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Basics about Cpt code for Coil Embolization

Coil Embolization procedures are done to stop hemorrhage, to stop growth of tumors, varicocele or any congenital or acquired venous malformations.

Earlier we saw some of the coding tips for upper GI procedures, moderate conscious sedation and Spinal Epidural injection procedures.

Reasons for Performing Embolization Procedures

Aneurysms,
Arteriovenous malformations (AVMs),
Benign or malignant vascular neoplasms,
Bleeding
Organ protection

A variety of materials are used for embolization procedures, including autologous blood clots, gelfoam, polyvinyl alcohol (PVA), micro-spheres, theraspheres, sirspheres, coils, n-butyl cyanoacrylate (N-BCA), alcohol, detachable balloons, suture material, and Onyx.

The codes for coil embolization includes all the minor procedure included with them like supervision and interpretation, imaging guidance CPT codes and other services required for the intervention. The CPT codes for coil embolization are basically divided on the basis of three major diagnosis hemorrhage, tumors and malformation.

Embolization procedures typically start with a diagnostic angiogram,so knowledge of selective catheterization coding is a prerequisite for coding embolization procedures.

When the embolization is performed, it is usually the first time the area of abnormality has been studied angiographically. If there has been a prior study and treatment, a repeat diagnostic angiogram may be required to determine the current extent of the pathology.

Once an abnormality has been evaluated and blood supply determined (usually by selective or super selective catheterization and evaluation), it is followed by the injection or placement of the embolic material into the selected vessel(s) with follow-up exams performed to confirm successful completion of the procedure.

Basic procedure for CPT code for Coil Embolization

Embolization is performed to block an artery or vein. In this procedure, the catheter are introduced like placing a tunneled or non-tunneled central venous catheter. So, to treat a hemorrhage from an artery or vein, the blood vessel is blocked using beads, coil or any other device. So, to treat a blood vessel a needle is inserted into a blood vessel through the skin. A guide wire is inserted along the needle and the needle is removed.

Then a catheter is guided over the guide wire to treat the blood vessel. The guide wire is removed. The catheter then treats the blood vessel through blood vessel blocking device. Angiography can be taken to know about the progress of the exam. Angiography procedure codes should be coded in surgery if performed with this exam. This is the basic procedure performed during coil embolization.

Cpt Code for Coil Embolization for Varicocele

CPT code 37241-37244 include the Arterial embolizations in non-central nervous system/non-head and neck sites.

Varicocele is an abnormal enlargement of a network of veins in the scrotum. If the patient comes with a diagnosis of varicocele, we have separate CPT Code for coil embolization of varicocele. The CPT code for treating varicocele through embolization is 37241. CPT code 37241 involves embolization on vein for the treatment other than hemorrhage which includes Varicocele as well. This CPT code 37241 is used only for the venous related diagnosis. If you are clear with concept in coding embolization you can become a perfect surgery coder.

37241- Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)

For dialysis circuit permanent endovascular embolization or occlusion, use CPT code 36909.

+36909 – Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)

Selective catheter placements may be reported separately.
Stent placement to assist in placement of the embolic material during an embolization procedure (non-CNS, non-head and neck) is not reported separately, as it is part of the embolization procedure.
Covered stent placement to treat a pathology that could be embolized (e.g., torn vessel due to trauma), and the covered stent placement is the sole therapy (an embolization is not performed), then only the covered stent placement is reported, not the embolization.

An important concept regarding any embolization procedure that is different than most of the other vascular interventions, such as angioplasty and stent placement, is that it is billed per surgical field treated, not per vessel embolized. It does not matter how many particles or coils are placed, how many injections of emboli are involved, how many vessels are embolized, or the type of material used. It is one surgical field treated, hence, one embolization.

When determining what constitutes a surgical field, the transcatheter procedure must be compared to an open surgical procedure. Would the open procedure remove one organ, one tumor, etc.? If the answer is yes, it is one operative field.

A surgical field includes the treated and surrounding areas.
If multiple surgical fields are treated in the same session, code each separately and add modifier -59 or –XS to the additional embolization codes.
If two separate tumors in the same organ are separately treated it would be considered two surgical fields.

Cpt Code for Coil Embolization for splenic artery

CPT code 37242 is used for Vascular embolization or occlusion, arterial, other than hemorrhage or tumor.

The splenic artery is a present in abdominal region. If any condition like aneurysm, fistula or malformation other than hemorrhage is treated with embolization we have to use 37242 CPT code. This code is used only for artery related diagnosis except hemorrhage.

37242- Vascular embolization, inclusive of all radiological supervision and interpretation, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformation, arteriovenous malformation, arteriovenous fistulas, aneurysms, psuedoaneurysms)

Applies to proximal non-target embolization to prevent reflux embolization during the subsequent intended therapeutic embolization.

Non-target embolizations may only be reported when performed during a prior session (i.e.: embolization of GDA during TC-99 MAA mapping of hepatic tumor).

Specific to arterial system embolization.

Cpt Code for Coil Embolization for Arterial or Venous hemorrhage

In this situation the hemorrhage is considered as the main diagnosis for embolization treatment. Hence a patient with arterial or venous hemorrhage should be coded as 37244 for coil embolization treatment. The CPT code 37244 is used across all the hemorrhage except for nervous system, for arteries and veins.

37244- Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation

Used to describe embolization for hemorrhage or lymphatic extravasation

Can be used in the venous, arterial, or lymphatic systems

Cpt Code for Coil Embolization for tumors, ischemia and infarction

Patient with diagnosis of tumors, ischemia and infarction have a separate CPT code when treated with embolization. The CPT code 37243 is used to code when the embolization is performed for tumors, ischemia and infarction. So, check for the diagnosis whenever we are coding an embolization codes along with blood vessel, artery or vein, to code a correct CPT code.

37243- Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction

Used to describe embolization of a tumor or to cause organ ischemia/infarction.

Specific to arterial system embolization.

Included in this category are both chemoembolization and radioisotope embolization.

Cpt Code for Coil embolization for Central Nervous System

There are two CPT Codes used especially for the embolization procedures performed in the Central Nervous System and Non-Central Nervous System. The central nervous system includes the intracranial region & spinal cord. The Non-Central Nervous System includes blood vessel in the head or neck region (common carotid, external carotid, vertebral and their branches).

We have already seen how a stent is placed in carotid artery and innominate artery, which is also a complex procedure.Here, we just have to code depending on the artery or vein being treated percutaneously for embolization, that particular region will lead to correct CPT code.

61626- Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; non-central nervous system, head or neck (extracranial, brachiocephalic branch)

61624- Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; central nervous system (intracranial, spinal cord)

Use CPT code 75894 for radiological supervision and interpretation

Important coding tips

The pathology may be described by different pathologies. For example, a patient may have a tumor that is hemorrhaging. In that case, the reason the embolization is being performed at “this” time is the decision factor. The embolization, in this case, is to stop the acute bleeding, so it is coded to hemorrhage (37244).

Code the embolization based on the “immediate” medical necessity.

If performing embolization to redirect blood flow or to protect another organ report 37242.
If performing an embolization on an actively bleeding tumor report 37244.
If performing an embolization to infarct a tumor report 37243.

Hope, this article helps you how to learn more about coding coil embolization procedure codes and which will eventually help you to self prepares for coding certification exam. I you liked the article do share it.