20 Jul 2017

Embolization Coding Guidelines

Vascular Embolization

Embolization is a minimally invasive surgical procedure to prevent blood flow to an area of the body. The procedure is performed as an endovascular procedure.

This can be performed in all vascular system (Arterial, venous and lymphatic)

CPT 37241 – Venous Embolization (Endovascular)
                      Other than hemorrhage or hemodialysis access, eg: Venous malformation, Capillary hemangiomas, varicocele and visceral varices. 

CPT 37242 – Arterial Embolization (Endovascular)

Other than hemorrhage or tumor, eg: Congenital or acquired arterial malformations and arteriovenous fistulas, aneurysm and pseudoaneurysm.   

·   Injection to treat an extremity pseudoaneurysm – Use CPT 36002

CPT 37243 – Tumor Embolization
                      Tissue ablation and organ ischemia or infarction, eg: Benign or malignant tumors of the liver, kidney, uterus (Uterine arteries embolization for uterine fibroid) or other organs & BPH to shrink the size.      

·   Chemotherapy is given as part of an embolization – Use additional CPT 96420

·   When radioisotope (Yttrium- 90) is injected as part of an embolization – Use additional CPT 79445

CPT 37244 – Hemorrhage or vascular or lymphatic extravasation
                     Eg: GI bleed, trauma-induced hemorrhage, bronchial artery embolization for hemoptysis, embolization of uterine arteries for postpartum hemorrhage etc.
Note: Only one embolization code should be reported for each surgical field (entire extremity is one surgical field not per vessel), for multiple surgical fields at a single setting may be reported with multiple embolization codes with modifier 59.

·      Pelvic venous congestion syndrome (Bilateral ovarian vein, pelvic vein embolization) – Code only 37241

·      Bilateral varicocele venous embolization – 37241 x 2

There may be overlapping conditions like aneurysm and bleeding - Code only the immediate indication for the embolization (37244 in this case)

An intravascular stent is included in embolization if it is performed for the deployment of embolization coils such as aneurysm treatment.  

Diagnostic angiography is not included in Embolization. Append modifier 59.

Embolization include all the below services,

              ·    Associated radiological supervision and interpretation
              ·    Intra-procedural guidance
              ·    Road-mapping
              ·    Imaging  

For Central nervous system and the head and neck – 61624, 61626, 61710 and 75894

For ablation/sclerotherapy procedures for venous insufficiency/telangiectasia of the extremities/skin – 36468, 36470 and 36471


Test your Knowledge:

            A. Cardiovascular CPC Sample Quiz