interventional radiology

coding update

2020
2020 Interventional Radiology Coding Update

Coding for Endovascular and Interventional Procedures and Services

Society of Interventional Radiology (SIR)

American College of Radiology (ACR)

Edition 2020

Copyright © 2020 by the Society of Interventional Radiology and the American College
of Radiology. All rights reserved. No part of this publication covered by the copyright
hereon may be reproduced or copied in any form or by any means—graphic, electronic
or mechanical, including photocopying, taping or information storage and retrieval
systems—without written permission of the publishers.

CPT® five-digit codes, nomenclature and other data are copyright © 2019 American
Medical Association. No fee schedules, basic units, relative values or related listings are
included in CPT. The AMA assumes no liability for the data contained herein. CPT is a
listing of descriptive terms and five-digit numeric identifying codes and modifiers for
reporting medical services performed by physicians. This edition of the Update contains
only CPT terms, codes and modifiers that were selected by SIR for inclusion in this
publication.
Disclaimer
The Society of Interventional Radiology (SIR) and the American College of Radiology
(ACR) are providing this billing and coding update for educational and information
purposes only. It is not intended to provide legal, medical or any other kind of advice.
The update is meant to be an adjunct to the American Medical Association (AMA)
Current Procedural Terminology (CPT®2020/©2019). It is not comprehensive and
does not replace the CPT® 2020 Professional Edition. Our intent is to assist physicians,
business managers and coders. Therefore, a precise knowledge of the definitions of the
CPT descriptors and the appropriate services associated with each code is mandatory
for proper coding of physician service.

Every reasonable effort has been made to ensure the accuracy of this update, but SIR
and ACR and their employees, agents, officers and directors make no representation,
warranty or guarantee that the information provided is error-free or that the use of this
update will prevent differences of opinion or disputes with payers. The publication is
provided “as is” without warranty of any kind, either expressed or implied, including,
but not limited to, implied warranties or merchantability and fitness for a particular
purpose. Neither SIR nor ACR will bear any responsibility or liability for the results or
consequences of the use of this manual. The ultimate responsibility for correct use of
the Medicare and AMA CPT billing coding system lies with the user. SIR and ACR assume
no liability, legal, financial or otherwise for physicians or other entities who utilize the
information in this update in a manner inconsistent with the coverage and payment
policies of any payers, including but not limited to Medicare or any Medicare contractors,
to which the physician or other entity has submitted claims for the reimbursement of
services performed by the physician.
Preface
This 2020 edition of the Interventional Radiology Coding Update is intended to provide
physicians and coders with practical advice and information on coding for common
interventional radiological and endovascular procedures. When possible, the Coding
Update provides patient care scenarios and FAQs to highlight how codes should be used
and what codes may be appropriately reported.

In recent years, coding for IR has undergone major changes. Coding for interventional
radiology procedures can be complex and often not easily decipherable. In this Update,
we make our best effort to suggest accurate coding, but we are always open to
questions or comments on scenarios that are not addressed in this document. We also
encourage providers and coders to work with carriers on difficult coding issues.

In preparing this 2020 Update, the Society of Interventional Radiology and American
College of Radiology gratefully acknowledge the time and expertise that our physician
and clinical associate members volunteer to support the coding process and the
education of our membership.
Acknowledgments
SOCIETY OF INTERVENTIONAL RADIOLOGY (FAIRFAX, VA.)
Timothy L. Swan, MD, FSIR, FACR, SIR CPT Adviser, Marshfield Clinic, Marshfield, Wis.

Stephanie L. Dybul, MBA, RT(R)(VI), CIRCC, The Medical College of Wisconsin,

Milwaukee, Wis.

Waleska M. Pabon-Ramos, MD, MPH, Chair, SIR Economics Committee, Duke University
Medical Center, Durham, N.C.

Ammar Sarwar, MD, Beth Israel Deaconess Medical Center/Harvard Medical School,
Boston, Mass.

Michael Hall, MD, FSIR, SIR RUC Alternate Adviser, Beacon Health System, South Bend,
Ind.

C. Matthew Hawkins, MD, SIR Alternate CPT Adviser, Emory University, Atlanta, Ga.

Curtis Anderson, MD, PhD, SIR RUC Adviser, Florida Endovascular and Interventional,
Miami Lakes, Fla.

AMERICAN COLLEGE OF RADIOLOGY (RESTON, VA.)

ACR Economics Committees on Coding and Nomenclature and Interventional Radiology
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 5

Contents
8 Glossary of acronyms
10 Categories of CPT® codes
12 The basics of coding and reimbursement
21 Evaluation and management (E&M) codes
24 Bundled services
25 Deleted interventional radiology codes
25 Interventional radiology procedure codes
26 New and revised 2020 interventional radiology procedure codes:
A brief introduction
26 Endovascular repair of the infrarenal aorta
27 Spine injection, drainage or aspiration
28 Anatomic model 3D printing
29 Duplex scan for preoperative mapping of
hemodialysis access
30 Interventional radiology/radiology procedure codes
30 Fine needle aspiration codes
31 Soft-tissue marker
32 Aspiration/injection of integumentary system
32 Breast biopsies and placement of localization devices
35 Musculoskeletal system (biopsy, aspiration, injection)
37 Knee arthrography
37 Bone ablation
37 Vertebroplasty and vertebral augmentation
39 Arthrogram
39 Lungs and pleura
40 Ablation therapy—pulmonary
41 Endovascular repair of the thoracic aorta
42 Endovascular repair of the infrarenal aorta
45 Endovascular repair of visceral and infrarenal aorta using fenestrated endograft
47 Intravascular injection/catheter placement
48 Cervicocerebral angiography
51 Renal angiography
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 6

52 Venous procedures
52 Lower extremity venous insufficiency treatment
56 Central venous access procedures
61 Central venous access device procedures
62 Portal decompression procedures
62 Transcatheter therapy and biopsy
63 Mechanical thrombectomy
65 Vena cava filter
66 IV infusion for intracranial thrombolysis
66 Foreign body retrieval
66 Transcatheter biopsy
66 Transcatheter thrombolytic infusion therapy
68 Carotid stent placement
70 Lower extremity endovascular arterial revascularization
74 Transcatheter stent procedures
76 Vascular embolization and occlusion procedures
77 Transluminal angioplasty
78 Intravascular ultrasound
78 Hemic and lymphatic systems
79 Liver/biliary procedures
80 Percutaneous biliary procedures
84 Sclerotherapy of fluid collection
84 Drainage of abscess
86 Percutaneous gastroenteric tube procedures
88 Percutaneous genitourinary interventions
94 Intracranial and extracranial endovascular interventions
98 Lumbar puncture
98 Myelography
100 Destruction by neurolytic agent (e.g., chemical, thermal, electrical or
radiofrequency), chemodenervation–somatic nerves
104 Radiological supervision and interpretation codes
110 Biopsy and drainage catheter
110 Imaging guidance
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 7

111 Ultrasound guidance

113 Fluoroscopic guidance
114 CT guidance
115 MR guidance
116 Radiopharmaceutical administration
116 Cerebrovascular arterial studies, ultrasound
116 Extremity arterial studies, ultrasound
117 Extremity arterial-venous studies
117 Chemotherapy administration
118 Time-based moderate sedation
118 MR-guided focused ultrasound ablation
119 Category III codes
120 Sacral augmentation with cavity creation
120 Atherectomy procedures above the
inguinal ligament
123 Frequently asked questions
123 Evaluation and management (E&M) procedures
125 Central venous access procedures
129 Arterial access
132 Venous
132 Dialysis circuit
134 Vascular interventions
138 Vascular embolization
144 Miscellaneous vascular interventions
146 Endovascular aneurysm repair
146 Nonvascular intervention
151 Individual coverage request sample letters
152 Letter for ovarian vein embolization to treat pelvic venous congestion
syndrome
156 Letter for MRI of the pelvis for UFE
159 Letter for percutaneous cryoablation of pulmonary tumor(s)
167 Letter for mechanochemical venous ablation
172 Charge sheets
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 8

Glossary of acronyms
AAA Abdominal aortic aneurysm
ACR American College of Radiology
AMA American Medical Association
APC Ambulatory payment classification
APM Advanced alternative payment model
AV Arteriovenous
CF Conversion factor
CMD Carrier medical director
CMS Centers for Medicare and Medicaid Services
CPT Current procedural terminology
E&M Evaluation and management
EVLA Endovenous laser ablation
FDA U.S. Food and Drug Administration
GPCI Geographic practice cost index
GSV Great saphenous vein
HCFA Health Care Financing Administration
HCPCS Healthcare Common Procedure Coding System
HOPPS Hospital Outpatient Prospective Payment System
IDE Investigational device exemption
IVUS Intravascular ultrasound
MAC Medicare administrative contractor
MACRA Medicare Reauthorization and Children’s Health Act of 2015
MIPS Merit-based incentive payment system
MOCA Mechanicochemical ablation
MP Malpractice
MPFS Medicare Physician Fee Schedule
MPPR Multiple-procedure payment reduction
MRgFUS MR-guided focused ultrasound
MUE Medically unlikely edit
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 9

NCCI National Correct Coding Initiative

PE Practice expense
PICC Peripherally inserted central catheter
PQRS Physician quality reporting system
PTA Percutaneous transluminal angioplasty
QPP Quality payment program
RAW Relativity assessment workgroup
RBRVS Resource-based relative value scale
RFA Radiofrequency ablation
RS&I Radiological supervision and interpretation
RS&I/S&I Radiological supervision and interpretation/imaging supervision
and interpretation
RUC RVS Update Committee
RVS Relative value scale
RVU Relative value unit
SIR Society of Interventional Radiology
US Ultrasound
VAS Visual analogue scale
VCSS Venous clinical severity score
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 10

Categories of CPT® codes

CPT code proposal requests submitted to the AMA CPT Editorial Panel must identify
what category of CPT code is being sought; the panel reviews requests for three types
of CPT codes.

CATEGORY I CODES
These represent established services and procedures, performed by a variety of
providers, in multiple geographical locations, with appropriate U.S. Food and Drug
Administration (FDA) approval for all aspects of the procedure.

CATEGORY II CODES
These codes are used to track performance measures. They are intended to facilitate
data collection and not serve for billing purposes. Category II codes also are used in
the Physician Quality Reporting System (PQRS) to report quality measures related to
services provided under the Medicare Physician Fee Schedule (MPFS). The Centers for
Medicare and Medicaid Services (CMS) PQRS is a reporting program associated with
a negative payment adjustment (penalty) for eligible professionals (EPs) who do not
successfully submit measure data to CMS. The adjustments are applied to payments for
covered MPFS services furnished to Medicare Part B fee-for-service beneficiaries.

A detailed overview of the new Medicare Reauthorization and Children’s Health Act of
2015, or MACRA, is available on the SIR website. The Quality Payment Program (QPP)
has two payment systems—the Merit-based Incentive Payment System (MIPS) and
Advanced Alternative Payment Models (APMs). In 2017, CMS commenced data collection
under MIPS. Detailing compliance with MIPS is beyond the scope of the Coding Update,
but we encourage all SIR members to familiarize themselves with how to report quality
metrics. See more at: [Link]
macra-matters/. Or visit [Link]/ quality-safety/quality-measurement.

CATEGORY III CODES

These codes are issued for emerging technologies not meeting standards for a Category
I code. Additional information regarding the different categories of CPT codes can be
found on the AMA website at [Link]/practice-management/category-iii-codes.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 11

HCPCS CODES
CMS operates a parallel coding system, known as the Healthcare Common Procedure
Coding System (HCPCS). HCPCS codes are divided into three levels: Level I codes are
five-digit numeric codes used to report physician services and are equivalent to CPT
Category I codes; Level II codes, which are five-digit alphanumeric codes (leading
alpha character followed by four numeric characters) used to report products, supplies
and services not included in the CPT codes; and Level III codes were local codes, use
of which was discontinued in 2003. More information may be found at: [Link]/
medhcpcsgeninfo.

A listing of current HCPCS Level II codes may be found at: [Link]/medicare/coding/

hcpcsreleasecodesets/[Link].

Level II HCPCS codes include:

G-CODES—temporary codes issued by CMS to describe procedures and

professional services and are principally used to be reimbursed for new technology.

S-CODES—temporary codes issued by CMS, often at the request of a commercial

carrier. While S-codes are not eligible for use within the Medicare program,
commercial carriers may elect to utilize these codes to facilitate claims processing.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 12

The basics of coding and

reimbursement
THE RESOURCE-BASED RELATIVE-VALUE SCALE
PAYMENT SYSTEM
In 1992, Medicare adopted a national system of payment using the resource-based
relative value scale (RBRVS). Under the RBRVS, procedures are weighted and assigned a
value on the basis of their difficulty, intensity, time and resource utilization. In the RBRVS
system, a procedure’s RVU total is derived by summing the physician’s work (time and
intensity), the practice expense (PE) related to performing the service, and malpractice
costs associated with the procedure.

Additionally, to take into account regional cost variations, CMS folds in what is termed
the geographic practice cost index (GPCI). The GPCI rates are reviewed annually by CMS
for their relevancy and accuracy.

CMS annually publishes a MPFS Final Rule, which contains a figure called the conversion
factor (CF), a $/RVU that will be paid for claims submitted during the year subject to the
Final Rule.

With the budget neutrality adjustment to account for changes in RVUs, as required by
law, the proposed CY 2020 MPFS conversion factor is $36.09, a slight increase above
the CY 2019 MPFS conversion factor of $36.04. As part of CMS 2020 Final Rule for Part
B services, total combined payments to interventional radiology (IR) and diagnostic
radiology (DR) for the entire mix of services these specialties billed to Medicare (based
on 2016 data) are estimated to increase by about $14.3 million in CY 2018 relative to
2017. This represents an increase in estimated payments of about 0.3 percent, reflecting
changes in RVUs and a slight increase in the conversion factor. In CY 2019, payments
made to interventional radiologists, identified clinicians who bill with specialty code
94, are expected to increase by about $3.8 million, or 1.1 percent.

PART B PAYMENT
Determining how much a service is paid is not a straightforward task. In recent years,
most of the Medicare administrative contractors (MACs) have published helpful tables
on their websites that show the MPFS for the coming year for their covered region.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 13

Depending on whether a provider practices in the nonfacility (i.e., physician office) or

facility (i.e., hospital) setting, or an ambulatory surgery center, the actual formula for
provider payment is as follows:

2020 nonfacility pricing amount = [(work RVU * work GPCI) + (transitioned

nonfacility PE RVU * PE GPCI) + (MP (malpractice) RVU * MP GPCI)] * CF

2020 facility pricing amount = [(work RVU * work GPCI) + (transitioned facility PE
RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF

SIR has posted tables that display all the 2020 RVU component values for the common
interventional radiology CPT codes: [Link]/globalassets/018-mfs-final-rule-
[Link].

Radiology practices can also obtain current data about any CPT code by using the
tool on the CMS website at [Link]/medicare/medicare-fee-for-servicepayment/
pfslookup/[Link].

CPT PROCESS
CPT codes are developed by the AMA CPT Editorial Panel in consultation with CMS and
the CPT Advisory Committee, which includes representatives from numerous specialty
and subspecialty societies and allied medical societies. CPT Advisory Committee
membership is limited to those national medical societies seated in the AMA House of
Delegates. Seats in the AMA House of Delegates are determined by the percentage of
each society’s membership that are also members of the AMA.

Since the practice of medicine is dynamic, the need for new or modified CPT codes
to reflect changes in practice often arises. Code change proposals are submitted to
the AMA through the medical specialty societies, or individuals, through a standard
application process.

Assessment of the supporting scientific literature and informal survey by the societies of
a number of individuals performing the procedure in question helps assess the need for
the new procedural code, its validity and the language that will be proposed to describe
it. After a case can be made to support editing CPT to include a new procedure, the
application is heard by the CPT Editorial Panel, which is made up of representatives of
approximately 20 medical and allied organizations. If the new or modified CPT code
is approved by the CPT Editorial Panel, that code advances into the RUC process (see
below) for valuation.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 14

The AMA holds three CPT Editorial Panel meetings per year, most commonly in
February, May and October. The general public is allowed to register for and attend AMA
CPT Editorial Panel meetings. To ensure release of the updated CPT manual each fall,
all proposed additions or revisions to Category I CPT codes for the upcoming calendar
year must be considered by the Panel during the calendar year one year prior to the fall
publication. For example, new Category I 2020 CPT codes were approved by the Panel
during CY 2018 CPT Editorial Panel meetings. The CPT cycle has stringent deadlines
for submission of proposals that are well in advance of panel meetings to ensure all
advisors from all representative societies have an opportunity to review and comment.
Information regarding CPT submission deadlines and panel meetings can be found on
the AMA website, [Link]/ practice-management/cpt-upcoming-meetings-
calendar.

