Radiology Coding Alert

Question: Which codes apply to this report? May I report the diagnostic venography separately? The diagnosis is bleeding esophageal varices. The physician used right internal jugular vein access to perform angiography of the hepatic vein. He determined transvenous intrahepatic portosystemic shunt placement was appropriate for the patient. He moved the catheter farther into the hepatic vein and used venography to assess the portal vein. He switched to a cannula to create a puncture site and then used a balloon to create a tract. He inserted a stent under fluoro in the portal and hepatic veins. He checked pressures and did some final imaging before completing the procedure.

Utah Subscriber

Answer: Based on the information given, the most appropriate diagnosis code is 456.0 (Esophageal varices with bleeding).

Caution: If documentation shows the varices are caused by another condition, you should instead report 456.20 (Esophageal varices in diseases classified elsewhere with bleeding) as a secondary code with a code for the underlying condition as primary, such as 572.3 (Portal hypertension).

For the procedure, one code will cover both the diagnostic and intervention services: 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]).

You should not separately report the same-session venography or portography that confirms the need for TIPS. The imaging and catheterization are included in 37182.