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:

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:

Your carrier may cover a wide range of diagnoses for TIPS, or it may be one of the payers with a short list. If your carrier is hesitant to expand coverage for TIPS codes, submit a letter demonstrating medical necessity for your TIPS services, says Alice Church, CCS-P, coding and reimbursement analyst at Wolcott, Wood & Taylor, a medical billing firm in Chicago.

"There are no payable diagnoses on Illinois'non-coronary vascular stent LMRP for liver problems. I met with a Medicare representative who suggested that I send supporting documentation so the carrier could review the claim on a case-by-case basis. We did this, and I am happy to say that we received payment for stenting and angioplasty for one claim so far," Church says.

If you have similar coverage problems with your insurer, gather other carriers'LMRPs to demonstrate how various carriers perceive medical necessity for TIPS. "I have a copy of Virginia's TIPS LMRP, and they have payable diagnoses of esophageal varices, portal hypertension, gastric varices, etc., which are not on Illinois'policy. The carriers aren't going to change the LMRPs unless someone takes action," Church says.