Typically, each July CMS issues a draft rule for the Medicare Physician Fee Schedule
and the Hospital Outpatient Prospective Payment System (HOPPS) for the upcoming
year. In the proposed rules, CMS will review new codes, proposed RVU and PE values
recommended by the RUC (see below), while the HOPPS proposed rule focuses on
policies related to services provided in the hospital outpatient setting. CMS allows a
comment period of 60 days when specialty societies and interested parties respond to
the proposed rules. CMS considers these comments, responds to them, and may alter
the proposed rule in response to comments in the publication of the Final Rule in early
November.

THE RELATIVE VALUE SCALE UPDATE COMMITTEE (RUC)

PROCESS
Codes are submitted to the RUC for valuation if they are new or revised CPT codes,
potentially misvalued codes identified by CMS, or ongoing RUC review (screens).

NEW OR REVISED CPT CODES

When the CPT Editorial Panel approves a new Category I CPT code, the Relative Value
Scale (RVS) Update Committee (RUC) process is initiated and a recommended relative
value is developed. This provides Medicare and other payers a uniform scale on which to
base payment. In the case of a revised code, depending on the nature of the change, the
code’s value may be re-evaluated through the RUC process. Category III codes are not
referred to the RUC for valuation; instead, reimbursement levels are set directly by those
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 15

insurance carriers electing to provide coverage for the performance of these “emerging
technologies.”

The RUC develops physician work RVU recommendations for CPT codes. Specialties
comprising the RUC Advisory Committee designate their “level of interest” for
developing work RVU recommendations based on recent actions taken by the CPT
Editorial Panel. Developing work values for new procedures is determined utilizing a
standardized random physician survey, with consideration given to time, intensity and
relative risk of the procedure. The survey generates data on time and intensity of the
procedure, and the necessary pre- and postprocedural work, comparing the proposed
code to a group of similar recently valued codes. Each individual surveyed is asked to
weight the procedure in comparison to a defined standard procedure with which they
are familiar.

These data are collated and summarized for the valuation process. If more than one
specialty is involved, a consensus value must be reached before recommendation can be
made to the RUC.

In a process parallel to work RVU valuation, direct practice expenses—including supplies,

equipment and clinical staff time—are also examined for both facility (hospital) and
nonfacility (office settings). For example, even for facility-based services there is
often a direct practice expense for clinical staff time spent on the completion of pre-
service diagnostic/referral forms, coordination of pre-surgery services, scheduling of
facility space for a procedure, review of test and exam results, follow-up phone calls,
and prescriptions. As with the physician work value, these data are also summarized
for consideration by the RUC and, if more than one specialty is involved, consensus
regarding these inputs must be reached before recommendation can be made.

Once the proposed work value and practice expense inputs are derived the
recommendations are submitted for consideration to the RUC. After debate, the RUC
will either adopt a recommendation, derive a new value through on-site negotiations,
or reject the recommendation altogether. Rejected recommendations must start anew
if the sponsoring society wants to pursue RUC valuation. Adopted physician work RVU
and PE recommendations are then forwarded to CMS. CMS’ final decision on RVUs
and other payment policies usually appear each November in the Federal Register to
be implemented the following January. A copy of the MPFS is available to the general
public for download via the CMS webpage, [Link]/medicare/medicare-fee-for-
service-payment/physicianfeesched/[Link].
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 16

In an environment of mandated “budget neutrality,” it is understood that additional new

procedures and their derived RVU value may negatively impact the payment associated
with RVUs of existing codes. The extent of any change is determined by the number of
RVUs assigned to the procedure and the number of times the procedure is performed
annually. This provides a clear incentive to societies with representatives on the RUC to
ensure that all valuations are fair and accurate.

It is the intent of Medicare RVS (also known as the RBRVS) to pay for services on the
basis of the amount of work involved without regard to the specialty of the provider(s)
performing the service. Since 1992, all physician specialty types use the same CPT
code(s) to report the procedural component(s) of an interventional radiology service.

Similarly, the supervision of imaging personnel and interpretation of images obtained

during the procedure is reported using RS&I/S&I CPT code(s) without regard to the
specialty of the physician who performs the service. If a single physician performs both
the procedure and supervision and interpretation of the service, that single physician
utilizes both codes (i.e., procedural and RS&I/S&I). If several physicians perform portions
of a service, each must report only those CPT codes reflecting the procedure he or she
performed.

POTENTIALLY MISVALUED CODES

Upon the implementation of the Medicare RBRVS MPFS in January 1992, Congress,
through the Omnibus Budget Reconciliation Act of 1990, required CMS to review the
physician’s work relative value units within the Medicare Fee Schedule (MFS). CMS was
required to conduct these reviews at least once every five years. This process, known
as the five-year review, was used to identify and reconsider the valuation of potentially
misvalued codes. The results from the first five-year review were implemented on Jan. 1,
1997. Subsequent reviews were implemented every five years in 2002 and 2007.

Prompted by concerns raised by the Medicare Payment Advisory Commission

(MedPAC), legislators, CMS and others in 2006, the AMA established the Five-year
Review Identification Workgroup as a subcommittee under the RUC. The Five-
year Review Identification Workgroup (since renamed as the Relativity Assessment
Workgroup [RAW]) engages in an ongoing iterative process to identify potentially
misvalued codes, replacing the traditional, formal five-year review process. RAW
identifies groups of potentially misvalued codes through 12 different screens including:
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 17

services reported together, new technology services to rereview, high-volume growth,

fastest growing procedures and old Harvard-valued codes with utilization of more than
30,000. Since its inception, RAW has targeted more than 1,800 services for further
review by the RUC, including many radiology and interventional radiology codes. For
additional information on the RUC screening process, see [Link]/about-us/ruc.

CMS also identifies potentially misvalued codes through its screening processes and
requests these codes be reviewed by RUC.

NATIONAL CORRECT CODING INITIATIVE (NCCI)

In 1996, to prevent payment of perceived abuses in procedural reporting, Congress
authorized the Health Care Financing Administration (HCFA, now CMS) to begin the
National Correct Coding Initiative (NCCI). The primary intent of the NCCI is to promote
correct coding through identification of code pairs that cannot or should not be reported
in the same patient encounter (so called “procedure-to-procedure coding edits” or PTP
edits). NCCI PTP edits also prevent erroneous independent reporting of one or more
services inherent to (included in) a comprehensive procedure code (commonly referred
to as “unbundling”).

NCCI edits are developed by CMS through a subcontract with Correct Coding Solutions
LLC ([Link]). Most proposed new NCCI edits are distributed by
the AMA to specialty societies for comment. For all these NCCI edits, SIR’s and ACR’s
coding advisers carefully review the proposed edits, and both societies frequently
comment and submit opinion letters objecting to a proposed edit if clinical scenario and
typical patient care practices indicate that the edit might be in error.

An NCCI modifier indicator of “0” indicates that NCCI-associated modifiers cannot be used
to bypass the edit. A modifier indicator of “1” indicates that NCCI-associated modifiers
can be used to bypass an edit under appropriate circumstances (please see the Modifier
chapter for additional information). Information about NCCI edits is available on the CMS
webpage, [Link]/nationalcorrectcodinited/ncciep/[Link]#topofpage. The left
side of the NCCI page has several links to specific NCCI policy pages.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 18

MEDICALLY UNLIKELY EDITS (MUES)

In January 2007, CMS developed “medically unlikely edits” (MUEs) to reduce the claims
error rate in Part B payments. These edits result in the limitation of the frequency (or
number of units) of a particular service that can be reported for a beneficiary by the
same provider/provider group on a single date of service. Although CMS publishes most
MUE values on its website ([Link]/medicare/coding/nationalcorrectcodinited/mue.
html), other MUE values are confidential and are for CMS’ and CMS contractors’ use only.
The latter group of MUE values should not be released since CMS does not publish them.

Ongoing maintenance of MUEs is similar to PTP edits with specialty societies being given
an opportunity to comment/challenge existing and proposed MUEs.

MODIFIER USAGE
Modifiers are two-character suffixes (alpha and/or numeric) that are used in conjunction
with CPT codes to justify, elaborate or further clarify the reporting of a particular service.
Modifiers explain specifically how the service described by the code was rendered by
the provider. Proper use of modifiers is critical, as incorrect modifier usage is often cited
as a reason for lost or improper reimbursement. Below is a list of the most common
modifiers used in interventional radiology billing. (Refer to Appendix A of the CPT® 2020
Professional Edition for a complete list of modifiers and descriptions.)

–22 (increased service): When an extraordinary amount of time, skill and effort were
used to complete a procedure, a –22 modifier may be appended to the base service.
The documentation should support why this is considered above and beyond what
is typically encountered during this procedure. Necessary documentation elements
include a description of what technical aspects are different from the standard code,
documentation of the increased time from what is typical for the given procedure and a
description of the extenuating circumstance that made the overall service an increased
effort. Some payers may increase reimbursement rates when this modifier is used, if
appropriately documented.

–26 (professional component): Used most often in a hospital or ambulatory surgery

center when a radiologist is only interpreting images and not providing the imaging
equipment.

–TC (technical component): Used by the hospital or surgery center to cover the expense
of the equipment, staff, etc. of the facility.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 19

–50 (bilateral procedure): This is appended to surgical codes when an identical

procedure is performed bilaterally (left and right) in the same body system. This is not
used when the CPT descriptor states the procedure is bilateral. Refer to the Medicare
Physician Fee Schedule, which dictates when modifier –50 can be used on a specific
code. Modifier –50 is not used for RS&I codes.

–LT/–RT (left/right): These modifiers may be used to further clarify the laterality,
especially when multiple codes are being submitted in one encounter.

–52 (reduced service): When a service is partially performed, it may be appropriate to

use a –52 modifier. Use of this modifier indicates that not all of the services required
by a CPT code descriptor were performed. Use this modifier only to clarify that not all
aspects of the service were rendered. Some payers may reduce reimbursement rates
when this modifier is used. Do not use this modifier for terminated procedures or exams;
instead use modifier –53.

–53 (discontinued procedure): Used when a procedure or service is terminated due to

extenuating circumstances or something that may threaten the well-being of the patient,
the intended procedure code can be billed with this modifier. This modifier may only be
used after the induction of anesthesia and should not be used for the cancellation of an
elective procedure. The use of a –53 modifier indicates some level of effort to provide
the service was rendered. Supporting documentation should state why the procedure
was terminated and provide an approximate percentage of the procedure that was
performed. (Note that hospital outpatient facilities would report modifier –73 or –74 for
discontinued procedure.)

–59 (distinct procedural service): Used to indicate that a service was distinct or
independent of another service that was billed in conjunction. This modifier is used when
services that may typically be considered inherent to one another are actually performed
on distinct sites, systems or sessions. Documentation must support a different session,
different procedure or surgery, different site or organ system, separate incision/excision,
separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily
encountered or performed on the same day by the same individual. Modifier –59 is
known to be the most widely misused modifier. To counteract its misuse, in 2015, CMS
introduced the “X{EPSU} modifiers.” These modifiers are to be used to further clarify the
reason for the distinct service.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 20

They are used in place of –59 when the scenario fit the more specific “X{EPSU}”
modifier. Not all carriers have adopted the use of these modifiers, and providers should
reach out to their billing offices for recommended use.

• –XE: Separate encounter

• –XP: Separate practitioner
• –XS: Separate structure
• –XU: Unusual nonoverlapping service

–25 (significant E&M service by same physician on date of procedure): Required

when an E&M service is provided on the same day as a procedure with a global fee
period (–000 or –010). An E&M service should only be reported on the same when
the physician indicates that the service is for a significant and separately identifiable
service, above and beyond the usual pre- or postoperative work of the procedure. In
the instance of initial consultation occurring on the same day as procedure, there should
be documentation of a formal request made to the IR service for consultation, with
documentation of the medical decision making that occurred.

–57 (decision for surgery made within a global surgical period): Required when an E&M
service is provided on the same-day-of or on-the-day-before a procedure with a –090
day global period. Similar to modifier –25 above, the E&M service provided must be a
significant and separately identifiable service, above and beyond the usual pre- or post-
operative work of the procedure.

Each payer/carrier will have different rules and policies on appropriate modifier usage
for claim submission. Reimbursement and reimbursement adjustments will differ by
payer. Supporting documentation and justification for the use of some modifiers will
also differ by payer.

ADD-ON CODE EDITS

Certain “add-on” codes (those codes identified with a “+” designation) can be reported
in conjunction with only a limited number of particular codes, resulting in the rejection
of the add-on code when reported in conjunction with a code not on the approved list.
CMS has asserted that these edits are determined at the local level.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 21

Evaluation and Management (E&M)

codes
CMS eliminated payment for outpatient (99241–99245) and inpatient (99251–99255)
consultation codes for Medicare beneficiaries. CMS mandated that any consultation
service on Medicare beneficiaries be reported using evaluation and management
codes rather than consultation codes. This does not mean that consultations should
not be performed on Medicare patients. It also does not mean that the CPT codes for
consultation services have been eliminated. They have not. It only means that when
these services are provided to Medicare patients, they will be reported with evaluation
and management codes appropriate to the site of service.

Consultations performed in an outpatient office are to be reported using the existing

evaluation and management codes for new (99201–99205) or established (99211–
99215) Medicare patients. Consultations performed on (Medicare) inpatients are
reported using the existing codes for initial (99221–99223) or subsequent (99231–
99233) hospital care visits.

Why has CMS chosen this method of reporting consultations? There have always been
discrepancies between the CMS requirements for reporting consultations and the
AMA’s interpretation of these requirements. Thus, consultation services were often
reported inappropriately by not meeting the CMS’ definition of a consultation or not
having appropriate documentation to support the use of consultation codes per CMS
requirements. Further, documentation requirements for consultations have evolved.

They were initially stricter than for other types of E&M services but are now similar—
enough so that CMS indicated that higher payment for consultation was not appropriate.

With the elimination of the office consultation codes, the work RVUs for new and
established office visits were increased slightly. Similarly, the work RVUs for initial
hospital and facility visits were increased. This has increased the payments for both
services. In addition, the increased use of these visits will be incorporated into PE and
malpractice RVU calculations.

Finally, the incremental work RVUs for the E&M codes that are built into the 10-day and
90-day global surgical codes were increased as well.

Some third-party payers may choose to follow this policy and others may not. Therefore,
all physicians providing consultation services must be aware of the payment policies
 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 22

from their local and regional providers to know which codes to submit when rendering
these services.

E&M CODING AND THE INTERVENTIONAL RADIOLOGIST

Over the past several years, interventional radiology practices have encountered a
handful of instances in which some hospital systems prohibit the coding or payers
deny payment for E&M claims submitted by radiologists and interventional radiologists.
SIR’s and ACR’s standing position is that E&M services are allowable and should be
appropriately reported by any provider performing the services, including radiologists
and interventional radiologists.

We understand that some carriers have denied payments for E&M services provided by
all radiologists because they have assumed that the services being reported were not
true E&M services but rather focused history and physicals to satisfy Joint Commission
(formerly Joint Commission on Accreditation of Healthcare Organizations) requirements
for current documentation on the chart for invasive procedures. However, Interventional
Radiology is a clinical specialty, thus it is fully appropriate for interventional radiologists
to document patient care activities with E&M codes.

Our societies have worked to educate several carriers about the nature of E&M work
provided by interventional radiologists and to differentiate these E&M services from the
pre and post-procedural work that is included in procedural valuations.

Many interventional radiology procedures require longitudinal care, identical to many

other surgical and medical specialties. Upon consultation, patients are seen prior
to procedure to determine the care plan, evaluate their state of health, assess the
presenting illness and determine the appropriateness of different therapeutic options.
Appropriate testing is ordered to fully diagnose their pathology. The patient is advised
of all potential treatment options including, but not limited to, minimally invasive
therapies provided by interventional radiologists. If the patient’s condition is deemed
suitable for treatment by the interventional radiologist, then he or she is scheduled
for treatment and the service is rendered. Follow-up care is given as appropriate, and
patients are often followed in a clinical office to monitor the effectiveness of the therapy
and the progress of the underlying condition. This is identical to services provided by
medical and surgical specialists such as gastroenterologists, surgeons and cardiologists.

