Interventional radiology practices consistently receive payment from Medicare and most private insurers for uterine artery embolization (UAE), a relatively new and highly effective treatment for uterine fibroid tumors. As recently as two or three years ago, however, some
radiology billing departments reported reimbursement problems because of the novel nature of the procedure.
For instance, Jeff Fulkerson, BA, CPC, coding specialist at the Emory Clinic in Atlanta notes that radiologists in the Emory practice perform up to five UAEs each month. "We've had no denials that I can recall, and we do enough of these procedures to know successful reimbursement depends, in part, upon a coder's understanding of the three primary components of the procedure angiography, catheterization and embolization which of these can be billed more than once if performed multiple times, and how to use the most appropriate modifiers to meet various payer requirements," he says.
Multiple Imaging and Catheterization Codes Assigned
During UAE, Fulkerson explains, the interventionalist advances a catheter through the arterial system to the uterine artery. Once the catheter is in position, the radiologist implants particles, coils or other embolization devices to block the blood flow to the fibroid tumors. Deprived of blood, the tumors shrink. UAE is generally performed in both uterine arteries to ensure that all access to blood flow is interrupted. In some cases, collateral arteries are also treated to complete the therapy.
Access to the patient's vascular system is achieved at the common femoral artery. According to Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm for hospital-based practices in Chattanooga, Tenn., the radiologist typically begins with a contralateral approach initially treating the arteries on the opposite side of the body from the side punctured in the single femoral access point. In some cases, the interventionalist may first place the catheter in the aorta in order to assess the multiple potential arteries to the uterus. If this is done, the radiological supervision and interpretation (RS&I) code for nonselective abdominal and proximal runoff arteriography is CPT 75630 (aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation). The code for nonselective catheter placement, 36200 (introduction of catheter, aorta), is not charged because the work will be included in any subsequent selective or superselective vascular catheterizations from the same puncture site.
"Next the guidewire and catheter are advanced into the contralateral internal iliac artery," she explains. The interventional radiologist may obtain images of the internal iliac artery circulation. Subsequently, the catheter is further advanced into the uterine artery branch of the internal iliac artery. Images of the uterine artery that is feeding the uterus and the fibroids to be treated [...]
