Radiology Coding Alert

Plus: Prepare to add peripheral vessel mechanical thrombectomy to your claims

If you code for central venous access device assessment, also known as a central line patency check, CPT Codes 2006 is easing your burden by giving this service its own code.

Until now, you've had to bill for this procedure using an unlisted-procedure code plus a fluoroscopy code, says Cheryl A. Schad, BA Ed, CPC, ACS-RA, owner and radiology coding and compliance consultant with Schad Medical Management in Mullica Hill, N.J. That means delays and denials despite the work and value inherent in the service.

But CPT 2006 is adding a new code for this procedure, so you might see appropriate reimbursement for it, Schad says.

Use new code 36598 (Contrast injections[s] for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report) when your physician injects contrast to see if there's a problem with a venous access device (such as fibrin around the ends), says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. You should also use the code when the injection checks an unintended, clinically significant change in position. The radiologist looks to see if the contrast is able to pass through.
 
Rejoice Over Renal Radiofrequency Ablation Code

The American Medical Association heard your pleas regarding another procedure, as well. CPT 2006 code 50592 (Ablation, one or more renal tumor[s], percutaneous, unilateral, radiofrequency) covers radiofrequency ablation of one or more renal tumors.

This is a very welcome change because previously you had to use an unlisted-procedure code, Schad says.

Make the Most of Mechanical Thrombectomy Codes

In 2005, there are codes for mechanical thrombectomy only if the physician performs it in a coronary vessel or arteriovenous fistula. But starting in January, you'll be able to bill for mechanical thrombectomy in peripheral vessels as well, Miller says.

In 2006, CPT opens up your options with these three new codes for arterial mechanical thrombectomy:

• CPT 37184 --Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel

• +37185--...second and all subsequent vessel(s) within the same vascular family

• +37186--Secondary percutaneous transluminal thrombectomy (e.g., nonprimary mechanical, snare basket, suction technique), noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy.

You'll also have two new venous mechanical thrombectomy codes:

• 37187--Percutaneous transluminal mechanical thrombectomy vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance

• 37188--...repeat treatment on subsequent day during course of thrombolytic therapy.