Basics of Interventional Radiology Coding 2017 Prepared and Published By: MedLearn Publishing A Division of Panacea Healthcare Solutions, Inc. 287 East Sixth Street, Suite 400 St. Paul, MN 55101 1-800-252-1578 www.panaceainc.com
TABLE OF CONTENTS Introduction... 1 Abbreviations... 2 Modifiers... 5 The Basics... 13 Diagnostic vs. Therapeutic... 14 Global, Technical, and Professional... 14 Hospital vs. Physician Coding... 15 Physician / Other Qualified Healthcare Provider... 15 Guidance... 16 Moderate (Conscious) Sedation... 18 Coverage... 19 Part 1: NON-VASCULAR INTERVENTIONAL RADIOLOGY... 21 Biopsy... 23 Guidance... 24 Aspiration Biopsy... 24 Non-Aspiration Needle Biopsy... 25 Breast Biopsy... 27 Breast Localization Without Biopsy... 28 Post-Procedure Mammogram... 29 Specimen Radiograph... 30 Soft Tissue Marker... 30 Sample Cases: Biopsy... 30 Case 1: Ultrasound-Guided Fine Needle Aspiration Right Neck Lymph Node... 30 Case 2: Ultrasound Breast Biopsy Left... 31 Drainage... 33 Cyst Aspiration... 33 Joint Aspiration... 34 Catheter-Assisted Drainage...35 Pleural Aspiration / Drainage... 37 Abdominal Aspiration / Drainage... 38 Paracentesis... 38 iii
Tunneled Intraperitoneal Catheter... 38 Cholecystostomy Tube Placement... 39 Drainage Catheter Check and Change... 39 Sclerosis... 40 Other Aspiration / Drainage... 40 Sample Cases: Drainage... 41 Case 1: Fluoroscopic and Ultrasound-Guided Placement of a Suprapubic Catheter (14-French Pigtail)... 41 Case 2: Thoracentesis... 42 Case 3: CT-Guided Pelvic Abscess Drainage... 43 Case 4: Ultrasound-Guided Right Thoracentesis, Ultrasound and Fluoroscopic-Guided Right Perinephric Drain Placement... 44 Ablation / Destruction... 45 Tumor Ablation... 45 Ablation Guidance Codes...47 Nerve Destruction... 47 Cyst Ablation... 48 Sample Cases: Ablation... 49 Case 1: Pulmonary RFA... 49 Case 2: Renal Cyst Aspiration and Sclerosis... 50 Pain Management Injections... 51 Spinal Injections... 51 Epidural Injections... 52 Facet Joint Injections... 55 Thoracic Paravertebral Block... 57 Sacroiliac Joint Injection...58 Blood Patch... 58 Other Pain Management Injections... 59 Sample Cases: Pain Management... 60 Case 1: Ultrasound-Guided Injection of the Posterior Knee... 60 Case 2: Synovial Cyst Aspiration and Facet Injection... 61 Spinal Procedures... 63 Lumbar Puncture... 63 Myelography... 64 Discography... 66 iv
Vertebroplasty, Vertebral Augmentation, and Sacroplasty... 67 Sample Cases: Spinal Procedures... 70 Case 1: Diagnostic Lumbar Puncture and Intrathecal Methotrexate Injection... 70 Case 2: Vertebroplasty... 70 Joint Procedures... 73 Arthrography... 73 Shoulder... 73 Elbow... 73 Wrist... 73 Hip... 74 Knee... 74 Ankle... 74 Sacroiliac Joint... 74 CT/MR Arthrography... 74 Aspiration, Arthrocentesis, Injection... 75 Sample Cases: Joint Procedures... 76 Case 1: Shoulder MRI Arthrogram... 76 Case 2: Wrist Injection...77 Digestive System, Biliary System and General Abdominal Procedures... 79 Salivary Glands... 79 Esophagus... 80 Stomach... 81 Colon and Rectum... 82 Liver... 83 Biliary Tract... 84 Pancreas... 91 Biopsy... 91 General Abdomen / Peritoneum... 91 Drainage... 91 Biopsy... 92 Fiducial Markers... 92 Peritoneal Cavity Evaluation and Catheters... 93 Gastrostomy, Duodenostomy, Jejunostomy, Cecostomy and Other Colonic Tubes... 94 Sample Cases: Digestive System, Biliary System, and General Abdominal Procedures... 95 Case 1: Cholangiogram, Biopsy, and Biliary Drainage... 95 v
