# is Cath placement billable with 37243



## carps14 (Mar 3, 2014)

I am confused with the verbage that the CPT book has for TRANSARTERIAL HEPATIC CHEMOEMBOLIZATION
it says "code also diagnostic angiography and cath placement using modifier 59 when performed"  If there wasn't a billable diagnostic angio does that mean the cath placement in bundled in with 37243? OR is cath placement always billable??  
Thank you


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## dpeoples (Mar 3, 2014)

carps14 said:


> I am confused with the verbage that the CPT book has for TRANSARTERIAL HEPATIC CHEMOEMBOLIZATION
> it says "code also diagnostic angiography and cath placement using modifier 59 when performed"  If there wasn't a billable diagnostic angio does that mean the cath placement in bundled in with 37243? OR is cath placement always billable??
> Thank you



My understanding is that catheter placement is always separatley billable, even though it may require a modifier, but angiography is not always billable. 

HTH


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## carps14 (Mar 3, 2014)

thank you for your input!!


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## Lisa Bledsoe (Mar 12, 2014)

*please clarify and help*

In follow up to the previous question, I need clarification please on "road mapping".  Please see the following note.  My question is this:  Am I able to code for the SMA, Celiac and Hepatic cath's and angio's?  Or is this part of road mapping?  TIA! 

The patient received intravenous conscious sedation with a total of 3 mg of Versed and 150 mcg Fentanyl administered by interventional radiology nursing staff.  The patient was under continuous
physiologic monitoring of heart rate, blood pressure, respiratory rate and oxygen saturation for the entire 60 minutes of the procedure.

Patient was placed supine on the fluoroscopy table and a patient identification time-out checklist was completed.  The right common femoral artery was evaluated with ultrasound and confirmed to be
patent. Using real time US guidance and fluoroscopy the CFA was punctured with a micropuncture set.  Images were saved for documentation.  A 5 French sheath was placed over a Bentson wire.  A SOS-1
selective catheter was used to select the SMA and diagnostic arteriography performed carried out to the portal venous phase.  The celiac artery was then selected and diagnostic arteriography
performed.  A microcatheter was coaxially advanced to the gastrohepatic trunk hepatic artery and diagnostic arteriogram performed. Further sub selection of the left hepatic artery arising from the
left gastric was achieved and diagnostic arteriography was performed. Embolization was undertaken from this position using Adriamycin mixed with Ethiodol and 150-250 micron PVA until near stasis was
achieved.  Post-embolization arteriogram was performed.  

Micro catheter was used to subselect the superior right hepatic artery and diagnostic arteriography was performed.  The segment 8 branch was further sub selected and diagnostic arteriogram was
performed.  Embolization was undertaken from this position using the same embolic mixture to near stasis.  Post embolization arteriogram was performed.  

Next the middle hepatic artery arising from the proper hepatic artery was selected and diagnostic arteriogram was performed.  Further sub selection of the segment 4A branch was achieved and
diagnostic arteriogram performed.  Chemo embolization was undertaken from this position using the same embolic mixture filled near stasis.  Post embolization arteriogram was performed.   

Catheters were removed and right external iliac arteriogram was performed through the sheath.  A StarClose device was used for hemostasis.

FINDINGS: Right CFA is patent and of normal caliber.  SMA anatomy is normal, the portal vein is patent with hepatopedal flow.   

Celiac artery anatomy is variant with a gastrohepatic trunk supplying the the remaining left lateral liver and a portion of segment four.  Faint tumor blush is demonstrated with arterial feeders
arising from the right, middle and left gastrohepatic arteries. Subselective embolization from each these distributions was performed. Post-embolization angiogram demonstrates stasis in the embolized
arteries.   

COMPLICATIONS: None.

IMPRESSION: UNCOMPLICATED SUBSELECTIVE CHEMOEMBOLIZATION OF THREE DISTINCT LIVER LESIONS AS ABOVE.


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## dpeoples (Mar 12, 2014)

Lisa Bledsoe said:


> In follow up to the previous question, I need clarification please on "road mapping".  Please see the following note.  My question is this:  Am I able to code for the SMA, Celiac and Hepatic cath's and angio's?  Or is this part of road mapping?  TIA!
> 
> The patient received intravenous conscious sedation with a total of 3 mg of Versed and 150 mcg Fentanyl administered by interventional radiology nursing staff.  The patient was under continuous
> physiologic monitoring of heart rate, blood pressure, respiratory rate and oxygen saturation for the entire 60 minutes of the procedure.
> ...



Lisa,
To answer the question you asked, another question has to been asked also, why is the patient having a procedure at all? Normal healthy patients do not undergo such treatments, so why is this patient being treated? 
I see no indication anywhere in this report that there is a medical issue being addressed, until the very end...liver lesions. How did the docs know there were liver lesions that needed to be embolized? That is where the diagnostic test are codeable. I often see that the condition being treated is already known, meaning it was previously diagnosed. So, without indication of a change in the patients condition, further "diagnositic" images should not be necessary. So, for a test to be truly diagnostic, the condition being treated, must be, by definition, unknown to the provider of the service.
Calling something a "diagnostic test" does not mean that it is.
Perhaps there is more to the report you posted, but as is, I would not code for diagnostic angiography (SMA, Celiac & Hepatic).

HTH


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## Lisa Bledsoe (Mar 12, 2014)

dpeoples said:


> Lisa,
> To answer the question you asked, another question has to been asked also, why is the patient having a procedure at all? Normal healthy patients do not undergo such treatments, so why is this patient being treated?
> I see no indication anywhere in this report that there is a medical issue being addressed, until the very end...liver lesions. How did the docs know there were liver lesions that needed to be embolized? That is where the diagnostic test are codeable. I often see that the condition being treated is already known, meaning it was previously diagnosed. So, without indication of a change in the patients condition, further "diagnositic" images should not be necessary. So, for a test to be truly diagnostic, the condition being treated, must be, by definition, unknown to the provider of the service.
> Calling something a "diagnostic test" does not mean that it is.
> ...



Thank you so much Danny!  That was my gut instinct, but I started over-thinkng!  As always, you have been extremely helpful!


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