For inpatients, it is appropriate to perform and document consultations. If the consult is

performed and fully documented on the same day as a major (90-day global) procedure
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 23

one should add modifier –57 to the E&M code. If performed and fully documented on
the same day as a minor procedure (10-day global), one should add modifier –25 to
the E&M code. These modifiers are required to designate that the E&M service involved
medical decision making and is a separate service, rendering it reportable. It is not
appropriate to report an E&M service when the decision to perform a procedure has
already been made, and the physician is merely evaluating the patient as appropriate
prior to the planned procedure or for moderate sedation purposes. Following inpatients
longitudinally (rounding) also frequently leads to changes in patient management.
However, global period rules should be followed when billing such services.

To help clarify the guidelines, SIR stated in 2006: “If you, an interventional radiology
physician, are asked by another physician to see a patient for input into that patient’s
management and you evaluate that patient to develop an assessment and plan and
then document the encounter and your recommendations appropriately, then you have
performed the work of a consultation and should bill the correct E&M code. However,
if you are seeing a patient before a previously arranged procedure and the purpose of
that visit is to confirm that the patient can go through that procedure and to obtain
informed consent for the procedure, then consider that encounter to be bundled into the
procedure itself and do not bill separately for that encounter” (“Coding for consultations
in interventional radiology,” IR News, Nov./Dec. 2006, p.14).

EVALUATION AND MANAGEMENT, NON-FACE-TO-FACE

CONSULTATIONS BETWEEN PRACTITIONERS
There have been revisions and additions to the evaluation and management code family
for non-face-to-face interprofessional consultations. This code family acknowledges
the use of multiple methods whereby non-face-to-face consultations occur, which now
include: telephone, internet or electronic health records consultations. The consultant
should use codes 99446–99449 or 99451 to report this type of non-face-to-face
service.

Interprofessional telephone/internet/electronic health record consultation is an

assessment and management service in which a patient’s treating (e.g., attending or
primary) physician requests the opinion and/or treatment advice of a specific specialty
physician, the consultant, to assist the treating physician in the diagnosis and/or
management of the patient’s problem without patient face-to-face contact with the
consultant.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 24

99446 Interprofessional telephone/internet/electronic health record assessment

and management service provided by a consultative physician, including
a verbal and written report to the patient’s treating/requesting physician
or other qualified health care professional; 5-10 minutes of medical
consultative discussion and review

99447 11–20 minutes of medical consultative discussion and review

99448 21–30 minutes of medical consultative discussion and review

99449 31 minutes or more of medical consultative discussion and review

99451 Interprofessional telephone/internet/electronic health record assessment

and management service provided by a consultative physician, including
a written report to the patient’s treating/requesting physician or
other qualified health care professional, 5 minutes or more of medical
consultative time

99452 Under Interprofessional Telephone/internet/Electronic Health Record

Consultations. The Current Procedural Terminology (CPT) code 99452
as maintained by American Medical Association, is a medical procedural
code under the range - Interprofessional Telephone/internet/Electronic
Health Record Consultations.

Bundled services
It is imperative that hospitals continue to report all services and the associated costs,
including those for services that have been bundled/packaged into others.

The 2008 HOPPS Final Rule warns that not reporting these bundled services and
associated costs can and will have a dramatic negative impact on future payment rates.
Per CMS, “If packaged services and their charges are not reported, the payment for the
services into which their cost is packaged may be understated. Therefore, it is important
that hospitals report all services furnished and the associated charges.” (Source: The
Medicare Program: Changes to the Hospital Outpatient Prospective Payment System
and CY 2008 Payment Rates, pages 66634–66635.) CMS asserted that the APC rates
for the procedural component of many interventional radiology services were increased
to offset the bundling of the previously separately reimbursed imaging.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 25

Deleted interventional radiology codes

The following is a list of codes used in interventional radiology practices that were
deleted effective Jan. 1, 2020. For further information and a detailed listing of all code
changes, refer to the CPT® 2020 Professional Edition codebook.

0254T 
Endovascular repair of iliac artery bifurcation (e.g., aneurysm,
pseudoaneurysm, arteriovenous malformation, trauma, dissection)
using bifurcated endograft from the common iliac artery into both
the external and internal iliac artery, including all selective and/or
nonselective catheterization(s) required for device placement and
all associated radiological supervision and interpretation, unilateral
(Deleted Dec. 31, 2019 — See 34717, 34718)

Interventional radiology procedure

codes
The following list of code ranges is provided to assist the user of this update in identifying
those services that may be frequently performed by a physician practicing interventional
radiology. Most code descriptors presented are the “short descriptors” established by
CMS. Almost all descriptors presented in this update are truncated in some manner. For
a full description of these procedures, please refer to the complete text of the AMA CPT®
2020 Professional Edition codebook. No code should ever be used without consulting the
complete text of that particular code, including introductory language, parenthetical notes,
subcategory notes, and overall category and section notes.

Key

The following symbols are used in this section:

l = new CPT code

+ = add-on code

 = revised code

# = resequenced code
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 26

New and revised 2020 interventional

radiology procedure codes:
A brief introduction
(Additional information is found in the numerical section of this update.)

Please consult the accompanying introductory language describing the codes and
reporting instructions in the CPT® 2020 Professional Edition codebook.

ENDOVASCULAR REPAIR OF THE INFRARENAL AORTA

Two new codes 34717 and 34718 have been created for the treatment zone defined as
the portion of the iliac artery(ies)—e.g., common, internal, external iliac arteries—that
contains the endograft. Category III code 0254T for bifurcated iliac branch device has
been deleted.

A new add-on code 34717 is reported at the time of aorto-iliac artery endograft
placement (34703, 34704, 34705, 34706) for deployment of a bifurcated endograft
in the common iliac artery with extension(s) into both the internal iliac and external
iliac arteries, when performed, to maintain perfusion in both vessels for treatment of
iliac artery pathology (with or without rupture) such as aneurysm, pseudoaneurysm,
dissection, penetrating ulcer, arteriovenous malformation or traumatic disruption. The
iliac branched endograft is a multipiece system that consists of a bifurcated device that
is placed in the common iliac artery and the additional extension(s) that are placed
into both the internal iliac artery and external iliac/common femoral arteries as needed
as well as a proximal extension that overlaps with an aorto-iliac endograft, when
performed. All additional extensions proximally into the common iliac artery or distally
into the external iliac and/or common femoral arteries are inherent to these codes.

For endovascular repair of iliac artery by deployment of an iliac branched endograft, see
34717, 34718.

+l34717 Endovascular repair of iliac artery at the time of aorto-iliac artery

endograft placement, when performed, for rupture or other than rupture,
unilateral
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 27

Report 34717 only once per side. For bilateral procedure, report 34717
twice, do not report with –50.

For placement of an iliac branched endograft at a separate setting than

aorto-iliac endograft placement, use 34718.

 34718 Endovascular repair of iliac artery not associated with placement of an

aorto-iliac artery endograft at the same session, by deployment of an iliac
branched endograft, including pre-procedure sizing, device selections, all
ipsilateral selective iliac artery catheterization(s), radiological supervision
and interpretation, all endograft extensions(s) proximally to the aortic
bifurcation and distally in the internal iliac, external iliac, and common
femoral artery(ies), and treatment zone angioplasty/stenting, when
performed, for other than rupture (eg, for aneurysm, pseudoaneurysm,
dissection, arteriovenous malformation, penetrating ulcer, unilateral

For bilateral placement of an iliac branched endograft, report modifier 50

Do not report 34718 in conjunction with 34701, 34702, 34703, 34704,

34705, 34706, 34707, 34808, 34709, 34717

Do not report 34718 with 34710, 34711 on the same side

For placement of an iliac branched endograft in the same setting as

aorto-iliac endograft placement, use 34717

For placement of an isolated iliac branched endograft for rupture, use 37799

SPINE INJECTION, DRAINAGE OR ASPIRATION

New codes have been added to report lumbar puncture procedures. CPT codes 62270
and 62272 have been revised. Report code 62328 for diagnostic spinal lumbar puncture
with fluoroscopic or CT guidance. For therapeutic spinal puncture for drainage of
cerebrospinal fluid with fluoroscopic or CT guidance report code 62329.

62270 Lumbar puncture, diagnostic;

 62328 with fluoroscopic or CT guidance

Do not report 62270, 62328 with 77003, 77012

For ultrasound or MRI guidance see codes 76942, 77021

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 28

62272 Lumbar puncture, therapeutic (by needle or catheter to drain CSF);

 62329 with fluoroscopic or CT guidance

Do not report 62272, 62329 with 77003, 77012

For ultrasound or MRI guidance see codes 76942, 77021

ANATOMIC MODEL 3D PRINTING

Four new Category III codes have been created (effective as of July 1, 2019) to report
the work performed in developing and printing 3D anatomic models and subsequent
fashioning of cutting/drilling guides. CPT codes 0559T and +0560T are to be
reported when printing anatomic structures, such as (but not limited to) bones, arteries,
veins, nerves, ureters, muscles, tendons and ligaments, joints, visceral organs, and brain.
0561T and +0562T are to be reported when printing cutting or drilling guides. It
may be necessary to make a 3D-printed model and a 3D-printed cutting or drilling
guide on the same patient to assist with surgery. These codes should not be reported in
conjunction with 76376 or 76377. As Category III codes, there is no assigned work RVU
value and these codes are typically carrier priced, so check with your local carriers on
reimbursement for these codes.

 0559T Anatomic model 3D-printed from image data set(s); first individually
prepared and processed component of an anatomic structure

+0560T Anatomic model 3D-printed from image data set(s); each additional
individually prepared and processed component of an anatomic structure
(List separately in addition to code for primary procedure)

0561T Anatomic guide 3D-printed and designed from image data set(s); first
anatomic guide

+0562T Anatomic guide 3D-printed and designed from image data set(s); each
additional anatomic guide (List separately in addition to code for primary
procedure)
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 29

DUPLEX SCAN FOR PREOPERATIVE MAPPING OF

HEMODIALYSIS ACCESS
Two new codes (93985 and 93986) have been established as Category I codes
describing duplex scan of arterial inflow and venous outflow for preoperative vessel
assessment prior to the creation of hemodialysis access. This exam was previously
reported with G0365. These codes should only be reported when a full and completed
evaluation of both the arterial inflow and venous outflow are performed for preoperative
assessment prior to creation of a hemodialysis access.

93985 Duplex scan of arterial inflow and venous outflow for preoperative vessel
assessment prior to creation of hemodialysis access; complete bilateral
study

93986 Duplex scan of arterial inflow and venous outflow for preoperative vessel
assessment prior to creation of hemodialysis access; complete unilateral
study
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 30

Interventional radiology/ radiology

procedure codes
FINE NEEDLE ASPIRATION CODES
10021 Fine needle aspiration biopsy, without imaging guidance; first lesion

10022 has been deleted. To report, see 10005, 10006, 10007, 10008, 10009, 10010,
10011, 10012.

+#10004 each additional lesion (List separately in addition to code for primary
procedure)

(Use 10004 in conjunction with 10021)

(Do not report 10004, 10021 in conjunction with 10005, 10006, 10007,
10008, 10009, 10010, 10011, 10012 for the same lesion)

(For evaluation of fine needle aspirate, see 88172, 88173, 88177)

#10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion

+#10006 each additional lesion (List separately in addition to code for primary
procedure)

(Use 10006 in conjunction with 10005)

(Do not report 10005, 10006 in conjunction with 76942)

(For evaluation of fine needle aspirate, see 88172, 88173, 88177)

#10007 Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion

+#10008 each additional lesion (List separately in addition to code for primary
procedure)

(Use 10008 in conjunction with 10007)

(Do not report 10007, 10008 in conjunction with 77002)

(For evaluation of fine needle aspirate, see 88172, 88173, 88177)

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 31

#10009 Fine needle aspiration biopsy, including CT guidance; first lesion

+#10010 each additional lesion (List separately in addition to code for primary
procedure)

(Use 10010 in conjunction with 10009)

(Do not report 10009, 10010 in conjunction with 77012)

(For evaluation of fine needle aspirate, see 88172, 88173, 88177)

#10011 Fine needle aspiration biopsy, including MR guidance; first lesion

+#10012 each additional lesion (List separately in addition to code for primary
procedure)

(Use 10012 in conjunction with 10011)

(Do not report 10011, 10012 in conjunction with 77021)

(For evaluation of fine needle aspirate, see 88172, 88173, 88177)

For percutaneous needle biopsy other than fine needle aspiration biopsy, see 19081–
19086 for breast, 20206 for muscle, 20220–20225 for bone, 32400 for pleura, 32405
for lung or mediastinum, 38505 for lymph node(s), 42400 for salivary gland, 47000–
47001 for liver, 48102 for pancreas, 49180 for abdominal or retroperitoneal mass,
50200 for kidney, 54500 for testis, 55700 for prostate, 54800 for epididymis, 60100
for thyroid, 62267 for nucleus pulposus, intervertebral disc, or paravertebral tissue,
62269 for spinal cord.

(For percutaneous image-guided fluid collection drainage by catheter of soft tissue [e.g.,
extremity, abdominal wall, neck], use 10030)

SOFT-TISSUE MARKER
Percutaneous placement of a soft tissue-marker (e.g., clip, metallic pellet, wire/needle,
radioactive seeds) with imaging guidance is reported with 10035 and 10036. If a more
specific site descriptor than soft tissue is applicable (e.g., breast), use the site-specific
codes for marker placement at that site. Report 10035 and 10036 only once per target,
regardless of how many markers are placed to mark that target. It would be appropriate
to report the add-on code 10036 for a second procedure or site, on the same side or
contralateral side.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 32

10035 Placement of soft-tissue localization device(s) (percutaneous), first

lesion, including imaging guidance

+10036 Placement of soft-tissue localization device(s) (percutaneous), each

additional lesion, including imaging guidance

Use 10036 in conjunction with 10035.

Do not report 10035, 10036 in conjunction with 76942, 77002, 77012,

77021.

To report a second procedure or site on the same side or contralateral side, use 10036.

ASPIRATION/INJECTION OF INTEGUMENTARY SYSTEM

10160 Aspiration via puncture of abscess, hematoma, bulla, or cyst.

Imaging guidance is separately billable with code 10160; use 77002,

77012, 77021 or 76942 to report appropriate modality-specific guidance.

19000 Aspiration via puncture of cyst of breast (single cyst).

+19001 Aspiration via puncture of cyst of breast (each additional cyst).

(For drainage of breast abscess, SIR and ACR recommend code 10160).

Imaging guidance is separately reportable with code 19000; use 77002,

77012, 77021 or 76942 to report appropriate modality-specific guidance.

19030 Injection for mammary galactogram or ductogram.

For RS&I/S&I, see 77053, 77054.

BREAST BIOPSIES AND PLACEMENT OF LOCALIZATION

DEVICES
Extensive changes have been made to the introductory guidelines in the Breast
subsection of CPT ® 2020 Professional Edition codebook to clarify breast biopsy,
percutaneous or open approach, procedures with or without imaging. The guidelines
instructions include how to report breast biopsies with placement of localization
device(s), imaging services and bilateral procedures.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 33

Percutaneous breast biopsies without imaging guidance are reported with 19100.

Please refer to CPT 2020 codebook for complete instructions on breast biopsies code
set.

Breast biopsies can be performed using a variety of imaging guidance techniques.

Choose the code (19081–19086) that describes the imaging modality used for the
biopsy. If more than one lesion is biopsied in the same setting (either same breast or
contralateral breast), use the add-on code(s) to describe each additional lesion biopsied.
The percutaneous placement of a localization device (e.g., clip, metallic pellet, wire/
needle, radioactive seeds) is included in the biopsy codes when performed; as well
as the imaging of the biopsy specimen, when performed. For reporting placement of
localization device in the breast under imaging guidance but without concurrent biopsy,
see codes 19281–19288.

19081 Breast biopsy (percutaneous), first lesion, using stereotactic guidance,

with placement of localization device(s), when performed, and imaging
of the biopsy specimen, when performed.

+19082 Breast biopsy (percutaneous), each additional lesion, using stereotactic

guidance, with placement of localization device(s), when performed, and
imaging of the biopsy specimen, when performed.

(Use 19082 in conjunction with 19081).

19083 Breast biopsy (percutaneous), first lesion, using ultrasound guidance,

with placement of localization device(s), when performed, and imaging
of the biopsy specimen, when performed.

+19084 Breast biopsy (percutaneous), each additional lesion, using ultrasound

guidance, with placement of localization device(s), when performed, and
imaging of the biopsy specimen, when performed.

(Use 19084 in conjunction with 19083).

