Overcoming Problems in Pulmonary Interventional Radiology Coding

CPT® radiology and interventional radiology coders know that interventional radiology remains tough. The services can seem loaded with endless intricacies complete with opportunities for errors. Even more, the PFS 2024 Final Rule is ironclad, locking in reimbursement decreases barring any last-minute legislation that may spare stakeholders. Every coding reimbursement dollar is at stake, making accurate understanding more important than ever. Radiology will experience an overall three percent decrease, while interventional radiology will brace for an aggregate decrease of four percent. Expert guidance is the key to unlocking success in 2024. Pulmonary interventional radiology procedures and in particular arterial thrombectomy are areas targeted by our experts for review. The following tips come from our nationally renowned Interventional Radiology Coder, a recognized resource used by coders across the nation to overcome challenges faced in everyday scenarios while ensuring successful reimbursement and compliance.

Pulmonary Interventional Radiology Coding Tips for Complete Comprehension

1. Arterial thrombectomy (37184–37186) does not have a correlating, specific S&I code that would be used in tandem. If other diagnostic or therapeutic procedures are performed with these procedures, code for them as well. Be mindful of modifier assignment. Codes are unilateral in nature.
2. Assign code 37184 or 37185 when the physician knows from the beginning of the patient encounter that percutaneous mechanical thrombectomy is the treatment to be delivered.
3. If code 37185 is submitted, it must be used in addition to code 37184.
4. Report 37185 for treatment of thrombus for any and all subsequent vessel(s) within the same vascular family.
5. Per Appendix L of the CPT® Manual, the pulmonary arteries are considered a single vascular family.

Tips for Pulmonary Arterial Stenting Coding

6. Codes 33900–33904 include vascular access, all catheter, and guidewire manipulation, fluoroscopy to guide the intervention, any post-diagnostic angiography for roadmapping purposes, post-implant evaluation, stent positioning and balloon inflation for stent delivery, and radiologic supervision and interpretation of the intervention. Diagnostic cardiac catheterization with a diagnostic angiogram may be reported with the appropriate angiography codes if performed at the same session.
7. Codes 33900–33904 do not include diagnostic right and left heart catheterization (93451–93453, 93456–93461, 93593–93598), diagnostic coronary angiography (93454–93461, 93563, 93564), or diagnostic angiography (93565–93568). These services may be separately reported in conjunction with codes 33900–33904, representing separate and distinct services from the pulmonary artery revascularization, if:
   • No prior study is available and a full diagnostic study is performed, or;
   • A prior study is available, but as documented in the medical record:
     • There is inadequate visualization of the anatomy and/or pathology, or;
     • The patient’s condition with respect to the clinical indication has changed since the prior study, or;
     • There is a clinical change during the procedure that requires new evaluation.

8. Do not report codes 33900–33904 in conjunction with 76000, 93451–93461, 93563–93568, 93593, 93594, or 93596–93598 for catheterization and angiography services intrinsic to the procedure.
9. Balloon angioplasty (92997, 92998) within the same target lesion as stent implant, either before or after the stent deployment, is not separately reported.
10. For balloon angioplasty at the same session as codes 33900–33904, but for a separate distinct lesion or in a separate artery, see codes 92997, 92998.
11. To report percutaneous pulmonary artery revascularization by stent placement in conjunction with diagnostic congenital cardiac catheterization, see codes 33900–33904.
12. For transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, see codes 33745, 33746.

These are not all the tips for comprehension.

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