Radiology Coding Alert

Interventional radiologists across the country are embracing a highly effective treatment for women suffering from uterine fibroids called uterine artery embolization (UAE). Although there have been some reimbursement difficulties because the procedure is relatively new, many coding professionals are reporting satisfactory payment ratesprovided they follow a straightforward coding strategy.

According to Scott Goodwin, MD, chief of vascular and interventional radiology at the University of California/Los Angeles Medical Center, the key to maximizing reimbursement begins with proper assignment of the diagnostic code. It is imperative that the radiologist provide an accurate ICD-9 code, he says. Embolization, in general, has been used to stop hemorrhages for a long timethree decades or moreand third-party payers are familiar with it under these circumstances. Nonetheless, many insurers are not acquainted with the use of embolization to treat uterine fibroid disease. Weve been using it as a method of treatment for only a few years, since the early 1990s.

Goodwin adds that he expects UAE use to grow because, in his experience, about 85 percent of the women who have undergone the procedure achieve substantial or complete resolution of their symptoms.

Diagnostic Codes for Abnormal Bleeding Produce Fewest Denials

Clearly, if the primary clinical reason for the UAE is to control hemorrhage, either on an acute or chronic basis, the ICD-9 code should reflect this fact. If the primary clinical concern is other than hemorrhage, however, the appropriate code for the clinical indication should be used. Under no circumstances should an ICD-9 code be chosen merely to improve reimbursement.

In most cases, Goodwin notes, an ICD-9 code from the 626-series is most successful (disorders of menstruation and other abnormal bleeding from female genital tract). According to Jackie Marrero, interventional billing specialist for the UCLA Radiology Medical Group, their practice generally assigns 626.2 (excessive or frequent menstruation [heavy periods, menorrhagia, menometrorrhagia, plymenorrhea]).

We have had the most success when we were able to use this diagnostic code, says Goodwin, who pioneered the use of UAE in the United States and estimates he has performed 250 of the procedures. In some instances, however, women dont experience abnormal bleeding with fibroid disease. They may be enduring a great deal of pain without bleeding, secondary to their uterine fibroids.

Under these circumstances ICD-9 625.9 (unspecified symptom associate with female genital organs) or 218.9 (leiomyoma of uterus, unspecified) may be assigned. We have had more denials when we have had to assign codes reflecting fibroids and pain without the abnormal bleeding, Goodwin notes.

Members of the Society of Cardiovascular and Interventional Radiology (SCVIR) concurs with [...]