Oncology & Hematology Coding Alert

Chemoembolization should block blood from flowing to tumors not block your cash flow. Know when to report this procedure, which additional codes to include and what to expect from payers to prevent impeded reimbursement. Use Diagnosis,Report to Identify the Procedure Transcatheter arterial chemoembolization (TACE) is a relatively new procedure, so you may still need help to identify it accurately and quickly.

During chemoembolization, the physician injects, directly into the hepatic artery, three chemotherapy drugs that saturate the tumor, stopping blood flow and thereby depriving the tumor of oxygen and nutrients, says Belinda Stanley, CPC, CIC, at Medical Asset Management in Atlanta. The starved tumor soaks in a very high concentration of drugs for a prolonged period of injection, causing the cells to die quickly, she says. Look for the diagnosis code to help figure out whether the physician performed this procedure, says Yvonne Almanza, RHIT, a coder at The Methodist Hospital in Houston. The procedure treats liver cancer either originating in the liver (155.0) or metastasized from another part of the body (for example, 197.7). You should also look for other indicators in the operative report, such as the acronym TACE. Read the report closely for other words, including "injection" and "islet cell transplant," Almanza says. Code Cocktail: Embolization, Angiography, Selections No one code describes both the embolization and chemotherapy injection, so you have to report these two codes for chemoembolization, Stanley says:
37204 Transcatheter occlusion or embolization percutaneous, any method, non-central nervous system, non-head or neck
75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation. Do not report separate codes for chemotherapy infusion, she says. The chemotherapy infusion codes 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type ...) and 75896 (Transcatheter therapy, infusion, any method ... radiological supervision and interpretation) do not accurately describe the procedure. You use these latter codes for chemotherapy infusions without embolization.

But you can report additional codes for medically necessary preprocedural diagnostic angiography, artery selections and completion angiography services. When you report these additional services, do not append modifier -51 (Multiple procedures) unless your carrier requests otherwise. Most carriers add this modifier on their own when necessary. Report Preprocedural Diagnostic Angiography If your physician performs a "medically necessary" angiography one that determines whether to use the embolotherapy or documents the tumor distribution for diagnostic reasons you should report 75726 (Angiography, visceral, selective or supraselective ... radiological supervision and interpretation), Almanza says. But if your physician performs a preprocedural angiography just for "road-mapping" (planning the embolotherapy) you cannot separately report the angiogram because it's included in the radiological interpretation and supervision (RS&I) code. Include Selection Codes In addition to medically necessary angiography codes, you should report appropriate selection codes for [...]