Radiology Coding Alert

TIPS coders, take note: You should no longer report five codes for TIPS procedures. The new transjugular intrahepatic portosystemic shunt (TIPS) codes (37182 and 37183) may seem too good to be true, but they include all aspects of the interven-tionalist's TIPS work.

The new TIPS codes are as follows:
CPT 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)
CPT 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 these codes are so comprehensive, they offer radiologists a simpler reporting method than in the past but with new codes come new challenges. For instance, some practices believe these codes will include every service the radiologist performs even procedures that should go above and beyond TIPS but this is not the case.

"If the radiologist performs anything outside of TIPS, such as an embolization of the coronary vein, he or she should code separately for it, in addition to using the appropriate new TIPS code," says Deborah Ovall, CMA, CCS, CIC, coder at the Medical College Hospitals of Ohio at Toledo.

But if the radiologist performs less than what the TIPS codes include, you should not report the 37182-37183 series at all. "The new codes are only for creating or revising a TIPS," Ovall says. Do not append modifier -52 (Reduced services) to 37182 or 37183 if you perform only certain portions of the service, such as portal vein catheterization (36481) or hepatic vein catheterizations (36011-36012) for diagnostic studies. Instead, report the services by submitting their individual codes. Open Procedures AreNot TIPS Because most radiologists refer to the procedure simply as "TIPS," forgetting that the "T" stands for "transjugular" can be easy because the radiologist performs TIPS percutaneously through the jugular vein, you should not report the TIPS codes for open procedures, although this would be quite unusual within an interventional practice. A parenthetical note in CPT Codes following 37182's descriptor directs practices to report 37140 (Venous anastomosis, open; portocaval) for open procedures. You should report 37140 instead of 37182 not in addition to it, Ovall advises. Fight for Reimbursement Most carriers have not yet published local medical review policies (LMRPs) for the new TIPS codes, but they will likely cover them on the same basis as the old codes. Some of the most commonly accepted diagnoses include:
452 Portal vein thrombosis
453.0 Budd-Chiari syndrome [...]