19085 Breast biopsy (percutaneous), first lesion, using magnetic resonance

guidance, with placement of localization device(s), when performed, and
imaging of the biopsy specimen, when performed.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 34

+19086 Breast biopsy (percutaneous), each additional lesion, using magnetic

resonance guidance, with placement of localization device(s), when
performed, and imaging of the biopsy specimen, when performed.

(Use 19086 in conjunction with 19085).

(Do not report 19081–19086 in conjunction with 19281–19288, 76098,

76942, 77002, 77021 for same lesion).

19100 Biopsy of breast; needle core (no imaging guidance)

(For fine needle aspiration biopsy, see 10004, 10005, 10006, 10007,
10008, 10009, 10010, 10011, 10012, 10021)

19281 Placement of breast localization device(s) (percutaneous) first lesion,

using mammographic guidance.

+19282 Placement of breast localization device(s) (percutaneous) each additional

lesion, using mammographic guidance.

Use 19282 in conjunction with 19281.

19283 Placement of breast localization device(s) (percutaneous) first lesion,

using stereotactic guidance.

+19284 Placement of breast localization device(s) (percutaneous) each additional

lesion, using stereotactic guidance.

Use 19284 in conjunction with 19283.

19285 Placement of breast localization device(s) (percutaneous) first lesion,

using ultrasound guidance.

+19286 Placement of breast localization device(s) (percutaneous) each additional

lesion, using ultrasound guidance.

Use 19286 in conjunction with 19285.

19287 Placement of breast localization device(s) (percutaneous) first lesion,

using magnetic resonance guidance.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 35

+19288 Placement of breast localization device(s) (percutaneous) each additional

lesion, using magnetic resonance guidance.

Use 19288 in conjunction with 19287.

Do not report 19281–19288 in conjunction with 19081–19086, 76942,

77002, 77021 for same lesion.

(For surgical specimen radiography, use 76098).

19296 Placement of radiotherapy after loading expandable catheter (single/

multichannel) in breast for interstitial radioelement application following
partial mastectomy, includes imaging guidance; on date separate from
partial mastectomy.

+19297 Concurrently with partial mastectomy (List separately in addition to code

for primary procedure).

19298 Placement of radiotherapy after loading brachytherapy catheters

(multiple tube and button type) into breast (at the time of or subsequent
to) partial mastectomy, includes imaging guidance.

MUSCULOSKELETAL SYSTEM (BIOPSY, ASPIRATION,

INJECTION)
20206 Muscle biopsy, percutaneous needle.

Imaging guidance is separately reportable with code 20206; use 77002,

77012, 77021 or 76942 to report appropriate modality-specific guidance.

20220 Bone biopsy, trocar/needle, superficial (e.g., ilium, sternum, ribs).

20225 Bone biopsy, trocar/needle, deep (e.g., vertebral body, femur).

Imaging guidance is separately reportable with code 20220 and 20225;

use 77002, 77012 or 77021 to report appropriate modality-specific
guidance.

Do not report 20225 in conjunction with vertebroplasty or vertebral

augmentation procedures (22510, 22511, 22512, 22513, 22514, 22515,
0200T, 0201T) when performed at the same level.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 36

20500 Injection of sinus tract, therapeutic.

20501 Injection of sinus tract, diagnostic (sinogram) For RS&I/S&I, see 76080.

For contrast injection and radiological evaluation of G-, J-, G-J,

cecostomy or duodenostomy tube, see 49465.

For reporting ultrasound guidance for arthrocentesis procedures (20604,

20606, 20611), please review the CPT® 2020 Professional Edition manual.

20600 Arthrocentesis, aspiration and/or injection of small joint or bursa (e.g.,

fingers, toes); without ultrasound guidance. (If fluoroscopic, CT or MRI
guidance is performed, see 77002, 77012, 77021).

20604 Arthrocentesis, aspiration and/or injection of small joint or bursa with

ultrasound guidance, with permanent recording and reporting.

(Do not report 20600 or 20604 in conjunction with 76942).

20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa

(e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle,
olecranon bursa); without ultrasound guidance. (For fluoroscopic, CT or
MR imaging guidance, see 77002, 77012, 77021).

20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa

(e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle,
olecranon bursa); with ultrasound guidance.

(Do not report 20605 or 20606 in conjunction with 76942).

20610 Major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa),
without ultrasound guidance. (If fluoroscopic, CT or MRI guidance is
performed, see 77002, 77012, 77021).

20611 Major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa)
with ultrasound guidance, with permanent recording and reporting.

(Do not report 20610 or 20611 in conjunction with 27369 or 76942).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 37

KNEE ARTHROGRAPHY
27369 Injection procedure for contrast knee arthrography or contrast-enhanced
CT/MRI knee arthrography

(Use 27369 in conjunction with 73580, 73701, 73702, 73722, 73723)

(Do not report 27369 with 20610, 20611, 29871)

(For arthrocentesis of the knee or injection of any material other than

contrast for subsequent arthrography, see 20610, 20611)

(When fluoroscopy-guided injection is performed for enhanced CT

arthrography, use 27369, 77002, and 73701 or 73702)

BONE ABLATION
Both codes 20982 and 20983 include any type of imaging guidance, regardless of
type(s) of modality used (previously it had been limited to CT guidance). The descriptors
also acknowledge that the work includes treatment of any direct tumor extension
outside the bone if performed.

20982 Radiofrequency one or more bone tumors, including adjacent soft tissue,
percutaneous, includes imaging guidance.

20983 Cryoablation, one or more bone tumors, including adjacent soft tissue,
percutaneous, including imaging guidance.

VERTEBROPLASTY AND VERTEBRAL AUGMENTATION

Six CPT codes (22510–22515) describe procedures for percutaneous vertebroplasty
(injecting cement into the vertebral cavity) of the cervical, thoracic, lumbosacral spine
and vertebral augmentation (creating a cavity followed by cement injection, e.g.,
kyphoplasty) of the thoracic and lumbar spine. The procedure codes are inclusive
of bone biopsy when performed and imaging guidance necessary to perform the
procedure. Use one code per vertebral body, regardless of whether unilateral or bilateral
injections are performed. Use one primary procedure code and an add-on code for
additional levels in the same setting, regardless of region. When treating the sacrum,
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 38

sacral procedures are reported only once per encounter. These codes bundle the surgical
and radiological portions of these procedures. Category III codes 0200T and 0201T
were changed and are now specific for sacral augmentation with use of a cavity creation
device (e.g., kyphoplasty). SIR and ACR recommend that, if a provider performs a
vertebroplasty in the sacral region, the Category I lumbosacral code should be reported
(i.e., 22511).

22510 Percutaneous vertebroplasty, of an initial cervicothoracic vertebral

body, includes imaging guidance and bone biopsy when performed.

22511 Percutaneous vertebroplasty, of an initial lumbosacral, vertebral body,

includes imaging guidance and bone biopsy when performed.

+22512 Percutaneous vertebroplasty of each additional cervicothoracic or

lumbosacral vertebral body, includes imaging guidance and bone biopsy
when performed.

(Use 22512 in conjunction with 22510, 22511).

(Do not report 22510–22512 in conjunction with 20225, 22310, 22315,

22325, 22327 when performed at the same level as 22510–22512).

22513 Percutaneous vertebral augmentation, of an initial thoracic vertebral

body, includes imaging guidance and bone biopsy when performed.

22514 Percutaneous vertebral augmentation, of an initial lumbar vertebral

body, includes imaging guidance and bone biopsy when performed.

+22515 Percutaneous vertebral augmentation of each additional thoracic or

lumbar vertebral body, includes imaging guidance and bone biopsy
when performed.

Use 22515 in conjunction with 22513, 22514.

(Do not report 22513–22515 in conjunction with 20225, 22310, 22315,

22325, 2232 when performed at the same level as 22513–22515).

(For sacral augmentation, report 0200T, 0201T. For facet joint

arthroplasty, use 0202T. For reporting cervical augmentation, see code
22899).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 39

ARTHROGRAM
Fluoroscopic guidance code 77002 is included in the RS&I/S&I for planar arthrography
procedures. Use 77002 only in cases of joint enhancement for CT or MRI-enhanced
study when planar arthrography is not also performed/reported.

23350 Injection for shoulder arthrogram.

For RS&I/S&I, see 73040.

24220 Injection for elbow arthrogram (for tennis elbow injection, see 20550).

For RS&I/S&I, see 73085.

27093 Injection for hip arthrogram without anesthesia.

For RS&I/S&I, see 73525.

27095 Injection for hip arthrogram with anesthesia.

For RS&I/S&I, see 73525.

27096 Sacroiliac joint injection (anesthetic or steroid), unilateral; includes image

guidance (fluoroscopy or CT) and arthrogram when performed.

For bilateral SI joint injection, report 27096 with modifier –50.

LUNGS AND PLEURA

32550 Insertion of indwelling tunneled pleural catheter with cuff.

If imaging guidance is performed, use 75989.

(Do not report 32550 in conjunction with 32554, 32555, 32556, 32557
when performed on the same side of the chest).

32551 Tube thoracostomy has been revised to indicate that this code is used for
reporting an open procedure.

(Do not report 32551 in conjunction with 33020, 33025, if pleural drain/
chest tube is placed on the ipsilateral side).

(For percutaneous chest tube placement, see 32556–32557).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 40

32553 Placement of an interstitial device(s), for radiation therapy guidance

(e.g., fiducial markers, dosimeter), percutaneous, intrathoracic, single or
multiple.

(Report supply of device separately).

(For percutaneous placement of an interstitial device[s], such as fiducial

marker or dosimeter, for radiation therapy guidance within the abdomen,
pelvis [except prostate] and/or retroperitoneum, report 49411).

Imaging guidance codes (76942, 77002, 77012 or 77021) and device codes (e.g.,
A4648, tissue marker, A4650, implantable radiation dosimeter or A4649, surgical
supply) are reported separately in conjunction with the interstitial device percutaneous
placement procedure codes.

Codes 32554–32557 are not to be reported in conjunction with codes 32550, 32551
when performed on the same side of the chest. Additionally, codes 32554–32557 cannot
be reported in conjunction with imaging codes 75989, 76942, 77002, 77012, 77021.

32554 Thoracentesis, via needle or catheter, without imaging guidance.

32555 Thoracentesis, via needle or catheter, with imaging guidance.

32556 Percutaneous insertion of indwelling pleural drainage catheter, without

imaging guidance.

32557 Percutaneous insertion of indwelling pleural drainage catheter, with

imaging guidance. To report insertion of indwelling tunneled pleural
catheter with cuff, see code 32550.

ABLATION THERAPY—PULMONARY
32994 Cryoablation of 1 or more tumors of the pleura or chest wall imaging
guidance when performed, unilateral.

32998 Radiofrequency ablation of 1 or more tumors of the pleura or chest wall

imaging guidance when performed, unilateral. If ablation is performed in
a bilateral setting, report codes 32994 or 32998 with modifier –50.

Codes 32994 and 32998 are used to report either reduction/“debulking” or the
eradication of pulmonary tumor(s).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 41

ENDOVASCULAR REPAIR OF THE THORACIC AORTA

The following family of codes describes repair of the thoracic aorta. This code set is
component coded; therefore, separate codes exist for the RS&I/S&I or imaging guidance
component of the procedure. Nonselective and selective catheter placement codes
are also separately reportable. Additional interventions outside of the treatment zone,
such as angioplasty, stenting and embolization, are also separately reportable. The
following codes can be used in the setting of a variety of morphologies (e.g., aneurysm,
pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma or traumatic
disruption).

Codes 33880 and 33881 include the initial graft plus additional grafts placed into the
descending thoracic aorta to the level of the celiac artery.

33880 Endovascular repair of the descending thoracic aorta, including coverage

of the left subclavian artery, initial graft.

For RS&I/S&I, see 75956.

33881 Endovascular repair of the descending thoracic aorta, not involving

coverage of the left subclavian artery, initial graft.

For RS&I/S&I, see 75957.

Codes 33883 and 33884 should be used when proximal extensions are placed in the
same setting as the initial graft or in a delayed setting.

33883 Placement of an initial proximal extension for repair of the descending

thoracic aorta.

For RS&I/S&I, see 75958.

+33884 Placement of each additional proximal extension for repair of the

descending thoracic aorta.

For RS&I/S&I, see 75958.

Use 33884 in conjunction with 33883.

Code 33886 should be used when a distal extension is placed in a delayed setting from
the initial graft.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 42

33886 Delayed placement of a distal extension after the initial repair of the
descending thoracic aorta.

For RS&I/S&I, see 75959

Do not report 33886 with 33880 or 33881

ENDOVASCULAR REPAIR OF THE INFRARENAL AORTA

The following family of codes describes endovascular repair of infrarenal abdominal
aortic pathology and procedures that support endograft services. This code set is bundle
coded, so codes below are inclusive of all imaging guidance.

Overall, the hierarchy of codes from 34701–34708 is based on the vascular anatomy
involved and type of endograft deployed. The new codes also distinguish between
endovascular repair “with rupture” (34702, 34704, 34706, 34708) and for “other than
rupture” (34701, 34703, 34705, 34707). Services that have been combined into 34701–
34708 and may not be separately reported include:

• Angioplasty and stenting performed within the treatment zone

• Placement of endografts
• Placement of extensions in the aorta from the renal arteries to the iliac
• Bifurcation treatment zone
• Nonselective catheterization
• Selective catheterization within the treatment zone
• Radiological supervision and interpretation

Important notes include:

1. Interventional procedures performed outside the endograft treatment zone at

the time of endovascular abdominal aortic aneurysm repair may be additionally
reported (e.g., renal angioplasty, arterial embolization, intravascular ultrasound,
balloon angioplasty, or stenting of native artery[s] outside the endograft
treatment zone, when done before or after deployment of endograft).

2. Selective catheterization of vessels outside the treatment zone may be reported

for diagnostic or therapeutic purposes.

3. The treatment zone is defined by those vessels that contain an endograft(s)

deployed during that operative session.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 43

34701 EVAR of infrarenal aorta with aorto-aortic tube endograft, for other than
rupture.

34702 EVAR of infrarenal aorta with aorto-aortic tube endograft, for rupture.

34703 EVAR of infrarenal aorta with aorto-uni-iliac endograft, for other than
rupture.

34704 EVAR of infrarenal aorta with aorto-uni-iliac endograft, for rupture.

34705 EVAR of infrarenal aorta with aorto-bi-iliac endograft, for other than
rupture.

34706 EVAR of infrarenal aorta with aorto-bi-iliac endograft, for rupture. For
simultaneous bilateral iliac artery aneurysm repairs report 34705 or
34706 with aorto-bi-iliac endograft. For isolated bilateral iliac artery
repair using iliac artery tube endografts, report 34707 or 34708 with
modifier –50.

34707 EVAR of iliac artery with ilio-iliac tube endograft, for other than rupture.

34708 EVAR of iliac artery with ilio-iliac tube endograft, for rupture. For
endovascular repair of iliac artery by deployment of an iliac branched
endograft, see 34717, 34718.

+34709 Placement of extension endograft distal to the common iliac or proximal

to the renal artery(ies) when performed in the same setting as initial
placement.

+34717 Endovascular repair of iliac artery at the time of aorto-iliac artery

endograft placement, when performed, for rupture or other than rupture,
unilateral.

Report 34717 only once per side. For bilateral procedure, report 34717
twice, do not report with –50.

For placement of an iliac branched endograft at a separate setting than

aorto-iliac endograft placement, use 34718.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 44

 34718 Endovascular repair of iliac artery not associated with placement of an

aorto-iliac artery endograft at the same session, by deployment of an iliac
branched endograft, including pre-procedure sizing, device selections, all
ipsilateral selective iliac artery catheterization(s), radiological supervision
and interpretation, all endograft extensions(s) proximally to the aortic
bifurcation and distally in the internal iliac, external iliac, and common
femoral artery(ies), and treatment zone angioplasty/stenting, when
performed, for other than rupture (e.g., for aneurysm, pseudoaneurysm,
dissection, arteriovenous malformation, penetrating ulcer, unilateral).

For bilateral placement of an iliac branched endograft, report modifier –50.

Do not report 34X01X in conjunction with 34701, 34702, 34703, 34704,

34705, 34706, 34707, 34708, 34709, 34717

Do not report 34718 with 34710, 34711 on the same side

For placement of an iliac branched endograft in the same setting as

aorto-iliac endograft placement, use 34717

For placement of an isolated iliac branched endograft for rupture, use

37799

34710 Delayed placement of a distal or proximal extension after the initial repair
of the infrarenal aorta or iliac artery, initial vessel treated.