Case 2: Cholangiogram with Stone Removal... 97 Urinary System... 99 Diagnostic Studies... 100 Therapeutic Procedures... 101 Sample Cases: Urinary System... 105 Case 1: Loopogram... 105 Case 2: Exchange of Nephroureteral Stent... 106 Part 2: VASCULAR INTERVENTIONAL RADIOLOGY... 109 Vascular Interventional Radiology... 111 Venous Access... 113 Venipuncture... 113 Central Venous Access... 114 Placement... 115 Centrally Inserted... 115 Peripherally Inserted... 118 Repair... 118 Replacement... 118 Removal... 119 Guidance... 120 Other CVA Catheter/Device Procedures... 121 Miscellaneous Venous Catheterization Procedures... 123 Sample Cases: Venous Access... 123 Case 1: Temporary Dialysis Catheter Placement... 123 Case 2: Tunneled Catheter and PICC Line... 124 Case 3: Tunneled Dialysis Catheter (TDC) Removal... 125 Treatment of Lower Extremity Incompetent Veins... 127 Sample Case: Incompetent Veins... 129 Diagnostic Angiography... 131 Vascular Angiography Basics... 133 Component Codes Vascular Angiography... 135 Catheterization... 136 Venous Non-selective Codes... 136 vi
Venous Selective Codes... 137 Arterial Non-selective Codes... 137 Arterial Selective Codes... 138 Diagnostic Imaging... 147 Venous S&I Codes... 147 Arterial S&I Codes... 148 Pulmonary S&I Codes... 151 Guidance... 151 Sample Cases: Component Coding... 152 Case 1: Abdominal Aortogram with Bilateral Lower Extremities... 152 Case 2: Right Upper Extremity Angiogram... 153 Complete Diagnostic Angiography... 154 Renal Angiography... 155 Carotid and Vertebral Diagnostic Angiography... 158 Sample Cases: Complete Angiography... 171 Case 1: Carotid/Vertebral Angiogram... 171 Case 2: Bilateral and Accessory Renal Artery Angiograms... 174 Vascular Interventions... 177 Angioplasty... 179 Stent Placement... 181 Atherectomy... 183 Thrombolysis... 184 Example 1... 186 Example 2... 186 Mechanical Thrombectomy... 188 Embolization... 191 Lower Extremity Revascularization... 193 Sample Cases: Vascular Interventions... 198 Case 1: Right Subclavian Angiogram and Stent... 198 Case 2: Aortic and Bilateral Iliac Artery Stenting... 199 Case 3: Popliteal Artery Stent... 200 Case 4: Visceral Embolization... 201 Carotid / Vertebral Interventions... 203 Angioplasty and Stent Placement... 203 Intracranial Mechanical Thrombectomy / Thrombolysis... 206 Non-Thrombolytic Agent Administration... 207 Occlusion / Embolization... 207 vii
Sample Cases: Vascular Interventions... 209 Case 1: Carotid Arteriogram and Intervention... 209 Case 2: Carotid Embolization... 211 Thoracic, Abdominal, and Iliac Aneurysm Stent Grafts... 213 EVAR Abdominal Aortic Aneurysm (AAA) Stent-Grafts (Non-fenestrated)... 214 Closure... 220 Additional Related Procedures... 221 Conversion to Open Repair... 222 FEVAR Fenestrated Endovascular Repair of the Visceral and Infrarenal Aorta... 222 TEVAR Thoracic Endovascular Aneursym Repair... 225 Additional Procedures... 228 Iliac Artery Endograft... 229 Additional Procedures... 231 Sample Case: Endovascular Stent Graft... 231 Arteriovenous Dialysis Graft Angiography and Intervention... 233 Sample Case: Arteriovenous Grafts... 240 Miscellaneous Vascular Interventions... 241 Vena Cava Filter... 241 Intravascular Foreign Body Removal... 242 Transcatheter Biopsy... 242 Transvenous Intrahepatic Portosystemic Shunts (TIPS)... 242 Thrombin Injection... 243 Y-90 Radioembolization... 244 Intravascular Ultrasound (IVUS)... 245 Sample Cases: Miscellaneous... 246 Case 1: Transjugular Biopsy... 246 Case 2: IVC Filter Placement... 247 viii