Radiology Coding Alert

Prevent denials by applying this news for 37620 and 75940.

Starting Jan. 1, 2012, you'll no longer be stuck tracking payer preferences for how to code removal of inferior vena cava (IVC) filters. CPT® 2012 offers a new code specific to that service, along with a new code each for insertion and repositioning.

• 37191, Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
• 37192, Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
• 37193, Retrieval (removal) of intravascular vena cava filter endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed.

Pick 37191 for Accurate Placement Coding

Old way: In 2011, you reported IVC filter placement using the following codes:

• 36010, Introduction of catheter, superior or inferior vena cava for catheterization
• 37620, Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular (umbrella device)
• 75940, Percutaneous placement of IVC filter, radiological supervision and interpretation.

New way: New code 37191 includes all of the above elements, so the single code is all you'll need to report filter placement. Because of this new all-in-one code, CPT® 2012 deletes the IVC-specific codes 37620 and 75940.

Tip: Although 36010 is still a valid code in 2012, you should not report it in conjunction with 37191 to describe catheter introduction performed for IVC filter placement. Code 37191 includes that catheter placement.

Resist Urge to Report Repositioning During Insertion

For 2012 dates of service, CPT® offers 37192 for the services required to reposition an IVC filter. A parenthetical note with the code makes it clear that 37192 does not apply when the physician repositions the filter during installation. Specifically, the instruction states, "Do not report 37192 in conjunction with 37191."

Reporting reality: IVC filter repositioning is a rare procedure in current practice, so you may not use this code often.

37203 and 75961 No Longer Belong on Removal Claims

Old way: In 2011, coding IVC filter removal wasn't as clear cut as insertion coding was. To describe removal, payers may have requested unlisted procedure codes. Alternatively, some payers preferred transcatheter retrieval codes 75961 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter], radiological supervision and interpretation) and 37203 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter) to describe the service.

New way: You should report 37193 to describe all of the elements required to remove the IVC filter. Guidelines for 2012 make it clear that you should not report 37193 alongside previously used codes 75961 and 37203.

One reason no specific code existed until now is that earlier filter models were permanent, so no code for removal was required. With this new code, CPT® is catching up with technological advances.