+34711 Delayed placement of a distal or proximal extension after the initial repair
of the infrarenal aorta or iliac artery, each additional vessel treated.

34712 Placement of endoanchors.

+34713 Percutaneous closure of femoral artery from large (12 French or greater)
sheath.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 45

ENDOVASCULAR REPAIR OF VISCERAL AND INFRARENAL

AORTA USING FENESTRATED ENDOGRAFT
The following family of codes is used to report endovascular abdominal aortic repair
(e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or
traumatic disruption) involving visceral branches using a fenestrated graft. These codes
include all associated radiological supervision and interpretation, including target zone
angioplasty and stenting, when performed.

34839 Physician planning for placement of a fenestrated visceral aortic

endograft, patient-specific and requiring a minimum of 90 minutes of
physician time.

(Do not report 34839 in conjunction with 76376, 76377).

(Do not report 34839 in conjunction with 34841, 34842, 34843, 34844,
34845, 34846, 34847, 34848, when performed on the day before or the
day of the fenestrated endovascular repair procedure).

34841 Endovascular repair of visceral aorta using a fenestrated visceral aortic

endograft, including one visceral artery endoprosthesis (superior mesenteric,
celiac or renal artery). All associated imaging guidance is included.

34842 Endovascular repair of visceral aorta using a fenestrated visceral aortic

endograft, including two visceral artery endoprosthesis (superior
mesenteric, celiac and/or renal artery[ies]). All associated imaging
guidance is included.

34843 Endovascular repair of visceral aorta using a fenestrated visceral aortic

endograft, including three visceral artery endoprosthesis (superior
mesenteric, celiac and/or renal artery[ies]). All associated imaging
guidance is included.

34844 Endovascular repair of visceral aorta using a fenestrated visceral aortic

endograft, including four or more visceral artery endoprosthesis (superior
mesenteric, celiac and/or renal artery[ies]). All associated imaging
guidance is included.

(Do not report 34841–34844 in conjunction with 34701–34706 or

34845–34848).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 46

34845 Endovascular repair of visceral aorta and infrarenal abdominal aorta

using a fenestrated visceral aortic endograft and concomitant unibody
or modular infrarenal aortic endograft, including one visceral artery
endoprosthesis (superior mesenteric, celiac or renal artery). All
associated imaging guidance is included.

34846 Endovascular repair of visceral aorta and infrarenal abdominal aorta

using a fenestrated visceral aortic endograft and concomitant unibody
or modular infrarenal aortic endograft, including two visceral artery
endoprostheses (superior mesenteric, celiac and/or renal artery[ies]). All
associated imaging guidance is included.

34847 Endovascular repair of visceral aorta and infrarenal abdominal aorta

using a fenestrated visceral aortic endograft and concomitant unibody
or modular infrarenal aortic endograft, including three visceral artery
endoprostheses (superior mesenteric, celiac and/or renal artery[ies]). All
associated imaging guidance is included.

34848 Endovascular repair of visceral aorta and infrarenal abdominal aorta

using a fenestrated visceral aortic endograft and concomitant unibody or
modular infrarenal aortic endograft, including four or more visceral artery
endoprostheses (superior mesenteric, celiac and/or renal artery[ies]). All
associated imaging guidance is included.

Do not report 34845–34848 in conjunction with 34701-34706, 34841–

34844, 35081, 35102.

Do not report 34841–34848 in conjunction with 37236–37237 for bare

metal or covered stents placed into the visceral branches within the
endoprosthesis target zone.

For placement of distal extension prosthesis[s] terminating in the internal

iliac, external iliac or common femoral artery[ies], see 34709, 34710,
34711, 34718.

Use 34845–34848 in conjunction with 37220–37223 only when these

procedures are performed outside the target treatment zone of the
endoprosthesis.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 47

INTRAVASCULAR INJECTION/CATHETER PLACEMENT

36000 Introduction of a needle/intracatheter vein

36002 Injection procedures for percutaneous treatment of extremity

pseudoaneurysm. (e.g., thrombin injection)

For imaging guidance, see 76942, 77002, 77012, 77021.

For ultrasound-guided compression repair of pseudoaneurysms, use

76936.

Do not report 36002 for vascular sealant of an arteriotomy site.

36005 Injection procedure for extremity venography (including introduction of

needle or intracatheter).

For radiological supervision and interpretation, see 75820 or 75822.

36010 Venous catheterization, vena cava (IVC or SVC)

(For venous catheterization for selective organ blood sampling, see

36500).

36011 Selective venous catheterization, first order vein.

36012 Selective venous catheterization, second or higher order vein.

36013 Catheterization, right heart or main pulmonary artery.

36014 Selective catheterization, left or right pulmonary artery.

36015 Selective catheterization, left or right segmental or subsegmental

pulmonary artery, each vessel.

36100 Catheterization by direct puncture, carotid or vertebral.

36140 Catheterization by direct puncture, of an extremity artery (upper or lower

extremity).

36160 Catheterization aorta, translumbar approach.

36200 Catheterization aorta, any approach but translumbar.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 48

36215 Selective arterial catheter placement, each first order thoracic or

brachiocephalic branch, within a vascular family.

36216 Selective arterial catheter placement, initial second order thoracic or

brachiocephalic branch, within a vascular family.

36217 Selective arterial catheter placement, initial third order or greater

thoracic or brachiocephalic branch, within a vascular family.

+36218 Selective arterial catheter placement, each additional second order

or third order or greater, thoracic or brachiocephalic branch, within a
vascular family.

Use 36218 in conjunction with 36216, 36217, 36225, 36226.

36245 Selective arterial catheterization placement, first order abdominal, pelvic

or lower extremity branch, within a vascular family.

36246 Selective arterial catheterization placement, initial second order

abdominal, pelvic or lower extremity branch, within a vascular family.

36247 Selective arterial catheterization placement, initial third order or greater

selective abdominal, pelvic or lower extremity branch, within a vascular
family.

+36248 Selective arterial catheterization placement, each additional second order

or third order or greater, abdominal, pelvic or lower extremity branch,
within a vascular family.

Use 36248 in conjunction with 36246, 36247.

CERVICOCEREBRAL ANGIOGRAPHY
The cervicocerebral angiography codes 36221–36228 report nonselective and
selective arterial catheter placement and diagnostic imaging of the aortic arch, carotid
and vertebral arteries. The code set is based upon a combination of location of the
catheter during the angiography and which vessel(s) were studied. Please consult the
accompanying introductory language describing the codes and reporting instructions in
the CPT® 2020 Professional Edition codebook.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 49

These codes describe arterial contrast injections with arterial, capillary and venous-
phase imaging, when performed. Accessing the vessel, placement of catheter(s),
contrast injection(s), fluoroscopy, RS&I and the closure of the arteriotomy by pressure
or by application of an arterial closure device is inherent in codes 36221–36226 and not
separately reportable. Add modifier –50 to codes 36222–36226 if the same procedure
is performed on both sides. Report add-on codes 36227, 36228 twice; do not append
modifier –50 if the same procedure is performed on both sides. Modifier –59 may be
used to indicate when different carotid and/or vertebral arteries are being studied in the
same session.

Codes 36221–36226 progress up a hierarchy in which the lesser intensive services are
included in the higher intensity code—i.e., use the code of the most intensive service
provided. For example, 36221 is reported for nonselective catheter placement, thoracic
aorta, with angiography of the aortic arch and great vessel origins. Do not report 36221
in conjunction with 36222–36226 selective codes, as these include the work of 36221
when performed.

36221 Nonselective catheter placement in the thoracic aorta (which includes

aortic arch or root), with angiography of the arch and extracranial
arteries, if performed (e.g., carotid, vertebral, and/or intracranial vessels)
unilateral or bilateral, includes associated supervision and interpretation.

Do not report 36221 with 36222–36226.

36222 Selective catheter placement in the common carotid or innominate

artery, unilateral, with angiography of the ipsilateral extracranial carotid
circulation, includes associated supervision and interpretation and
includes angiography of the cervicocerebral arch, when performed.

36223 Selective catheter placement in the common carotid or innominate

artery, unilateral, with angiography of the ipsilateral intracranial carotid
circulation, includes associated supervision and interpretation and
includes angiography of the extracranial carotid and cervicocerebral arch,
when performed.

36224 Selective catheter placement in the internal carotid artery, unilateral, with
angiography of the ipsilateral intracranial carotid circulation, includes
associated supervision and interpretation and includes angiography of
the extracranial carotid and cervicocerebral arch, when performed.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 50

Do not report the common or internal carotid or innominate artery

selective catheter placement codes 36223 or 36224 in conjunction with
the stenting codes 37215, 37216 or 37218 for the treated carotid artery.

Do not report 36222, 36223 or 36224 together for ipsilateral

angiography. Select the most comprehensive service following the
hierarchy of complexity.

36225 Selective catheter placement in the subclavian or innominate artery,

unilateral, with angiography of the ipsilateral vertebral circulation,
includes associated supervision and interpretation and, includes
angiography of the cervicocerebral arch, when performed.

36226 Selective catheter placement in the vertebral artery, unilateral, with

angiography of the ipsilateral vertebral, includes associated supervision
and interpretation and includes angiography of the cervicocerebral arch,
when performed.

Do not report 36225 with 36226 for ipsilateral angiography. Select the
most comprehensive service following the hierarchy of complexity.

+36227 Selective catheter placement in the external carotid artery, unilateral,

with angiography of the ipsilateral external carotid circulation, includes
associated supervision and interpretation.

Note that 36227 is an add-on code. This code must be reported in

conjunction with 36222, 36223 or 36224.

+36228 Selective catheter placement, each additional intracranial branch of

the internal carotid or vertebral arteries, unilateral, with angiography
of the selected vessel circulation, includes associated supervision and
interpretation.

Note that 36228 is an add-on code. This code must be reported in

conjunction with 36223, 36224, 36225 or 36226.

(Do not report 36228 more than twice per side).

Report 76376 or 76377 for 3D rendering when performed in conjunction

with 36221–36228.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 51

CPT code 76937 for ultrasound guidance for vascular access is reportable when performed
(and documentation requirements are met) in conjunction with 36221–36228.

RENAL ANGIOGRAPHY
The renal angiography codes, 36251–36254, include arterial access and catheter
placement, contrast injection(s), fluoroscopy, flush aortogram, image postprocessing,
permanent images recording, and radiological supervision and interpretation (RS&I).
Therefore, it is not appropriate to report these services separately.

36251 Unilateral selective catheter placement (first-order), main renal artery

and any accessory renal artery(ies) for renal angiography, includes
associated supervision and interpretation, includes pressure gradient
measurements when performed, and flush aortogram when performed.

36252 Bilateral selective catheter placement (first-order), main renal artery and
any accessory renal artery(ies) for renal angiography, includes associated
supervision and interpretation, includes pressure gradient measurements
when performed, and flush aortogram when performed.

36253 Unilateral superselective catheter placement (second order or higher)

renal artery branch(es) and any accessory renal artery(ies) for renal
angiography, includes associated supervision and interpretation, includes
pressure gradient measurements when performed, and flush aortogram
when performed.

Do not report 36253 with 36251 when performed for the same kidney.

36254 Bilateral superselective catheter placement (second order or higher) renal

artery branch(es) and any accessory renal artery(ies) for renal angiography,
includes associated supervision and interpretation, pressure gradient
measurements when performed, and flush aortogram when performed.

(Do not report 36254 in conjunction with 36252).

(Do not report 36251, 36252, 36253, 36254 in conjunction with

0338T–0339T).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 52

VENOUS PROCEDURES
36400 Venipuncture, necessitating physician’s skill, younger than 3 years old.

36410 Venipuncture, necessitating physician’s skill, 3 years or older.

Codes 36400 and 36410 are not to be used to report routine venipuncture.

LOWER EXTREMITY VENOUS INSUFFICIENCY TREATMENT

In recent years, there have been many additional codes added and revisions to the
existing codes in the venous insufficiency coding family. The family of codes cover the
different modalities and methods available for treating the spectrum of lower extremity
venous insufficiency.

Codes 36465, 36466 describe injection(s) of a non-compounded foam sclerosant into

an extremity truncal vein (e.g., great saphenous vein, accessory saphenous vein) using
ultrasound-guided compression of the junction of the central vein (saphenofemoral
junction or saphenopopliteal junction) to limit the dispersion of injectate. Imaging
guidance is included in these codes and may not be reported separately.

Stab phlebectomy as a means to treat varicose veins is reported with 37765, 37766.

Other ablative therapeutic procedures include thermal, mechanochemical, and adhesive

techniques. Thermal ablative techniques are divided by modality/energy used to achieve
the thermal ablation (RF ablation [36475–36476], laser ablation [36478–36479]).

Mechanochemical ablation (36473–36474) combines the use of an injected sclerosant

and disruption of the venous intima by a mechanical device. Chemical adhesive (36482,
36483) ablation includes various glue injections to create a cast that obstructs the
incompetent vein. All of these code sets consist of a primary code to report the initial
vein treated and an add-on code to report the second and subsequent veins treated,
within the same extremity. Regardless of how many veins are treated in addition to
the initial vein, the add-on codes are only reportable once per extremity treated. If
the same treatment is performed bilaterally, use modifier –50. Imaging guidance and
catheterization is included in these codes and may not be separately reported.

The CPT code for venous embolization (37241) has been proposed by some individuals
as an appropriate code for venous insufficiency. However, SIR has noted in its coding
education that 37241 is to be used for venous embolization or occlusion, excluding
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 53

lower extremity venous insufficiency. The October 2014 edition of the AMA guidance
publication, CPT Assistant, contains an excellent overview of how to code lower
extremity venous insufficiency procedure.

Codes 93970, 93971 describing extremity venous duplex imaging for the imaging
services associated with the guidance and monitoring of endovenous ablation may not
be reported. However, there may be occasions when a patient requires a diagnostic
extremity Doppler ultrasound on the same day as the endovenous ablation. In this case,
one should separately report the diagnostic study using codes 93970, 93971. CMS
requires modifier use signifying the provision of a separate and distinct service.

SCLEROTHERAPY
36468 Injection therapy (sclerosing solution), spider veins.

36470 Injection therapy (sclerosing solution), single vein (other than spider).

36471 Injection therapy (sclerosing solution), multiple veins (other than spider)
same leg.

Codes 36470 and 36471 are used to report treatment of veins larger
than spider veins but smaller than varicosities in main veins such as the
saphenous vein.

Only report 36468, 36470 and 36471 once per extremity per session,
regardless of the number of needle injections performed.

Ultrasound guidance (76942), when performed, is not included in 36468,

36470, 36471 and may be reported separately.

36465 Injection therapy (non-compounded foam sclerosant) single incompetent

extremity truncal vein (e.g., great saphenous vein, accessory saphenous
vein) includes ultrasound guidance and compression maneuvers to guide
dispersion of injectate

36466 Injection therapy (non-compounded foam sclerosant) multiple

incompetent truncal veins (e.g., great saphenous vein, accessory
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 54

saphenous vein), same leg, includes ultrasound guidance and

compression maneuvers to guide dispersion of injectate

For injection of a sclerosant into an incompetent vein without compression

maneuvers to guide dispersion of the injectate, see 36470, 36471.

ABLATION TECHNIQUES
36473 Mechanochemical, EVAT of incompetent vein extremity, percutaneous,
first vein treated.

+36474 Mechanochemical, EVAT of incompetent vein extremity, percutaneous,

subsequent vein(s) treated in a single extremity, each through separate
access sites.

(Use 36474 in conjunction with 36473).

(Do not report 36474 more than once per extremity)

Do not report 36473, 36474 in conjunction with 29520, 29530, 29540,

29550, 29580, 29581, 29584, for the same extremity.

Do not report 36473, 36474 in conjunction with 36000–36005, 36410,

36425, 36475–36479, 37241, 75894, 76000, 76937, 76942, 76998,
77022, 93970, 93971, in the same surgical field

36475 Radiofrequency, EVAT of incompetent vein, extremity, percutaneous, first

vein treated.

+36476 Radiofrequency, EVAT of incompetent vein extremity, percutaneous,

subsequent vein(s) treated in a single extremity, each through separate
access sites.

(Use 36476 in conjunction with 36475).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 55

(Do not report 36475, 36476 in conjunction with 36000–36005, 36410,

36425, 36478, 36479, 36482, 36483, 37241–37244, 75894, 76000,
76937, 76942, 76998, 77022, 93970, 93971 in the same surgical field)

(Do not report 36475, 36476 in conjunction with 29520, 29530, 29540,
29550, 29580, 29581, 29584, for the same extremity)

36478 Laser, EVAT of incompetent vein, extremity; first vein treated.

+36479 Laser, EVAT of incompetent vein extremity, percutaneous, subsequent

vein(s) treated in a single extremity, each through separate access sites.

