Radiology Coding Alert

Retrain your brain to prevent 75898 follow-up study mishaps.

Big changes are in the works for thrombolysis infusion. CPT® 2013, effective Jan. 1, 2013, swaps out your old non-coronary codes for an all new set that focuses on the initial day, subsequent day, and final day of therapy.

2012: Review Thrombolysis and Radiology Options

Infusion: In 2012, your code choices included the following codes for infusion and radiological supervision and interpretation (S&I):

• 37201, Transcatheter therapy, infusion for thrombolysis other than coronary
• 75896, Transcatheter therapy, infusion, any method (e.g., thrombolysis other than coronary), radiological supervision and interpretation.

Follow-up: For follow-up angiography through an existing catheter to check the patient’s progress, the appropriate 2012 code was:

• 75898, Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion.

Exchange: If the physician exchanged the catheter, you used the following codes for 2012 services:

• 37209, Exchange of a previously placed intravascular catheter during thrombolytic therapy
• 75900, Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation.

2013: Base Code Choice on Vessel and Day

CPT® 2013 deletes 37201 and 37209, and replaces them with new options that include S&I. Because the new infusion codes include S&I, 75900 has been deleted for 2013. Codes 75896 and 75898 have not been deleted, but they have been revised to specify they apply to transcatheter therapy infusion "other than for thrombolysis," says Julie Graham, BA, CPC, coder and compliance specialist for Concentra in Texas.

Initial day: New 2013 codes 37211 and 37212 vary based on whether the infusion is arterial or venous. To properly apply these codes, you also need to remember that the codes include related services (such as S&I, follow-up angiography, catheter repositioning or exchange), and that 37211 and 37212 are specific to the initial treatment day. You should report each code only once for the date of service:

• 37211, Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day
• 37212, Transcatheter therapy, venous infusion for thrombolysis, any method, including. radiological supervision and interpretation, initial treatment day.

Subsequent day: In 2013, you have two options to choose from for treatment subsequent to the initial day of treatment. Both 37213 and 37214 include S&I, thrombolytic therapy, follow-up angiography, and catheter repositioning or exchange. The difference between the two codes is that 37214 also includes completing the thrombolysis service by removing the catheter and closing the vessel involved. The codes are defined as follows and are intended to be reported only once per day:

• 37213, Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed 
• 37214, Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method.

Symbols: When you review the codes in your CPT® text, you’ll see two symbols next to each of the new codes. The first is #. This symbol means "resequenced code" and indicates that a code is out of numerical order. CPT® 2013 places 37211-37214 after 37200 and before 37202. By placing the codes out of numerical order, CPT® is able to add new codes near similar transcatheter service codes without having to renumber entire sections.

The other symbol is. This symbol indicates moderate sedation services performed by the same provider are included in the service and should not be charged separately.

S&I: Steer Clear of Separate Imaging Codes

As mentioned above, codes 75896 and 75898 have been revised in 2013 because they are no longer appropriate for thrombolysis S&I. The new code definitions are:

• 75896, Transcatheter therapy, infusion other than for thrombolysis, radiological supervision and interpretation
• 75898, Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis.

Crucial: Take special care to remember that follow-up angiography code 75898 is no longer appropriate for thrombolysis services. "Coders will need to beware of trying to bill 75898 for the follow-up done same day as this is now included with 37211," says Graham. Same-day follow-up angiography is also included in 37212, according to CPT® guidelines.

"You can, however, bill 37213 on a subsequent day," she adds. Or report 37214 for a subsequent day that includes completion of thrombolysis. Recall that the subsequent day codes include follow-up angiography and all other services related to the thrombolysis performed on that day.

Guidelines: Polish Your Claims With These Tips

To help in the transition from old codes to new, you may want to jot a few notes in your CPT® resource.

For instance, Graham finds it helpful "to write the old code(s), in parentheses, next to the new code." This technique helps with the "mental transition in understanding the new codes, as well as ensuring that I don’t overlook their respective revisions or use outdated codes," says Graham. 

As an example, whether you use a manual or software, you can make a note with codes 37211 and 37212 as a reminder that you used to use 37201, 75896, and 75898 for the same services.

Guidelines: If you use a manual, you also may want to make a note next to the codes that there are important guidelines before 37184. Key points include:

• Intraprocedural thrombolytic injections aren’t reportable with mechanical thrombectomy, but 37211-37214 are appropriate for "subsequent or prior continuous infusion of a thrombolytic"
• For bilateral thrombolytic infusion through separate access sites, append modifier 50 (Bilateral procedure) to 37211 or 37212
• Report only 37211 or 37212 if the physician begins and completes thrombolysis on the same date (don’t report 37214)
• Catheter placement(s), diagnostic studies, and other percutaneous interventions may be separately reportable
• Related E/M services on the same date are included in thrombolysis, but separately identifiable E/M services are reportable with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service)
• Ultrasound guidance for vascular access is separately reportable using +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]), assuming code requirements are met.