Question: The April 2003 Radiology Coding Alert article regarding chemoembolization recommended reporting 37204 and 75894 for this service. Immediately after we perform chemoembolizations, we usually perform a completion angiogram to determine the liver's condition and the status of the tumor after the embolization. Is this included in these codes, or can we report the angiography separately? Minneapolis subscriber
Answer: Although 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) describes the actual embolization, and 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation) describes the radiological supervision and interpretation (RS&I), as well as all angiography inherent in the embolotherapy, you should report additional codes for your clinically necessary preprocedural diagnostic angiography and completion angiography services during transcatheter arterial chemoembolization (TACE).
If you perform the preprocedure angiography as "road-mapping" (to plan the embolotherapy), it is included in the RS&I code. You should, however, separately report preprocedural diagnostic angiograms if you use them to determine whether the embolotherapy is warranted, or to document the tumor distribution for diagnostic reasons. Vascular access is not included in the TACE procedural work, so you should separately report these services. If you catheterize the common hepatic artery and inject contrast, you should report 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) for the catheterization and 75726 (Angiography, visceral, selective or supraselective [with or without flush aortogram], radiological supervision and interpretation) for the angiogram. If you perform this study in the proper hepatic artery, you should report 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family). If you take multiple views without catheter repositioning, do not report other surgical or RS&I codes. But if you subsequently move the catheter to other arteries, such as the left hepatic artery, and inject contrast, you should report only one unit of the highest order vessel catheterized, along with +36248 (... additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family) for each additional vessel catheterization and +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation) for each additional vessel studied in the same vascular family. If, after the TACE, you perform a completion angiogram, you should report 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion). [...]