Radiology Coding Alert

Question: Should we report the new TIPS codes if we perform a TIPS evaluation without any revision? We place the catheter through the TIPS and into the portal vein, measuring pressures and performing venography.

New Jersey Subscriber

Answer: You should not report the new codes 37182 (Insertion of transvenous intrahepatic portosystemic shunt[s] [TIPS] [includes venous access, hepatic and portal vein catheterization, portography with hemo-dynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation]) or 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]) unless you actually create or revise a TIPS.

These comprehensive codes include all of the services you perform during TIPS creation or revision, but you cannot append modifier -52 (Reduced services) to them if you performed a diagnostic study of an existing TIPS.

You should instead report 75887 (Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation) for measuring the pressures, and 36481 (Percutaneous portal vein catheterization by any method) for the catheter placement through the TIPS into the portal vein.

If a separate hepatic vein study is necessary, either with or without hemodynamic measurements, you should also report the radiological supervision and interpretation codes, but merely following the contrast through the TIPS and into the systemic venous circulation does not warrant the use of the hepatic venography codes.