Part B Insider (Multispecialty) Coding Alert

Published on Sun May 28, 2006 PDF

Before you code for transvenous intrahepatic portosystemic shunt (TIPS), you must know when the procedure is--and isn't--medically necessary. Here's a quick primer to help you stay ahead of the TIPS coding curve.

TIPS is considered medically necessary for the following indications:

1. Acute variceal bleeding that cannot be successfully controlled with medical treatment or sclerotherapy;

2. Recurrent variceal bleeding in patients who are resistant to or intolerant of conventional medical management, sclerotherapy or pharmacologic therapy; and

3. Patients with end-stage liver disease who are active candidates for liver transplants and who require bleeding control from esophageal varices.

TIPS is considered not medically necessary for the following indications:

1. As therapy for refractory ascites and portal decompression for patients with hepatic venous outflow obstruction (Budd-Chiari syndrome);

2. As initial therapy of acute variceal hemorrhage;

3. As initial therapy to prevent initial or recurrent variceal   hemorrhage; and

4. For reduction of intraoperative morbidity during liver transplant surgery.

Source: www.regence.com/trgmedpol/surgery/sur78.html.