(Use 36479 in conjunction with 36478).

(Do not report 36478, 36479 in conjunction with 29520, 29530, 29550,
29580, 29581, 29584 for the same extremity)

(Do not report 36479, 36479 with 36000, 36002, 36005, 36410, 36425,
36475, 36476, 36482, 36483, 37241, 75894, 76000, 76937, 36942,
76998, 77022, 93970, 93971 in the same surgical field).

36482 Endovenous ablation therapy of incompetent vein, extremity, by

transcatheter delivery of a chemical adhesive (e.g., cyanoacrylate)
remote from the access site, inclusive of all imaging guidance and
monitoring, percutaneous; first vein treated.

+36483 Subsequent vein(s) treated in a single extremity, each through separate

access sites (List separately in addition to code for primary procedure).

(Use 36483 in conjunction with 36482)

(Do not report 36483 more than once per extremity)

(Do not report 36482, 36483 in conjunction with 36000, 36002, 36005,
36410, 36425, 36475, 36476, 36478, 36479, 37241, 75894, 76000,
76937, 76942, 76998, 77022, 93970, 93971 in the same surgical field)

(Do not report 36482, 36483 with 29520, 29530, 29540, 29550, 29580,
29581, 29584 for the same extremity)
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 56

STAB PHLEBECTOMY
37765 Stab phlebectomy (10–20 incisions), one extremity.

37766 Stab phlebectomy (more than 20 incisions), one extremity. (Less than 10
incisions, use unlisted code 37799).

Imaging guidance is not included in codes 37765 and 37766.

ADDITIONAL VENOUS CATHETERIZATIONS

36481 Portal venous catheterization, percutaneous.

(This service only includes nonselective portal vein catheter placement.

Code additionally any selective catheter placement and other necessary
venous access).

36500 Selective venous catheterization for venous organ sampling (use once for
each organ sampled) (for RS&I/S&I, use 75893).

Do not report venous catheterization codes (36010–36012) in

combination with 36500 for site sampled.

CENTRAL VENOUS ACCESS PROCEDURES

Central venous access (CVA) devices’ entry site is either peripheral (e.g., basilic, cephalic
or saphenous vein entry site) or central (jugular, subclavian, inferior vena cava, femoral
vein) with the catheter/device tip placed into the superior/inferior vena cava, right
atrium, or subclavian, brachiocephalic innominate or iliac vein. Placement can be either
“nontunneled,” with a short tract created through which the catheter is advanced from
the skin entry site to the point of venous cannulation, or “tunneled,” which requires a
counter incision with a segment of the device placed subcutaneously. To accurately
code venous access device insertion, the site of entry, type of device, age of patient and
tunneling status must be known.

Many of the CPT codes in this section are dependent on the age of the patient (younger
than 5 years or 5 years and greater). Refer to the AMA CPT® 2020 Professional Edition
manual for the differentiation related to age when noted.
 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 57

With the exception of peripherally inserted central catheter placement, the codes in
the central venous access family are component coded; therefore, radiologic guidance
supervision and interpretation is separately reportable when performed.

CENTRAL VENOUS ACCESS PLACEMENT

When reportable, for RS&I/S&I provided in conjunction with central venous access
device insertion, replacement, or removal, see code 77001 for fluoroscopic guidance and
76937 for ultrasound guidance.

36555, 36556 Centrally inserted, nontunneled CV catheter. (See AMA CPT® 2020 and
36569 were edited in 2019 Professional Edition for differentiation related
to age).

36557, 36558 Centrally inserted, tunneled CV catheter, no port/no pump. (See AMA
CPT® 2020 Professional Edition manual for differentiation related to age).

36560, 36561 Centrally inserted, tunneled CV catheter with subcutaneous port. (See
AMA CPT® 2020 Professional Edition manual for differentiation related to
age).

36563 Centrally inserted, tunneled CV catheter with subcutaneous pump.

36565 Centrally inserted, tunneled CV catheter, requiring two catheters via two
separate access sites; no port/no pump. (e.g., Tesio type catheter).

36566 Centrally inserted, tunneled CV catheter; requiring two catheters via two
separate access sites with subcutaneous, port.

36568 Peripherally inserted, CV catheter, no port/no pump (PICC) without

imaging guidance, younger than 5 years of age

36569 Peripherally inserted, CV catheter, no port/no pump (PICC) without

imaging guidance, older than 5 years of age

Do not report 36568, 36569 with 76937, 77001

36570 Peripherally inserted central venous access device, with subcutaneous

port; younger than 5 years of age
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 58

36571 Peripherally inserted central venous access device, with subcutaneous

port; age 5 years or older

36572 Peripherally inserted, CV catheter, no port/no pump (PICC) performed

under imaging guidance, younger than 5 years of age.

36573 For placement of PICC, without subcutaneous port or pump, with

imaging guidance, age 5 years or older

CENTRAL VENOUS ACCESS REPAIR

Repair codes are used when the device is “fixed” without replacement of either the
catheter or port/pump component.

36575 Repair CV catheter, tunneled or nontunneled without subcutaneous port.

36576 Repair CV catheter, with subcutaneous port.

CENTRAL VENOUS ACCESS REPLACEMENT OR EXCHANGE

For RS&I/S&I provided in conjunction with central venous access device insertion,
replacement or removal, see code 77001.

A partial replacement code is used if only the catheter component of the device
is replaced. If the entire device is replaced through the same access site, then the
appropriate complete replacement code is reported.

36580 Complete replacement nontunneled CV catheter, without subcutaneous

port.

36581 Complete replacement tunneled CV catheter, without subcutaneous port,

through same access.

36582 Complete replacement tunneled CV catheter, with subcutaneous port,

through same access.

36583 Complete replacement tunneled CV catheter, with subcutaneous pump,

through same access.
 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 59

36584 Complete replacement peripherally inserted CV catheter, without

subcutaneous pump or port, through same access including RS&I.

(Do not report 36584 in conjunction with 76937, 77001)

(For replacement of a peripherally inserted central venous catheter

[PICC] without subcutaneous port or pump, through same venous access,
without imaging guidance, use 37799)

36585 Complete replacement peripherally inserted CV catheter, with

subcutaneous port, through same access.

36578 Partial replacement (catheter only) of CV catheter, with subcutaneous

port/pump

CENTRAL VENOUS ACCESS REMOVAL

When the entire device is removed, the appropriate removal code is reported. There is
not a code for the removal of non-tunneled devices as this work is considered inherent
to an E&M service (see discussion of E&M coding beginning on page 4 of the AMA CPT®
2020 Professional Edition). If a venous access device is removed and a new device
placed through a separate site, both the appropriate removal and placement codes are
reported.

Please see the central venous access device grid on the following page for a
comprehensive summary of the codes for central venous access device placement.

36589 Removal of tunneled CV catheter, no port/no pump.

36590 Removal of tunneled CV catheter, with port.

(For RS&I/S&I provided in conjunction with central venous access device

insertion, replacement or removal, see code 77001).

CENTRAL VENOUS ACCESS SPECIMEN COLLECTION

As indicated in the code descriptor, 36598 specifically includes fluoroscopy; image
documentation and report production are considered integral to this service.

Parenthetical text prohibits the reporting of 76000 (fluoroscopy, up to 1 hour physician

time), 36595 and 36596 (codes used to report removal of CVA device obstructive
material). Additionally, parenthetical text has been added cross-referencing the
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 60

diagnostic venography codes 75820, 75825 and 75827, which would be applicable
when a more extensive diagnostic study than that of 36598 is provided.

36591 Collection of blood specimen from a completely implantable venous

access device.

36592 Collection of blood specimen using established central or peripheral

catheter, venous, not otherwise specified.

36593 Declotting by thrombolytic agent of implanted vascular access device or

catheter.

36595 Mechanical removal pericatheter obstructive material from CVA device

(e.g., fibrin sheath stripping) via a separate venous access.

For RS&I/S&I, see 75901.

36596 Mechanical removal intraluminal obstructive material from CVA device

(e.g., catheter brushing) via the device lumen.

For RS&I/S&I, see 75902.

36597 Repositioning of CVC using fluoroscopic guidance.

For RS&I/S&I see 76000.

36598 Contrast injection(s) for radiologic evaluation of existing central venous

access device, including fluoroscopy, image documentation and report.

(Do not report 36598 in conjunction with 76000).

(Do not report 36598 in conjunction with 36595, 36596).

(For complete diagnostic studies, see 75820, 75825, 75827).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 61
CENTRAL VENOUS ACCESS DEVICE PROCEDURES
PARTIAL
DEVICE DEVICE REPLACEMENT COMPLETE
SITE TYPE AGE INSERTION REPAIR (CATH ONLY) REPLACEMENT REMOVAL

Nontunneled under 5 36555

36575 36580 99XXX **
5 and older 36556

Tunneled (no port, under 5 36557

no pump) 36575 36581 36589
5 and older 36558
Centrally Inserted

Tunneled port under 5 36560

36576 36578 36582 36590
5 and older 36561

Tunneled pump not

36563 36576 36578 36583 36590
specified

Two tunneled cath, 36575 36581 36589

not
two access sites 36565
specified (X 2)* (X 2)* (X 2)*
(no port, no pump)

Two tunneled cath, 36576 36578 36582 36590

not
two access sites 36566
specified (X 2)* (X 2)* (X 2)* (X 2)*
(port)

Nontunneled
(PICC), without
under 5 36568
image guidance
36575 36999 99XXX **
Peripherally Inserted

5 and older 36569

Nontunneled
(PICC), with image under 5 36572
guidance 36575 36584 99XXX **
5 and older 36573

Tunneled port under 5 36570

36576 36578 36585 36590
5 and older 36571
IMAGING GUIDANCE
77001 Fluoro guidance placement, partial/complete replacement or removal

76937 Ultrasound guidance vascular access

*F
 or multicatheter devices use the appropriate repair, partial replacement, complete replacement or removal code
describing the service with a frequency of two.
** Removal of a nontunneled device is considered inherent to E&M, report appropriate level of E&M provided.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 62

PORTAL DECOMPRESSION PROCEDURES

Codes 37182 and 37183 describe all the work involved with shunt creation or revision
including all imaging guidance, venous access, portal vein catheterization (shunt
recanalization), hemodynamic evaluation, tract preparation, angioplasty and stent
placement. However, if variceal embolization is performed in conjunction with TIPS
or TIPS revision, this service is separately reportable. Catheterization of the varix (via
the TIPS) is reported using selective venous catheterization codes (36011–36012) and
transcatheter embolization is reported using code 37241 or 37244, depending on the
indication for the embolization.

Unlike many other surgical procedures, TIPS insertion and revision procedures as
described by codes 37182/37183, respectively, have 0-day global periods and, therefore,
do not include pre- or postprocedural E&M work. E&M work performed outside of the
1-day global period is separately reported (see E&M section).

37182 Insert hepatic shunt (TIPS).

37183 Revision previously placed hepatic shunt (TIPS).

TRANSCATHETER THERAPY AND BIOPSY

Catheterization and RS&I/S&I are reported in addition to the codes for transcatheter
therapy and biopsy procedures unless the code descriptor specifically indicates that
these services are included. These services do not include any preceding diagnostic
radiological supervision and interpretation (RS&I/S&I) studies, catheter placement or
RS&I/S&I services provided in conjunction with the therapeutic procedure unless the
code descriptor specifically indicates that these services are included.

The corresponding transcatheter therapy and biopsy RS&I/S&I codes include:

• Contrast injections, angiography/venography and fluoroscopic guidance

• Vessel measurement

• Roadmapping

• Completion angiography/venography (except in those circumstances when code

75898 is applicable)

• Diagnostic angiography that is performed to confirm known pathology

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 63

MECHANICAL THROMBECTOMY
Five codes (37184, 37185, 37186 for arterial and 37187, 37188 for venous) were
established to report mechanical thrombectomy in peripheral vessels. These codes are
not to be used for coronary or intracranial vessel. (For coronary arterial mechanical
thrombectomy, see code 92973 and for intracranial, see code 61645.) They can be used
in both native vessels or bypass grafts. Code(s) for catheter placement(s), diagnostic
studies and other percutaneous interventions (e.g., transluminal balloon angioplasty,
stent placement) provided are separately reportable. However, there are no separate
RS&I codes to report imaging services provided in conjunction with mechanical
thrombectomy.

Arteriography and/or venography related to guidance and monitoring of the mechanical

thrombectomy and the same session completion study(ies) for this service are included
in codes 37184–37188. However, diagnostic arteriography or venography provided to
diagnose a problem before therapy is begun is separately reportable. Also included and
not separately reported are any intraoperative injection(s) of thrombolytic. However,
subsequent or prior continuous infusion of thrombolysis is not an included service and is
separately reportable using codes 37211–37214.

PRIMARY VS. SECONDARY ARTERIAL MECHANICAL THROMBECTOMY

The arterial mechanical thrombectomy codes differentiate between primary and
secondary mechanical thrombectomy. The differentiation between primary and
secondary mechanical thrombectomy is not dependent on whether mechanical
thrombectomy is the only percutaneous procedure provided.

Both primary and secondary mechanical thrombectomy can be provided in conjunction

with other percutaneous interventions. Primary arterial mechanical thrombectomy is
defined by the planned intent to provide the service.

Most commonly, primary mechanical thrombectomy will precede another percutaneous

intervention, with the decision regarding the need for other services not made until after
mechanical thrombectomy has been performed. PTA and/or stenting or thrombolytic
infusion services may follow the performance of primary mechanical thrombectomy.

Mechanical thrombectomy is considered primary, as the need for these other services
was not known prior to the mechanical thrombectomy. Occasionally, the performance of
primary mechanical thrombectomy may follow another percutaneous intervention.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 64

Performance of mechanical thrombectomy after a course of thrombolytic infusion

therapy is the most common example of primary mechanical thrombectomy following
another percutaneous intervention.

Secondary arterial mechanical thrombectomy, also commonly referred to as rescue

mechanical thrombectomy, is always performed in conjunction with another
percutaneous intervention (e.g., percutaneous transluminal balloon angioplasty, stent
placement). These circumstances include those in which a small amount of clot is
present in the lesion and needs to be removed prior to PTA/stent or thrombus/embolus
has complicated a PTA/stent procedure, requiring removal of the thrombus/embolus
to complete the procedure. For secondary mechanical thrombectomy, pretreatment
planning, performance of the procedure and postprocedure evaluation are not focused
on removal of the clot. Secondary arterial mechanical thrombectomy is reported using
add-on code 37186 and is not reportable at the same session as the primary mechanical
thrombectomy codes (37184, 37185).

ARTERIAL MECHANICAL THROMBECTOMY

37184 Primary percutaneous transluminal arterial mechanical thrombectomy,
initial vessel.

+37185 Primary percutaneous transluminal arterial mechanical thrombectomy,

second and all subsequent arteries within the same vascular family.

Code 37185 should be used in conjunction with 37184.

Do not report 37184 or 37185 in conjunction with 61645, 76000 or

96374.

+37186 Secondary percutaneous transluminal arterial thrombectomy provided in

conjunction with another percutaneous intervention other than primary
mechanical thrombectomy.

Do not code 37186 with 37184 or 37185.

VENOUS MECHANICAL THROMBECTOMY

As the use of venous mechanical thrombectomy was found to not be quite as variable
as that of arterial mechanical thrombectomy, determination was made that two codes
could effectively capture these services. Venous mechanical thrombectomy may be
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 65

the only intervention in the treatment of venous thrombus or it may be provided in

conjunction with thrombolytic infusion therapy; code 37187 may be used to report
venous mechanical thrombectomy either by itself or in conjunction with other
percutaneous interventions.

Occasionally, it is necessary to repeat venous mechanical thrombectomy during a course

of thrombolytic therapy. For example, mechanical thrombectomy may initially be used
to debulk venous thrombus, followed by pharmacological thrombolysis (separately
reportable using code procedural 37212–37214) and, if the thrombus is particularly
resistant, it may be necessary to repeat venous mechanical thrombectomy. Code 37188
is used to report repeat venous mechanical thrombectomy on a subsequent day of
treatment during a course of pharmacological thrombolysis.

37187 Percutaneous transluminal venous mechanical thrombectomy.

37188 Percutaneous transluminal venous mechanical thrombectomy, repeat

treatment on subsequent day during course of thrombolytic therapy.

Do not report 37187 or 37188 in conjunction with 76000, 96375.

