Oncology & Hematology Coding Alert

Question: When my oncologist performs chemoembolization, I report both 37204 and 75894. But if he administers a completion angiogram immediately after the embolization to determine the liver's condition and the tumor's status, should I include the angiogram in the two codes, or can I report it separately?

Puerto Rico Subscriber
 
Answer: Procedure code 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) describes the embolization, and 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation) describes the radiological supervision and interpretation as well as all angiography inherent in the embolotherapy. Even so, you should report additional codes for preprocedural diagnostic angiography and completion angiography services during transcatheter arterial chemoembolization (TACE).
 
If your oncologist performs the preprocedure angiography as "road-mapping" (to plan the embolotherapy), you can include that in 75894. But you should separately report preprocedural diagnostic angiograms if your physician uses them to determine whether the embolotherapy is warranted or to document the tumor distribution for diagnostic reasons.
 
The TACE procedural work doesn't include vascular access, so you should separately report these services. If your oncologist catheterizes the common hepatic artery and injects contrast, you should report 36246 (Selective catheter placement, arterial system; initial second-order abdominal, pelvic, or lower-extremity artery branch, within a vascular family) for the catheterization and 75726 (Angiography, visceral, selective or supraselective [with or without flush aortogram], radiological supervision and interpretation) for the angiogram.

 - Answers to Reader Questions and You Be the Coder were provided by Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.; and Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.