Radiology Coding Alert

Although Radiology Coder have good reason to celebrate many of the new CPT Changes in 2003, some of the coding clarity may come with a price. Voluminous new codes corral lots of individual components under a single heading, raising concerns about whether RVUs will reflect the level of effort required by these procedures. Of particular interest are codes relating to insertion and revision of transvenous intrahepatic portosystemic shunts (TIPS). TIPS for the New 'Wal-Mart' Codes "Sometimes you have to be careful what you ask for," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., an Atlanta-based firm. For example, you'll find several codes that combine multiple component procedures under a single descriptor, as with the new TIPS codes:   37182 Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation)     37183 Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, stent placement and all associated imaging guidance and documentation).   Because they include everything from venous access, hepatic and portal vein catheterization, portography, track formation and stent placement to imaging guidance and documentation, Parman likens the new TIPS codes to "one-stop shopping."

While comprehensive codes have the benefit of clarity, the RVUs will be critical, Parman says. The risk with "Wal-Mart codes," where you can get everything in one place, is that reimbursement may not reflect the level of clinical effort. Balloon Occlusion Also Bunched In another case of one-stop shopping, the new temporary balloon occlusion code at least clarifies the old competing theories about how to code arterial occlusions:   61623 Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiography required for balloon occlusion and to exclude vascular injury post occlusion.   "We really needed 61623 because no one knew whether to use a modifier -52 for reduced service or a modifier -22 (Unusual procedural services) for a more complicated service," Parman says. This new code is perfectly clear, but it bundles virtually everything, including the concomitant neurological monitoring, all angiography, as well as checking the procedure afterwards. Yet-to-be-disclosed RVUs will be critical here, too. Gotta Love Those Pericatheter Codes There's no quibbling about long-needed codes for the removal of pericatheter obstructive material:   36536 Mechanical removal of pericatheter obstructive material (e.g., fibrin sheath) from central venous device via separate venous access     36537 Mechanical removal of intraluminal (intracatheter) obstructive material from [...]