Radiology Coding Alert

Question: If a TIPS patient returns less than 90 days after placement for portal angiography to check patency, may I report the service, or is it included in the global?

Georgia Subscriber

Answer: You may report the patency check separately.

TIPS code 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]) has a 0-day global period.

That means related preoperative and postoperative services on the day of the procedure are included in the fee schedule payment for 37182, but services after the day of the procedure are eligible for separate payment.

More on patency check: Once the TIPS is in place, the patient may require portal angiography to monitor the shunt patency (checking that the shunt isn't blocked). Report catheterization of the portal vein via the TIPS shunt using 36481 (Percutaneous portal vein catheterization by any method) and the imaging service using 75885 (Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation) or 75887 (Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation), depending on whether the physician performs hemodynamic evaluation.

Warning: Don't confuse a patency check with angiography performed to prove the TIPS is intact at the completion of the 37182 service. You should not report that completion angiography separately.