Radiology Coding Alert

Get paid for angiography on separate date of service

Good news: TIPS (transvenous intrahepatic portosystemic shunt) has a 0-day global period for Medicare physician payment. Read on to see how this quirk can earn you extra money for E/M and corrective services.

CPT 37182 (Insertion of transvenous intrahepatic portosystemic shunt[s] [TIPS] ...) and 37183 (Revision of transvenous intrahepatic portosystemic shunt[s] [TIPS] ...) don't include E/M work performed before and after the day of the procedure. What this means for you: You may code medically necessary E/M services separately from the TIPS, says Stacy Gregory, RCC, CPC, charge capture and reconciliation specialist for Franciscan Health System in Tacoma, Wash.

Remember: Check for appropriate documentation of E/M requirements before you code. Obtaining consent before the procedure and reviewing records to support the procedure do NOT count as separately reportable services. You need documentation of higher-level decision-making to code an E/M.

And, as always, check your payer's policy to be sure you're following its specific guidelines.

The limited global period also means that procedures necessary to correct a shunt complication (such as shunt revision) usually fall outside of the global period and therefore are separately payable and do not require a modifier.

Once the TIPS is in place, the patient may require portal angiography to monitor the shunt patency on separate dates of service. Report catheterization of the portal vein via the TIPS shunt with 36481 (Percutaneous portal vein catheterization by any method), and the imaging service, as appropriate, with 75885 (Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation) or 75887 (Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation). Caution: Don't report an angiography performed just to prove the TIPS is intact at the completion of the procedure.