Code 37188 is also reportable in conjunction with other percutaneous

interventions.

VENA CAVA FILTER

Three codes (37191–37193) were established to describe procedures for placement,
repositioning and retrieval of vena cava filters. These codes include all imaging guidance
(ultrasound and fluoroscopic) necessary to place the filter. This includes guidance for
vessel access, vessel selection and all intraprocedural imaging, including intravascular
ultrasound if performed; do not report codes 37252–37253 in conjunction with 37191–
39193.

37191 Insertion of intravascular vena cava filter, via an endovascular approach.

37192 Repositioning of intravascular vena cava filter, endovascular approach.

(Do not report 37192 in conjunction with 37191).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 66

37193 Retrieval (removal) of intravascular vena cava filter, endovascular

approach.

(Do not report 37193 in conjunction with 37197).

IV INFUSION FOR INTRACRANIAL THROMBOLYSIS

This code (37195) is to be used when a thrombolytic agent is infused through a
(peripheral) intravenous catheter for the purposes of resolving cerebral clot. For
intracranial thrombolysis via transcatheter approach, see codes 61645, 61650–61651.

37195 Thrombolysis, cerebral, by intravenous infusion.

FOREIGN BODY RETRIEVAL

37197 Percutaneous transcatheter foreign body retrieval, includes all imaging
guidance (ultrasound, intravascular ultrasound or fluoroscopy).

For removal of IVC filter, see code 37193.

TRANSCATHETER BIOPSY
Code(s) for catheter placement(s), diagnostic studies and other percutaneous
interventions (e.g., transluminal balloon angioplasty, stent placement) provided are
separately reportable in addition to transcatheter biopsy.

37200 Transcatheter biopsy.

For RS&I/S&I, see 75970.

TRANSCATHETER THROMBOLYTIC INFUSION THERAPY

Four codes were established to report arterial and venous transcatheter thrombolytic
infusion therapy. These codes cover the entire therapeutic period of time. Critical
guidance on these codes can be found on page 283 in the CPT® 2020 Professional
Edition codebook.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 67

Codes 61645–61651 have been established to represent intracranial arterial

thrombectomy and/or transcatheter infusion therapies. Do not use 37211–37214 to
report thrombolytic therapy of the intracranial or coronary vasculature.

Codes 37211 and 37212 are used to report the entire initial (calendar) day of
transcatheter thrombolytic infusion. This includes follow-up arteriography/venography
and catheter position change or exchange, when performed. Consequently, if initiation
and completion therapy occur on the same calendar day, only the initial code (37211 or
37212) is reportable.

Code(s) for catheter placement(s), diagnostic studies and other percutaneous

interventions (e.g., transluminal balloon angioplasty, stent placement) provided are
separately reportable in addition to thrombolytic therapy.

Codes 37211–37214 include fluoroscopic guidance and associated RS&I. Ultrasound

guidance for vascular access (see code 76937) may be reported separately when all
required elements are performed. Do not report 75898 in conjunction with 37211–37214.

Establishment of bilateral thrombolytic infusion through separate access site(s) may be

reported with modifier –50 in conjunction with codes 37211, 37212.

37211 Transcatheter thrombolytic infusion therapy, arterial, initial treatment

day.

37212 Transcatheter thrombolytic infusion therapy, venous; initial treatment

day.

37213 Transcatheter thrombolytic infusion therapy, arterial or venous infusion,

continued treatment on subsequent day.

Includes all follow-up catheter contrast injections, catheter position

change or exchange, when performed.

37214 Final day transcatheter thrombolytic infusion therapy. Code 37214

includes all final contract injections, removal of catheter and vessel
closure by any method.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 68

CAROTID STENT PLACEMENT

Carotid stent placement is coded with one of four CPT codes. The codes are based
on whether the stent is placed in the cervical carotid artery (37215–37216) or the
intrathoracic carotid artery (37217–37218).

Carotid stent placement codes include the following services for the vessel being treated:

• Ipsilateral selective carotid catheterization

• All diagnostic and roadmapping angiography (including arch angiogram, if

necessary to repeat, and intracranial views)

• All angioplasties within the stent target zone

• Preparation and deployment of the stent

A physician may elect to perform and may separately report diagnostic cerebral
angiography for the contralateral vessel not being stented at the same session as carotid
stent placement if these services have not been previously provided. Therefore, even
if the physician performs bilateral cerebral and cervical diagnostic studies at the time
of carotid stent placement, he or she may only report 36222–59 or 36223–59 for the
contralateral study.

Vascular coding conventions dictate that nonselective catheter placement is always

included in the service of selective catheter placement when performed from the
same access site. Since the carotid stent codes include the work of selective catheter
placement into the vessel being stented, providers may not additionally report
nonselective catheter placement, unless two separate catheters are introduced into
two separate arteries and/or the provider performs the nonselective and selective
catheterizations at two separate patient encounters on the same date of service.

If diagnostic cerebral angiography was completed at a prior setting and the subsequent
stent deployment is undertaken within an adequately short time (with no change in the
patient’s clinical status occurring in the interim that would mandate a repeat diagnostic
study), these repeat diagnostic services are not reportable.

If distal protection with carotid stenting is attempted but placement of the distal
protection device is found not to be possible and carotid stenting is subsequently
performed without distal protection, then code 37216 is reported.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 69

37215 Transcatheter placement of cervical carotid artery stent with distal

embolic protection, via an open or percutaneous approach.

37216 Transcatheter placement of cervical carotid artery stent without distal

embolic protection, via an open or percutaneous approach. 37215 and
37216 include all ipsilateral selective catheterization, all diagnostic
imaging for ipsilateral, cervical and cerebral carotid angiography, and
angioplasty of the target lesion. Following diagnostic angiography,
if carotid stenting is not indicated, then the appropriate codes for
cervicocerebral angiography codes (36221–36224) should be reported in
lieu of 37215 and 37216.

37217 Transcatheter placement of an intrathoracic common carotid artery or

innominate artery stent by retrograde treatment, via open ipsilateral
cervical carotid artery exposure.

37217 includes open vessel exposure, as well as standard closure of the

vessel. All access, ipsilateral selective catheterization, diagnostic imaging
for ipsilateral, cervical and cerebral carotid angiography, and angioplasty
of the target lesion.

37218 Transcatheter placement of an intrathoracic common carotid artery

or innominate artery stent by antegrade treatment, via percutaneous
approach or open exposure.

Code 37218 includes all ipsilateral selective innominate and carotid

catheterization, all diagnostic imaging for ipsilateral extracranial
intrathoracic innominate and/or carotid artery stenting, and angioplasty
of the target lesion. Following diagnostic angiography, if carotid
stenting is not indicated, then the appropriate codes for cervicocerebral
angiography codes (36221–36224) should be reported in lieu of 37218.

(For open or percutaneous transcatheter placement of extracranial

vertebral artery stent[s], see 0075T, 0076T).

(For transcatheter placement of intracranial stent[s], use 61635).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 70

LOWER EXTREMITY ENDOVASCULAR ARTERIAL

REVASCULARIZATION
There are 16 codes that describe transcatheter therapies (via an open or percutaneous
approach) for lower extremity revascularization performed for treatment of occlusive
disease. The AMA CPT Professional Edition guidelines for these services are extensive,
and SIR recommends reading this language carefully.

These codes take into account the fact that multiple techniques may be needed to open
areas of disease in some vessels and that these interventions may take place in different
vascular territories. In general, the codes for interventions progress up a hierarchy of
intensity with the work of the less-intense intervention included in the higher intensity
code. For example, angioplasty prior to a stent placement would be a progression up
this hierarchy and only the stent code would be reported. Each of these codes includes
the work of accessing the artery, selecting the vessel, crossing the lesion, interpreting
the images, performing therapeutic intervention(s) in the entire vessel segment, using
any embolic protection device, performing final image interpretation and closing the
arteriotomy by any method. If angioplasty is performed in addition to facilitate a more
advanced procedure, such as atherectomy, or stenting, it is included in the code for
the more advanced procedure. Mechanical thrombectomy and thrombolysis are not
included in the work of codes 37220–37235 and can be reported additionally with the
appropriate component codes when these techniques are used in combination with
PTA/stenting/atherectomy to restore flow to areas of occlusive disease. The codes apply
to the procedure if performed percutaneously or openly.

Revascularization procedures are grouped into three vascular territories based on the
anatomy and are specific to the procedures of angioplasty, stenting or atherectomy.
PTA is considered an inherent part of stenting or atherectomy procedures and is not
separately reportable. Each code applies to a single extremity.

1. Iliac territory: subdivided into common, internal and external iliac artery

a. 37220–37223.

b. Single code used for a single vessel.

c. Add-on codes used for additional iliac vessels that are treated (common,
internal or external).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 71

2. Femoral/popliteal territory: this entire territory is considered a single vessel

a. 37224–37227.

b. Includes the common, deep and superficial femoral as well as popliteal.

c. Since it is a single vessel, only a single code may be reported, even if multiple
lesions are treated.

d. If two procedures are performed in different areas of the vessel territory,

report the code that includes all therapies provided in that region.

3. Tibial/peroneal territory: subdivided into anterior tibial, posterior tibial and

peroneal

a. 37228–37235.

b. Report the initial vessel treated as the primary code for the highest level of
service provided within the tibial-peroneal territory with add-on codes for
additional vessels treated (not additional lesions or procedures in the same
vessel).

c. The tibioperoneal trunk is not considered a separate vessel.

If a lesion extends across the margin of a territory, but is opened with a single therapy,
report with only a single code. For example, if a distal popliteal artery stenosis extends
into the tibioperoneal trunk and the lesion is treated with a single angioplasty spanning
both lesions, only code a single vessel treatment.

If both legs are treated at the same time with different interventions, use modifier
–59 to indicate separate and distinct services performed on the same day. If the same
treatment/intervention is performed bilaterally in the same territory, use modifier –50.

When treating multiple vessels within a territory, report each additional vessel using
an add-on code, as applicable. Select the base code that represents the most complex
service using the following hierarchy of complexity (in descending order of complexity):
atherectomy and stent > atherectomy > stent > angioplasty. When treating multiple
lesions within the same vessel, report one service that reflects the combined procedures,
whether done on one lesion or different lesions, using the same hierarchy.

A “+” sign indicates an add-on code that must be used after the appropriate code for
the initial vessel treated.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 72

An editorial change was made to the lower extremity revascularization codes and
to the arterial stent codes as they pertain to lower extremity procedures. The lower
extremity revascularization code set (37220–37235) is now specifically to be used for
treatment of occlusive disease. For stenting of nonocclusive disease (e.g., aneurysm,
pseudoaneurysm, rupture/extravasation, vascular malformation or fistula) in the infra-
inguinal arteries, 37236–37237 should be used.

An additional editorial change was made to clarify that codes 37220–37223 should
be reported in conjunction with codes 34701–34711, 34718, 34845–34848, only when
iliac angioplasty or stenting is performed outside the target treatment zone of the
endoprosthesis, for the indication of occlusive disease. Category III code 0254T has been
converted to Category 1 codes 34717 and 34718, and has been deleted. Please review
the AMA CPT Professional Edition guidelines.

ILIAC ARTERY REVASCULARIZATION

37220 Initial iliac artery revascularization, transluminal angioplasty.

37221 Initial iliac artery revascularization, transluminal stent(s) placement with

or without angioplasty. (Report 37220, 37221 with 34701–34711, 34718,
34845–34848 only when 37220 or 37221 are performed outside the
treatment zone of the endograft)

+37222 Each additional ipsilateral iliac artery revascularization, transluminal

angioplasty.

(37222 is used in conjunction with 37220, 37221 for additional ipsilateral

iliac segment PTA).

+37223 Each additional ipsilateral iliac artery revascularization, transluminal stent

placement(s), with or without angioplasty.

(37223 is used in conjunction with 37221 for additional iliac segment

stent placement).

(Report 37222, 37223 with 34701–34711, 34718, 34845–34848 only

when 37222 or 37223 are performed outside the treatment zone of the
endograft)

For atherectomy of iliac artery, see codes 0238T.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 73

FEMORAL/POPLITEAL ARTERY REVASCULARIZATION

37224 Femoral, popliteal artery(ies) revascularization, transluminal angioplasty.

37225 Femoral, popliteal artery(ies) revascularization, atherectomy, with or

without angioplasty.

37226 Femoral and/or popliteal artery(ies) revascularization, transluminal stent

placement(s), with or without angioplasty.

37227 Femoral, popliteal artery(ies) revascularization, transluminal stent

placement(s) and atherectomy, with or without angioplasty.

TIBIAL/PERONEAL ARTERY REVASCULARIZATION

37228 Initial tibial/peroneal artery revascularization, transluminal angioplasty.

37229 Initial tibial/peroneal artery revascularization, atherectomy, with or

without angioplasty.

37230 Initial tibial/peroneal artery revascularization, transluminal stent

placement(s), with or without angioplasty.

37231 Initial tibial/peroneal artery revascularization, transluminal stent

placement(s) and atherectomy, with or without angioplasty.

+37232 Each additional ipsilateral tibial/peroneal artery revascularization,

transluminal angioplasty.

(37232 is used in conjunction with 37228–37231).

+37233 Each additional ipsilateral tibial/peroneal artery revascularization,

atherectomy, with or without angioplasty.

(37233 is used in conjunction with 37229, 37231).

+37234 Each additional ipsilateral tibial/peroneal artery revascularization,

transluminal stent placement(s), with or without angioplasty.

(37243 is used in conjunction with 37229–37231).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 74

+37235 Each additional ipsilateral tibial/peroneal artery revascularization,

transluminal stent placement(s) and atherectomy, with or without
angioplasty.

(37235 is used in conjunction with 37231).

TRANSCATHETER STENT PROCEDURES

CPT codes 37236–37239 are used to report transcatheter placement of an intravascular
stent(s), via percutaneous approach or open exposure, which include the RS&I and
angioplasty within the same vessel when performed. Multiple stents placed in a single
vessel may only be reported once. If code exits for stent placement in a more specific
vessel, use that code (e.g., lower extremity for revascularization, carotid artery,
extracranial vertebral, intracranial).

Codes 37236, 37237 are used to report stent insertion in an artery. These codes have
been editorially revised to exclude lower extremity artery(ies) for occlusive disease.
These codes also exclude cervical or intrathoracic carotid artery, extracranial vertebral
or intracranial arteries, and coronary arteries. There are dedicated CPT codes for these
vascular beds and the most specific CPT code should be used.

An editorial change in CPT now directs that codes 37236–37237 be used for stent
treatment of infrainguinal arterial nonocclusive disease. If both occlusive and
nonocclusive disease are treated in the same vessel, report the code for the dominant
pathology being treated.

Codes 37238, 37239 are used to report stent insertion in a vein.

Balloon angioplasty(ies), including failed angioplasty, pre-/postdilation following stent

placement, treatment of a lesion outside the stented segment in the same vessel,
arteriotomy closure by any means and imaging on completion of the treatment are
included in this family of codes. Angioplasty performed in a separate vessel may be
reported separately.

A stent code is reported when placed for the management of an aneurysm,

pseudoaneurysm or vascular extravasation.

Stents placed with the purpose of providing a latticework to assist in the embolization of
an aneurysm are included in the embolization code and are not separately reportable.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 75

Nonselective and/or selective catheterization is not included in these codes and may be
separately reported.

Intravascular ultrasound may be reported separately (see codes 37252, 37253).

37236 Initial artery, transcatheter placement of an intravascular stent(s) with or

without angioplasty within the same vessel.

+37237 Each additional artery transcatheter placement of an intravascular

stent(s) with or without angioplasty within the same vessel. For
placement of cervical carotid artery stent(s), see 37215, 37216.

For placement of extracranial vertebral artery stent see Category III

codes 0075T, 0076T.

For placement of intrathoracic common carotid/innominate artery

stent(s), see 37217, 37218.

For placement(s) in iliac, femoral, popliteal or tibial/peroneal artery(ies)

stents(s) for occlusive disease, see 37221, 37223, 37226, 37227, 37230,
37231, 37234, 37235.

For placement of intracranial stent(s), see 61635.

For visceral arteries stent(s) in conjunction with fenestrated endovascular

repair, see 34841–34848.

37238 Initial vein, transcatheter placement of an intravascular stent(s) with or

without angioplasty within the same vessel.

+37239 Each additional vein transcatheter placement of an intravascular

stent(s) with or without angioplasty within the same vessel. For stent
placement within a dialysis circuit see codes 36903, 36906. Use 36908
for transcatheter placement of intravascular stent(s), central dialysis
segment.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 76

VASCULAR EMBOLIZATION AND OCCLUSION

PROCEDURES
Codes 37241–37244 were established to describe non–central nervous system, non–
head and neck vascular and non–dialysis circuit embolization and occlusion procedures.

