Basics of Interventional Radiology Coding 2018 Prepared and Published By: MedLearn Publishing A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN 55101 1-800-252-1578 medlearnmedia.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... 71 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 Case 3: Joint Injection and Aspiration... 78 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 v
Sample Cases: Digestive System, Biliary System, and General Abdominal Procedures... 95 Case 1: Cholangiogram, Biopsy, and Biliary Drainage... 95 Case 2: Cholangiogram with Stone Removal... 97 Case 3: Tunneled Peritoneal Catheter... 99 Urinary System... 101 Diagnostic Studies... 102 Therapeutic Procedures... 103 Sample Cases: Urinary System... 107 Case 1: Loopogram... 107 Case 2: Exchange of Nephroureteral Stent... 108 Case 3: Brush Biopsy and Ureteral Stent Placement... 109 Part 2: VASCULAR INTERVENTIONAL RADIOLOGY... 111 Vascular Interventional Radiology... 113 Venous Access... 115 Venipuncture... 115 Central Venous Access... 116 Placement... 117 Centrally Inserted... 117 Peripherally Inserted... 120 Repair... 120 Replacement... 120 Removal... 121 Guidance... 122 Other CVA Catheter/Device Procedures... 123 Miscellaneous Venous Catheterization Procedures... 125 Sample Cases: Venous Access... 125 Case 1: Temporary Dialysis Catheter Placement... 125 Case 2: Tunneled Catheter and PICC Line... 126 Case 3: Tunneled Dialysis Catheter (TDC) Removal... 127 Treatment of Lower Extremity Incompetent Veins... 129 Sample Case: Incompetent Veins... 131 vi
Diagnostic Angiography... 133 Vascular Angiography Basics... 135 Component Codes Vascular Angiography... 137 Catheterization... 138 Venous Non-selective Codes... 138 Venous Selective Codes... 138 Arterial Non-selective Codes... 138 Arterial Selective Codes... 139 Diagnostic Imaging... 149 Venous S&I Codes... 149 Arterial S&I Codes... 150 Pulmonary S&I Codes... 153 Guidance... 153 Sample Cases: Component Coding... 154 Case 1: Abdominal Aortogram with Bilateral Lower Extremities... 154 Case 2: Right Upper Extremity Angiogram... 155 Complete Diagnostic Angiography... 156 Renal Angiography... 157 Carotid and Vertebral Diagnostic Angiography... 160 Sample Cases: Complete Angiography... 173 Case 1: Carotid/Vertebral Angiogram... 173 Case 2: Bilateral and Accessory Renal Artery Angiograms... 176 Vascular Interventions... 179 Angioplasty... 181 Stent Placement... 183 Atherectomy... 185 Thrombolysis... 186 Mechanical Thrombectomy... 190 Embolization... 193 Lower Extremity Revascularization... 195 Sample Cases: Vascular Interventions... 200 Case 1: Right Subclavian Angiogram and Stent... 200 Case 2: Aortic and Bilateral Iliac Artery Stenting... 201 Case 3: Popliteal Artery Stent... 202 Case 4: Visceral Embolization... 203 Carotid / Vertebral Interventions... 205 Angioplasty and Stent Placement... 205 vii
Intracranial Mechanical Thrombectomy / Thrombolysis... 209 Non-Thrombolytic Agent Administration... 209 Occlusion / Embolization... 210 Sample Cases: Vascular Interventions... 211 Case 1: Carotid Arteriogram and Intervention... 211 Case 2: Carotid Embolization... 214 Thoracic, Abdominal, and Iliac Stent Grafts... 216 EVAR Abdominal Aortic Aneurysm (AAA) Stent-Grafts (Non-fenestrated)... 217 FEVAR Fenestrated Endovascular Repair of the Visceral and Infrarenal Aorta... 223 TEVAR Thoracic Endovascular Aneursym Repair... 227 Sample Case: Endovascular Stent Graft... 233 Arteriovenous Dialysis Graft Angiography and Intervention... 235 Sample Case: Arteriovenous Grafts... 242 Miscellaneous Vascular Interventions... 243 Vena Cava Filter... 243 Intravascular Foreign Body Removal... 244 Transcatheter Biopsy... 244 Transvenous Intrahepatic Portosystemic Shunts (TIPS)... 245 Thrombin Injection... 246 Y-90 Radioembolization... 246 Intravascular Ultrasound (IVUS)... 248 Sample Cases: Miscellaneous... 248 Case 1: Transjugular Biopsy... 248 Case 2: IVC Filter Placement... 249 viii