Radiology Coding Alert

Question: The radiologist used jugular vein access and advanced the catheter through the vena cava into the hepatic vein. She advanced a needle through the vein wall and into the liver tissue to reach a portal vein branch. With a balloon catheter, she dilated the passage the needle created and placed a stent to keep the passage open and allow the blood to flow from the portal system. Documentation shows pre- and post-pressures and calculated gradients, as well as hepatic venography. The diagnosis is bleeding esophageal varices caused by alcoholic cirrhosis. Which CPT and ICD-9 codes apply to this case? Washington SubscriberAnswer: Code 37182 (Insertion of transvenous intrahepatic portosystemic shunt[s] [TIPS] [includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/ dilatation, stent placement and all associated imaging guidance and documentation]) is the only CPT code you need to describe inserting the shunt under imaging guidance. [...]