Tips for TIPS Master Intricate Component Coding To Yield Benefits
Published on Mon Oct 01, 2001
The two coding conventions used most often to report transjugular intrahepatic portosystemic shunt (TIPS) procedures occupy opposite ends of the billing spectrum. Some carriers and private payers recognize various single codes to report this complex and time-consuming procedure. Others demand component coding, and up to nine codes may be assigned.
The cause for this great discrepancy is the lack of a national billing policy for TIPS. As a result, some carriers, including AdminaStar Federal in Indiana, United Healthcare in Virginia and Trailblazer in Texas, require CPT 37799 (unlisted procedure, vascular surgery) be assigned when Medicare beneficiaries undergo the procedure. Most of these local medical review policies (LMRPs) have explicit language noting that 37799 encompasses all procedures and services involved in TIPS. Some even present a specific list of the component codes that are considered included and cannot be reported separately.
Infrequently, payers may require a different solitary code for TIPS, according to Lisa Riccio, assistant office manager for New Britain Radiological Associates in New Britain, Conn. "Sometimes, they will ask for 37140 (venous anastomosis; portocaval) to report the entire procedure. This requirement is unique to only a few carriers. Coders should check with the carrier or payer in question to find exactly what codes each wants."
In other areas, Medicare carriers have adopted a local code. For instance, Nationwide Medicare, which provides coverage in Ohio and West Virginia, requires that TIPS be reported with its own unique code, W0002 (percutaneous transjugular intrahepatic portosystemic shunt).
Most payers, however, have adopted the Society for Cardiovascular and Interventional Radiology's (SCVIR) recommendation for component coding that reflects the discrete services conducted during TIPS. This approach requires coders to understand clearly the intricacies of the operative report as well as the finer points of interventional radiology coding. Coders who master TIPS coding provide their practices with the opportunity to increase their reimbursement legitimately.
Diagnosis Code Is Vital to Reimbursement
According to Riccio, TIPS is performed in patients suffering from advanced liver diseases that result in portal hypertension, where the normal flow of blood through the liver is slowed or blocked by scarring or other damage. Patients with cirrhosis with or without concomitant hepatitis are prime candidates for TIPS, often considered a precursor to liver transplant.
Although each insurer may recognize different ICD-9 Codes supporting medical necessity, those most commonly reported include:
456.0 -- varicose veins of other sites; esophageal varices with bleeding
456.1 -- ... esophageal varices without mention of bleeding
452 -- portal vein thrombosis
453.0 -- Budd-Chiari syndrome
456.20 -- esophageal varices in diseases classified elsewhere; with bleeding
456.21 -- ... without [...]
