, 3655536556, 36568-36569, 36600-36625, 37202,
51701-51703, 71034, 75600, 75605, 75625,
75630, 75710, 75716, 75722, 75724, 75741,
75743, 75746, 75756, 75774, 75893, 76000-
161