Cardiology Coding Alert

Codes 37241-37244 see plenty of edits in the most recent Correct Coding Initiative update.

CPT® added vascular embolization codes 37241-37244 in January 2014. Nearly a year later, the Correct Coding Initiative (CCI) is still finding plenty of bundles to add for these codes. In the version effective Oct. 1, CCI 20.3 adds edit pairs to limit separate billing of radiology and vascular access procedures in addition to your primary surgical code.

Remember Codes Include Radiological Supervision

You’ll see a host of new edit pairs with the following codes for procedures that your cardiologist might perform:

• 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 (e.g., congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)
  
• 37242, … arterial, other than hemorrhage or tumor (e.g., congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)
  
• 37243, … for tumors, organ ischemia, or infarction
  
• 37244, … for arterial or venous hemorrhage or lymphatic extravasation.
  

The above codes specifically state that they include “all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention.” So it’s not surprising that CCI 20.3 adds dozens of edits bundling radiology codes into these 3724x codes.

“These edits support a change happening throughout CPT® to include the radiology and vascular access procedures as part of the primary procedure code, rather than billing separately for them,” says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash.

Check the Edits Before Reporting a Catheterization Code

CCI 20.3 also lists the preceding embolization/occlusion codes as column 1 codes with a host of column 2 codes related to catheterization. Mostly, these edits bundle nonselective catheterization into the procedure, explains Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department.

37241: You’ll find the following codes bundled into venous code 37241:

• 36005, Injection procedure for extremity venography (including introduction of needle or intracatheter)
  
• 36010, Introduction of catheter, superior or inferior vena cava
  
• 36013, Introduction of catheter, right heart or main pulmonary artery.
  

37242: CCI bundles many more codes into artery code 37242:

• Cervicocerebral codes, including 36100 (Introduction of needle or intracatheter, carotid or vertebral artery) and 36221-36226 for catheter placement with cervicocerebral angiography

o Keep in mind that rather than 37242, head and neck embolization falls under 61626 (Transcatheter permanent occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to        occlude a vascular malformation], percutaneous, any method; non-central nervous system, head or neck [extracranial, brachiocephalic branch])

• Extremity codes, including 36120 (Introduction of needle or intracatheter retrograde brachial artery) and 36140 (Introduction of needle or intracatheter extremity artery)
• Aorta code 36200 (Introduction of catheter, aorta)
• Renal codes 36251-36254 for catheter placement with renal artery angiography. 

37243: You’ll face many of the same edits for tumor, organ ischemia, and infarction code 37243:

• Brachial artery code 36120
• Aorta code 36200
• Catheter placement with cervicocerebral angiography codes 36221-36226
• Renal codes 36251-36254 for catheter placement with renal artery angiography.

37244: For vascular hemorrhage and lymphatic extravasation code 37244, you’ll see these codes bundled in:

• Vena cava code 36010 (Introduction of catheter, superior or inferior vena cava)
• Heart code 36013 (Introduction of catheter, right heart or main pulmonary artery)
• Extremity codes 36120, 36140, and 36005 (Injection procedure for extremity venography [including introduction of needle or intracatheter])
• Aorta code 36200
• Head and neck codes 36221-36226 for catheter placement with cervicocerebral angiography codes, and 36100 (Introduction of needle or intracatheter, carotid or vertebral artery)
• Renal codes 36251-36254 for catheter placement with renal artery angiography.