Radiology Coding Alert

Radiologists who offer chemoembolization treatment to liver cancer patients should always report at least two codes CPT 37204 and CPT 75894 to ensure appropriate reimbursement for your practice.

Because transcatheter arterial chemoembolization is a fairly new procedure, many radiology practices are unsure how to code it. The first step is to identify the procedure in the radiologist's operative report.

 "One of our physicians refers to it as 'TACE'in his notes," says Donna Rosenmayer, an independent coding consultant in St. Paul, Minn. "The physicians are always going to try to find ways to abbreviate 'transcatheter arterial chemoembolization.'So talk to the radiologists in your practice to find out how they document it."

If you are unclear whether the physician performed chemoembolization, look to the diagnosis code, says Yvonne Almanza, RHIT, coder in the radiology department at The Methodist Hospital in Houston. She recommends reading the operative report carefully to look for the key words "injection" and "islet cell transplant." "If the report states that the diagnosis is a hepatic tumor (155.x), then more than likely, the patient is there for treatment with embolization."

During chemoembolization, the physician injects chemotherapy drugs into the patient's hepatic artery, and then blocks the artery to stop blood supply to the tumor. Because no single code describes both services, you should report both 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) and 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation).

But don't submit your claim just yet. "You also want to bill for the angiogram selection," Almanza says. "For the physician to embolize the hepatic artery, he must first select the artery, and this is where you select a code from the 36245-36248 range (Selective catheter placement, arterial system ...)," depending on the artery branch location.

"If the physician also performs a medically necessary angiogram, you should report 75726 (Angiography, visceral, selective or supraselective [with or without flush aortogram], radiological supervision and interpretation) along with the selection codes," Almanza says.

If you perform transcatheter arterial chemoem-bolization with an initial second-order abdominal catheter placement and a visceral angiogram, you should report 37204, 75894, 36246 and 75726. You should not append any modifiers unless your carrier requests modifier -51 (Multiple procedures), but most carriers add this modifier on their own when necessary.

Because Medicare does not maintain a national coverage policy for chemoembolization, you should check your carrier's guidelines before submitting claims for this service. Reimbursement varies widely, and some insurers, such as BlueCross/BlueShield (BC/BS) of both Massachusetts and North Carolina, only cover chemoem-bolization on a case-by-case basis.

For example, BC/BS of Massachusetts'policy states, "We do not cover transcatheter chemoembolization of the hepatic artery for the treatment of cancer in the liver, because it has not been shown to improve the health outcomes of patients." The policy subsequently states, "For some patients, transcatheter chemoembolization may be appropriate for relief of pain or pressure from hepatoma or symptom relief for neuroendocrine tumor or carcinoid" and offers advice on how physicians can submit individual patient information for case-by-case coverage consideration.

Aetna's policy, however, confirms chemoembolization coverage for several liver cancer conditions and offers specific patient criteria required for reimbursement. Patients with unresectable, primary hepatocellular carcinoma, for instance, must have encapsulated nodule(s) less than 4 cm in diameter, a serum bilirubin concentration under 2.9 mg/dl, a serum creatinine level under 2.0 mg/dl, and no extra-hepatic metastasis.

Some carriers may require preauthorization for chemoembolization. If your claim is denied, it could cost your practice more than $2,000, so you should always request your carrier's coverage guidelines in writing before performing the procedure.