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Answer: A transjugular liver biopsy is a multiple-step procedure, so a corresponding number of codes should be assigned to describe it.
To begin the procedure, the interventional radiologist will insert a catheter and advance it through the venous system to the liver. Venous access is reported with a code from the 36000-36015 series, depending on the point of access and the veins traversed. Code 36011 (selective catheter placement, venous system; first order branch [e.g., renal vein, jugular vein]) describes the catheter placement most typically used, although 36012 (... second order, or more selective, branch [e.g., left adrenal vein, petrosal sinus]) could be reported if the procedure involves second-order venous catheter placement.
Most interventionalists use ultrasound guidance for needle placement, if guidance is used at all, which should be reported with CPT 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).
The radiologist may conduct a venogram with pressures for certain specific clinical conditions as well. This is reported with 75889 (hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation). Alternatively, a venogram without pressure measurements may be performed, which should be coded with CPT 75891 .
Finally, the biopsy itself is reported with 37200 (transcatheter biopsy), accompanied by 75970 (transcatheter biopsy, radiological supervision and interpretation). Venography used merely to guide the biopsy is included in 75970 and should not be billed separately. |
