Q: How is radioembolization for liver cancer coded?
A: Assign code 04L33DZ, Occlusion of Hepatic Artery with Intraluminal Device, Percutaneous Approach for the embolization procedure and code 3E053HZ, Introduction of Radioactive Substance into Peripheral Artery, Percutaneous Approach for the radiation.
Q: How are distal and/or proximal extensions coded when placed during EVAR/FEVAR/TEVAR procedures?
A: Extensions are considered part of the placement of the device and are not coded separately. Source: Coding Clinic, Fourth Quarter 2016: Page 89
Q: For the Ellipsys and WavelinQ procedures, are the balloon angioplasty and embolization coded separately?
A: No. Balloon angioplasty is integral to the Ellipsys procedure and embolization is integral to the WavelinQ procedure. Per ICD-10-PCS guideline B3.1b, components of a procedure that are integral to the procedure are not coded separately.
Q: In Coding Clinic, 4th Quarter 2021, page 45, they stated that a new approach value of percutaneous was added to table 031 to capture percutaneous AVF creation, such as the Ellipsys procedure. In the same issue on page 60, a description of the Ellipsys procedure is given in the description of new table X2K (new tech bypass). Which code is used to report Ellipsys procedure?
A: According to the ICD-10-CM/PCS Coordination and Maintenance Committee, percutaneous arteriovenous fistula creation using the Ellipsys device is reported with a New Technology code from the X2K table. The sixth character in that table describes the use of Thermal Resistance Energy (1), which is what makes the Ellipsys device unique from other methods of pAVF creation. A code from table 031 is used to report pAVF creation using other devices, such as the WavelinQ, which uses radiofrequency rather than thermal resistance energy to creation the AV connection. Haugen Consulting Group has submitted a question to Coding Clinic for clarification of their published advice.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.