Radiology Coding Alert

Question: May I report embolization of the right bronchial artery for a right lung tumor and the left bronchial artery for a left lung tumor separately? Or is this the same concept as uterine artery embolization where I should only report one service?

Illinois Subscriber

Answer: You may report 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) twice for a right and left lung embolization at the same encounter.

AMA's CPT Assistant (October 1998) reveals the key to proper reporting: "Code 37204 is intended to be reported for each operative field addressed."

The right and left bronchial arteries supply the right and left lungs, which are two separate operative fields.

CPT Assistant suggests appending modifier 59 (Distinct procedural service) to the codes for the second and subsequent fields.

In addition, you should report RS&I code 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation) twice.

Support: CPT Assistant (September 1998) states that "a single surgical code (37204) and S&I code (75894) are used for transcatheter embolization therapy." The article goes on to state that you report one pair of codes per field even if the physician treats multiple vessels in that field or uses many coils or other embolic materials in a single vessel.

"Additional surgical codes or S&I codes for embolization are only reported if different operative fields are treated (e.g., right and left kidney, right and left lung)."

Bronchial vs. uterine: The right and left uterine arteries supply the same end organ and are considered a single operative field. You should report one unit of 37210 (Uterine fibroid embolization [UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata], percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the procedure) per patient encounter.