Arterial catheter embolization is an interventional radiology (IR) procedure that requires detailed documentation to maximize coding and reimbursement. This procedure can be described in three primary CPT® codes, depending on the abnormality being treated: 37244, 37243 and 37242. Follow this guide for updated arterial embolization coding standards.

Key Takeaways

• Arterial embolization procedures are coded using CPT 37244 (for hemorrhage), 37243 (for tumors) and 37242 (for other arterial conditions).
• The correct embolization CPT code is determined through the primary reason for the procedure, which must be supported with a specific ICD-10 diagnosis code.
• Detailed vascular embolization documentation is essential for accurate coding and optimal reimbursement.

Three CPT^® codes describe these procedures, as follows:

Use of these codes is based on the abnormality being treated. They exclude embolization of the head, neck, or central nervous system (CNS). The embolization codes include the following steps, which should be documented but not coded separately:

• Direct vascular access (non-selective catheterization)
• Stent placement provided as support for embolization
• Guidance imaging and post-embolization angiography
• Intraprocedural cone beam CT with 3D reconstruction
• Multiple abnormalities in a single organ. For example, multiple tumors or aneurysms in a single kidney.

Selective catheter placement, and any associated diagnostic imaging that is not bundled, is also documented and coded separately. When embolization is performed in multiple operative fields they are reported and coded separately, but with an appropriate modifier such as -59 (-XS for Medicare billing), which is used to identify procedures that are not normally reported together but are appropriate under the circumstances.

Navigating ICD-10 Codes for Arterial Embolization

Correct CPT coding must be supported by a specific diagnosis code. The embolization codes include the following steps, which should be documented but not coded separately:

• Direct vascular access (non-selective catheterization)
• Stent placement provided as support for embolization
• Guidance imaging and post-embolization angiography
• Intraprocedural cone beam CT with 3D reconstruction
• Multiple abnormalities in a single organ

Here are some of the most common ICD-10 codes grouped by the condition they are used to treat

For Hemorrhage (CPT 37244)

Common procedures and their respective ICD-10 codes that also use the CPT code for arterial or venous hemorrhage or lymphatic extravasation:

• Gastrointestinal hemorrhage (K92.2)
• Acute ulcer with hemorrhage (K25.0)
• Active esophageal hemorrhage (I85.01)
• Bronchial bleeding, or hemoptysis (RO4.2)
• Postpartum hemorrhage (O72.0 to O72.3)

For Tumors (CPT 37243)

• Hepatic metastasis (C78.7)
• Osseous metastasis (C79.51)
• Renal cell carcinoma (C64.1 to C64.9)
• Uterine fibroids (D 25.0 to D25.9)
• Benign vascular neoplasms (D18.00)
• Malignant vascular neoplasms (C49.9)

For Other Conditions (CPT 37242)

Conditions other than hemorrhage or tumors that use arterial vascular embolization code 37242 include:

• Arteriovenous malformations (Q28.2)
• Aneurysms, non-bleeding (I72.0 to I72.9)
• Aortic pseudoaneurysm, non-bleeding (I77.810)
• Arteriovenous fistulae (I77.2)

How to Choose the Correct Embolization Code

To simply the code selection, follow this guide based on the primary reason for the procedure:

• Is the procedure a hemorrhage? ---> If yes, use CPT 37244.
• If not, is it for a tumor of organ ischemia? ---> If yes, use CPT 37243.
• If no to both, is it for another arterial issue, like an AVM or aneurysm? ---> If yes, use CPT 37242.
• Is a covered stent the sole treatment? If yes, use stent codes, not embolization codes.

HAP is Your Partner in Coding Agency

As with all procedures, but especially with interventional radiology, it is critical to successful coding, billing, and practice reimbursement that the operative report be as detailed as possible. Although some steps might not be billable due to bundling provisions, the documentation must include them to be complete and to give your coding team the opportunity to optimize your reimbursement. Subscribe to this blog for the latest information. 

Current Procedural Terminology (CPT) is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

Erin Stephens, CPC, CIRCC  is the Sr. Client Manager, Education at Healthcare Administrative Partners. 

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