# Coil Embolization using 37204 for Endovascular treatment



## jcrossley58@gmail.com (Dec 31, 2012)

I'm not sure who else to go to with my issue and I'm hoping you can help or direct me.  We had a patient that had coil embolization done endovascular.  The patient had coil occlusions RIMA/LIMA and left thoracic.  We charged for 2 coil's using 37204 as per our cardiology coder because the procedure was not open and done endovascular, therefore we are allowed to charge for 2 and not code based on operative site, which if it were open it would be charged for 1.  He said based on the maneuvering of the embolization process we can charge for 2 separate sites.


One of our coders who did coding for cardiology said that based on Dr. Z, this is correct and we can charge for 2.  I looked through AAPC web posts, etc and can not find this information anywhere, so now I'm starting to lean toward agreeing with the Nurse reviewer who is denying the appeal.  I also want to mention that the procedure was done on a 3 yr old child as I work for Boston Children's.


Can someone help?  I want to be able to present to the Nurse reviewer if we can charge per site and not operative field mainly for children. If I can present the documentation the Nurse reviewer would update their policy and procedures to allow this type of charging when our patient's come in for this type of procedure.  Please let me know if you need additonal information.


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## donnajrichmond (Dec 31, 2012)

jcrossley58@gmail.com said:


> I'm not sure who else to go to with my issue and I'm hoping you can help or direct me.  We had a patient that had coil embolization done endovascular.  The patient had coil occlusions RIMA/LIMA and left thoracic.  We charged for 2 coil's using 37204 as per our cardiology coder because the procedure was not open and done endovascular, therefore we are allowed to charge for 2 and not code based on operative site, which if it were open it would be charged for 1.  He said based on the maneuvering of the embolization process we can charge for 2 separate sites.
> 
> 
> One of our coders who did coding for cardiology said that based on Dr. Z, this is correct and we can charge for 2.  I looked through AAPC web posts, etc and can not find this information anywhere, so now I'm starting to lean toward agreeing with the Nurse reviewer who is denying the appeal.  I also want to mention that the procedure was done on a 3 yr old child as I work for Boston Children's.
> ...



Why was the embolization being done.  37204 is per operative site -per tumor, AVM, etc. -  if one tumor, AVM, etc. is embolized through multiple vessels, that is considered 1 site.  However, multiple tumors, AVMs, etc are considered separate sites.


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## jcrossley58@gmail.com (Jan 2, 2013)

*Coil Embolization using 37204 for Endovscular Treatment*

Hi Donna,

Thanks for getting back to me.  The embolization was not for AVM.  It was for a child who was 2 at the time of the procedure with HLHS s/p BDG with LPA patch augmentation coming in for pre-Fontain Cath.

procedure:

Proximal stenosis of LSCA with approximately 42 mmHg peak gradient. Post balloon dilation peak gradient 34 mmHg: RV 91/8, LSCA 67/43 M52.

Multiple aorto-pulmonary collaterals off left and right subclavian arteries.  Successful coil occlusion of residual RIMA and LIMA collateral flow, and left lateral thoracic vessel.

So, we are using 37204 for the coil embolizations through our Cardiac Cath Lab performed endovascluarly and not as an open procedure.  The cath lab states that because of all of the maneuvering to get from LIMA to RIMA we should be able to charge 2 coils as they are in different fields where the cath tip lands.

I can't find any documentation anywhere to find this information as being true as I am not expertise in cardiac cath coding (although I would like to be) and am hoping you can direct me to where I can look to prove to the Nurse reviewer we can charge this way.  I can only find documentaton for operative site only on open procedures.

Your help is greatly appreciated.


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## jewlz0879 (Jan 3, 2013)

But the nurses do not always understand coding and OUR rules. I have a Dr. Z book at home. I will look in there later and see what he says.


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## jcrossley58@gmail.com (Jan 3, 2013)

Thanks so much for doing that for me.  This way hopefully they will change their review procedures for this type of situation.


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## donnajrichmond (Jan 3, 2013)

jcrossley58@gmail.com said:


> Hi Donna,
> 
> Thanks for getting back to me.  The embolization was not for AVM.  It was for a child who was 2 at the time of the procedure with HLHS s/p BDG with LPA patch augmentation coming in for pre-Fontain Cath.
> 
> ...



In this case I agree with the denial - I would only code one embolization procedure (37204 / 75894 , however, you do get to code catheterization codes for each of the different families/vessels selected for embolization (from a groin access that would be probably 36217-RT and 36217-LT, possibly others depending on the entire procedure.  
I think, however, that this is a case where there is no consensus, so others will tell you to code twice.
I chose once because this is (in my opinion) one operative site / one field - the aortopulmonary collaterals feeding into the area where you will be doing the Fontan procedure.


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## jcrossley58@gmail.com (Jan 3, 2013)

Hi Donna,  thanks for this information.  This is helpful


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