General Surgery Coding Alert

Get ready for new renal catheter placement codes, too.

Surgical codes that describe the whole package are becoming the norm, and CPT® 2012 continues the trend. Inferior vena cava (IVC) filter procedures and renal angiography have new codes that combine surgical and imaging services into one neat bundle.

Clarify Your IVC Filter Options

Prepare for an all new way to report IVC filter services, defining the service as insertion, repositioning, or retrieval:

• 37191 -- Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
• 37192 -- Repositioning of intravascular vena cava filter ...
• 37193 -- Retrieval (removal) of intravascular vena cava filter ....

Old way: In 2011, you reported IVC filter placement with 36010 (Introduction of catheter, superior or inferior vena cava for catheterization), 37620 (Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]), and 75940 (Percutaneous placement of IVC filter, radiological supervision and interpretation). Because 37191 includes all of these elements, CPT® 2012 deletes the IVC-specific codes 37620 and 75940.

Clarify retrieval: Coding IVC filter removal wasn't as clear cut in 2011 as it is now. Before creation of 37193, payers may have requested unlisted procedure codes or transcatheter retrieval codes 75961 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter], radiological supervision and interpretation) and 37203 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter) to describe the service. Guidelines for 2012 make it clear that you should not report 37193 alongside 75961 and 37203.

Replace Your Old Renal Catheter Placement Codes

Renal angiography sports four new codes effective Jan. 1, 2012. Key elements distinguishing the codes include whether the service is first order or higher, and whether the service is unilateral or bilateral:

• 36251 -- Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
• 36252 -- ... bilateral
• 36253 -- Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
• 36254 -- ... bilateral.

Tip: When reporting the new renal codes, do not report 36254 with 36252, says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash., citing CPT® guidelines.

You also should not report 36253 with 36251 "when performed on the same renal/kidney. The accessory renal arteries only influence coding if the catheter placement is in a second or higher order position," Neighbors says.

Don't miss: The addition of these codes means you'll no longer use a code from 36245-+36248 (Selective catheter placement, arterial system...) to report the catheterization. And because imaging services are included in the new codes, CPT® deletes 75722-75724 (Angiography, renal ...).