This family of CPT codes bundles together the surgical and radiological portions of
the procedures. The vascular embolization and occlusion CPT codes bundle together
the previous transcatheter embolization surgical code (37204) with the RS&I codes
for embolization (75894) and postembolization follow-up angiography (75898). As a
result, CPT code 37204 was deleted. In 2014, code 37210 (previously used to report
non-emergent uterine artery embolization) was also deleted; this service is now being
reported with one of the embolization codes.

The embolization codes, 37241–37244, include all RS&I, intraprocedural guidance and
roadmapping, and imaging necessary to document procedure completion. However,
selective catheterizations needed to perform an embolization should be reported
separately.

Please note that the embolization code may only be reported once per surgical field,
regardless of the number of vessels embolized on that surgical field. A surgical field is
the area immediately surrounding and directly involved in a treatment/procedure. In
embolization, different organs typically represent different surgical fields. In some cases,
the same organ may consist of more than one surgical field, such as the lungs, where the
right and left lung are separate surgical fields.

Embolization procedures involving the central nervous system or the head or neck
are reported using codes 61624, 61626 or 61710 with any associated RS&I still
reported using code 75894 (RS&I for embolization) and 75898 (RS&I for completion
angiography).

Embolization or occlusion for branch vessels of a dialysis circuit should be used with
code 36909.

Embolization or occlusion of the ureter is reportable with code 50705.

37241 Vascular embolization or occlusion, venous, other than hemorrhage

(e.g., congenital or acquired venous malformations, venous and capillary
hemangiomas, varices, varicoceles).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 77

37242 Vascular embolization or occlusion, arterial, other than hemorrhage or

tumor (e.g., congenital or acquired arterial malformations, arteriovenous
malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms).

37243 Vascular embolization or occlusion, for tumors, organ ischemia or

infarction.

37244 Vascular embolization or occlusion, for arterial or venous hemorrhage or

lymphatic extravasation.

TRANSLUMINAL ANGIOPLASTY
CPT codes 37246–37249 are used to report transluminal balloon angioplasty, via
percutaneous approach or open exposure, which include the RS&I. Codes 37246 and
37247 are used to report angioplasty within an artery, when performed outside of
the central nervous system, coronary, pulmonary and lower extremities for occlusive
disease. There are dedicated CPT codes for these vascular beds and the most specific

CPT code should be used. Codes 37248 and 37249 are used to report angioplasty within
a vein, when performed outside of a dialysis circuit.

Multiple angioplasties performed in the same vessel or within the same lesion should
only be reported once.

When a separate and distinct lesion in a separate vessel is treated, the add-on codes
37247 or 37249 (respective of vascular bed) should be used. Do not report 37246–
37249 in combination with 37236–37239 when angioplasty and stenting are performed
in the same vessel and lesion in the same setting.

Nonselective and/or selective catheterization is not included in these codes and may be
separately reported.

Intravascular ultrasound may be reported separately (see codes 37252, 37253).

37246 Initial artery, transluminal balloon angioplasty, open or percutaneous,

within the same artery.

+37247 Each additional artery, transluminal balloon angioplasty. (List separately

in addition to code for primary procedure).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 78

37248 Initial vein, transluminal balloon angioplasty, open or percutaneous,

within the same vein.

+37249 Each additional vein, transluminal balloon angioplasty. (List separately

in addition to code for primary procedure). To report percutaneous
transluminal angioplasty in an artery, report codes 37246, 37247 except
in the central nervous system (61630, 61635), coronary (92920–92944),
pulmonary (92997, 92998) and lower extremities for occlusive disease
(37220–37235).

To report percutaneous transluminal angioplasty in a vein, report codes 37248, 37249

except in the dialysis circuit (36902, 36905, 36907) when approached through the
ipsilateral dialysis access.

INTRAVASCULAR ULTRASOUND
37252 and 37253 should be reported in addition to the therapeutic intervention (e.g.,
stent or stent graft placement, angioplasty, atherectomy, embolization, thrombolysis,
transcatheter biopsy), during which the intravascular ultrasound is performed.

Continuous lesions count as one vessel and should be reported with one code, even
if imaging of more than one vessel is performed. For example, if a lesion bridges into
two or more vessels, it would still be counted as one vessel, and therefore, it would be
reported with code 37252. If there are two separate vessels and each has a lesion that is
not continuous, then the add-on code 37253 should be used.

These IVUS codes are to be used for noncoronary vasculature.

+37252 Initial vessel, intravascular ultrasound.

+37253 Each additional vessel, intravascular ultrasound.

Use 37253 in conjunction with 37252.

HEMIC AND LYMPHATIC SYSTEMS

38200 Injection for splenoportogram.

For RS&I/S&I, see 75810.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 79

38220 Bone marrow collection by aspiration(s) only, for diagnostic purposes.

38221 Bone marrow biopsy(ies), by needle or trocar, for diagnostic purposes.

38222 Bone marrow biopsy(ies) and aspiration(s), for diagnostic purposes. Do

not report 38220 with 38221 in the same setting.

Imaging guidance is not included in bone marrow aspiration and biopsy codes. Report
the appropriate imaging guidance modality code if performed.

38505 Needle biopsy of superficial lymph node(s).

(See code 49180 for percutaneous biopsy of retroperitoneal lymph

nodes).

(See codes 10004–10012, 10021 for fine needle aspiration).

38790 Injection for lymphangiography (single extremity).

For RS&I/S&I, see 75801–75807.

38792 Injection for identification of sentinel node.

38794 Thoracic duct cannulation.

LIVER/BILIARY PROCEDURES
LIVER BIOPSY
47000 Percutaneous needle biopsy of liver.

+47001 Percutaneous needle liver biopsy, done at time of other procedure.

For RS&I, see 77002, 77012, 76942, 77021.

LIVER ABLATION
The following ablation codes do not include radiologic supervision and interpretation.
Therefore, imaging guidance is separately reportable with the following codes. Ablation
can be performed via an open approach with using intra-operative ultrasound guidance
or via a percutaneous approach using CT, MRI, fluoro or ultrasound guidance.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 80

47380 Open radiofrequency ablation, liver tumor(s).

(For imaging guidance, use 76940, US guidance for tissue ablation).

47381 Open cryosurgical ablation, liver tumor(s).

(For imaging guidance, use 76940, US guidance for tissue ablation).

47382 Percutaneous radiofrequency ablation, liver tumor(s).

(For imaging guidance, see 77013, 77022, 76940).

47383 Percutaneous cryoablation, liver tumor(s).

(For imaging guidance, see 77013, 77022, 76940).

PERCUTANEOUS BILIARY PROCEDURES

A comprehensive code set (47531–47544) was established to describe all image-guided
percutaneous biliary procedures. This code set differentiates image-guided procedures
from endoscopic procedures. These codes are intended to provide greater clarity and
granularity for coding percutaneous, image-guided biliary diagnostic and therapeutic
interventions. Please consult the accompanying introductory language describing
the codes and reporting instructions in the CPT® 2020 Professional Edition codebook.
These codes include diagnostic cholangiography, if performed, as well as all associated
imaging guidance (ultrasonography and/or fluoroscopic) and RS&I. Therefore, do not
report 47531 or 47532 with codes 47490, 47533–47541. Additionally, when a new
biliary drain catheter is placed, the codes include all elements of access into the biliary
tree.

These codes describe the placement, replacement and removal of external biliary
catheters (externally accessible drainage catheter placed in bile duct, that does not
terminate in the bowel) and internal-external catheters (externally accessible drainage
catheter that terminates in the bowel). The term “stent,” as used in this code set
describes a percutaneously placed device (e.g., metallic stent or plastic tube) that is
positioned completely internally within the biliary tree.

See page 340 in the CPT® 2020 Professional Edition codebook for introductory
guidelines.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 81

47490 Image-guided percutaneous cholecystostomy catheter placement.

47531 Injection cholangiography, through an existing access (e.g., via biliary

drainage catheter or cholecystostomy tube).

47532 Injection cholangiography, through a new access (e.g., percutaneous

transhepatic cholangiogram), includes all associated imaging.

Do not report 47531, 47532 in conjunction with 47490, 47533–47541 for

procedures performed through the same percutaneous access.

For intraoperative cholangiography, see 74300, 74301.

47533 Placement of external biliary drainage catheter, includes cholangiography

and all associated imaging.

47534 Placement of internal-external biliary drainage catheter, includes

cholangiography and all associated imaging.

47535 Conversion of external biliary drainage catheter to internal-external

biliary drainage catheter, includes cholangiography and all associate
imaging.

47536 Exchange of biliary drainage catheter (e.g., external, internal–

external or conversion of internal–external to external only), includes
cholangiography and all associated imaging.

Code 47536 may be reported for exchange of each biliary drainage

catheter, if more than one is present. Use modifier –59 for each additional
exchange.

47537 Removal of biliary drainage catheter, requiring fluoroscopic guidance

(e.g., with concurrent indwelling biliary stents); includes cholangiography.

Do not report 47537 in conjunction with 47538 for the same access.

For removal of biliary drainage catheter not requiring fluoroscopic

guidance, see E&M services.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 82

47538 Placement of stent(s) into a bile duct, via an existing access, each stent;
includes diagnostic cholangiography, all associated imaging guidance,
balloon dilation, catheter exchange(s) and catheter removal(s) when
performed.

Do not report 47538 in conjunction with 47536, 47537 for the same
percutaneous access.

47539 Placement of stent(s) into a bile duct, via a new access, each stent;
without placement of separate biliary drainage catheter. Includes
diagnostic cholangiography, all associated imaging guidance and balloon
dilation.

47540 Placement of stent(s) into a bile duct, via a new access, each stent; with
placement of separate biliary drainage catheter. Includes diagnostic
cholangiography, all associated imaging guidance and balloon dilation.

Do not repot 47538, 47539, 47540 in conjunction with 43277, 47542,

47555, 47556 for the same lesion in the same session.

Codes 47538–47540 should be reported once per session for stent(s) placed in a single
bile duct. It would be allowable to report these codes (47538–47540) more than once
per session for the following circumstances: 1) side-by-side stents within a single duct,
2) placement of stents in separate bile ducts, or 3) placement of stents through two or
more access sites. Do not report 47540 in conjunction with 47533, 47534 for the same
percutaneous access.

47541 Placement of access through the biliary tree and into small bowel to
assist with an endoscopic biliary procedure (e.g., rendezvous procedure)
via a new access; includes cholangiography and all associate imaging.

Do not report 47541 in conjunction with 47531, 47532, 47533, 47534,

47535, 47536, 47537, 47538, 47539, 47540.

Do not report 47541 when there is existing catheter access.

For use of existing access through the biliary tree into small bowel to
assist with an endoscopic biliary procedure, see 47535, 47536, 47537.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 83

+47542 Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty),

percutaneous, includes all associate imaging.

Use 47542 in conjunction with 47531, 47532, 47533, 47534, 47535,

47536, 47537, 47541.

Do not report 47542 in conjunction with 43262, 43277, 47538, 47539,

47540, 47555, 47556.

Do not report 47542 in conjunction with 47544, if a balloon is used for

removal of calculi, debris and/or sludge rather than for dilation.

For percutaneous balloon dilation of multiple ducts during the same

session, report an additional dilation once with 47542 and modifier –59,
regardless of the number of additional ducts dilated.

+47543 Endoluminal biopsy(ies) of biliary tree, by any method(s) (e.g., brush,

forceps and/or needle), includes all associate imaging.

Use 47543 in conjunction with 47531, 47532, 47533, 47534, 47535,

47536, 47537, 47538, 47539, 47540.

Report 47543 once per session.

For endoscopic brushings, see 43260, 47552. For endoscopic biopsy, see
43261, 47553.

+47544 Removal of calculi/debris from biliary duct(s) and/or gallbladder,

percutaneous, including destruction of calculi by any method (e.g.,
mechanical, electrohydraulic, lithotripsy), includes all associate imaging.

Use 47544 in conjunction with 47531, 47532, 47533, 47534, 47535,

47536, 47537, 47538, 47539, 47540.

Do not report 47544 if no calculi or debris are found, even if removal

device is deployed.

Do not report 47544 in conjunction with 43264, 47554.

Do not report 47544 in conjunction with 47531–47543 for removal of

incidental sludge and/or debris.

For endoscopic removal of calculi, see 43264, 47554. For endoscopic

destruction of calculi, use 43265.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 84

47553 Biliary endoscopy, with biopsy, single or multiple.

47554 Biliary endoscopy, through skin with stone removal.

47555 Biliary endoscopy, with dilation, no stent (Dilation without stent,

percutaneous).

For RS&I, see 74363.

47556 Biliary endoscopy, with dilation and stent (Dilation with stent,
percutaneous; see also 47801).

For RS&I, see 74363.

47801 Placement of bile duct stent (e.g., endoprosthesis) (see also code
47556).

SCLEROTHERAPY OF FLUID COLLECTION

CPT code 49185 was developed to describe sclerotherapy of fluid collections, such as
lymphoceles, cysts or seromas. This code includes contrast injections, if performed. Code
49185 should be reported once per day for each collection treated through a separate
catheter. Codes for access to and placement of drainage catheters into the collection
may be separately reportable. (See codes 10030, 10160, 49405–49407, 50390 for
catheter placement.) This code is intended for nonvascular collections and should not be
used for sclerosing of incompetent extremity veins, vascular or lymphatic malformations.

49185 Sclerotherapy of a percutaneous fluid collection.

Do not report 49424 or 76080 in combination with 49185.

DRAINAGE OF ABSCESS
To report image-guided catheter drainage of fluid collections/abscess, four bundled
codes are used—10030, 49405, 49406 and 49407. These codes bundle the surgical and
radiological portions of the procedure into single codes. These codes include the work
of placement of a drainage catheter within the collection, including all imaging guidance
(e.g., ultrasonography, fluoroscopic and/or CT). Therefore, do not report 10030, 49405–
49407 with S&I codes 75989, 76942, 77002, 77003, 77012 or 77021.
 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 85

It is not appropriate to report these codes for drainage procedures such as a catheter
aspiration of a fluid collection if a catheter is temporarily placed to drain the fluid but
then immediately removed.

The code structure for reporting the treatment and management of percutaneous
image-guided fluid collection drainage procedures follows anatomical location and
approach. A critical point is that one catheter placement into a single collection is
reported with a single code (i.e., considered one drainage). If multiple catheters
are placed into a collection, the appropriate code should be reported once for each
collection drained regardless of the number of catheters required to drain that
collection. If a single catheter is placed that drains multiple collections, a single drainage
code is reported. If separate catheters are placed in separate and distinct collections in
the same setting, then the appropriate code may be used for each drain placed in each
individual collection. The appropriate modifier (e.g., –59) should be included to indicate
that separate and distinct procedures have been performed.

10030 Soft tissue, percutaneous fluid collection drainage by catheter (e.g.,

abscess, hematoma, seroma, lymphocele, cyst), soft tissue (e.g.,
extremity, abdominal wall, neck), includes all associated imaging.

49405 Visceral, percutaneous, fluid collection drainage by catheter (e.g.,

abscess, hematoma, seroma, lymphocele, cyst), visceral (e.g., kidney,
liver, spleen, lung/mediastinum), includes all associated imaging.

49406 Peritoneal or retroperitoneal, percutaneous fluid collection drainage by

catheter, includes all associated imaging.

(For percutaneous insertion of a tunneled intraperitoneal catheter

without subcutaneous port, use 49418).

49407 Peritoneal or retroperitoneal, transvaginal or transrectal, fluid collection

drainage by catheter, includes all associated imaging.

(For thoracentesis, see 32554, 32555).

(For percutaneous pleural drainage by catheter, see 32556, 32557).

(For abdominal paracentesis [diagnostic or therapeutic], see 49082,

49083).

(For percutaneous cholecystostomy, use 47490).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 86

49418 Insert tunneled intraperitoneal catheter (e.g., dialysis catheter, ascites

management), includes all associated imaging, including contrast
injections if performed.

49419 Insert intraperitoneal cannula or catheter, with subcutaneous reservoir

(permanent).

49422 Removal of tunneled intraperitoneal catheter.

49423 Exchange of abscess drainage catheter.

49424 For RS&I/S&I, see 75984.

Injection for evaluation of abscess drainage catheter.

49425 For RS&I/S&I, see 76080.

Placement of peritoneal-venous shunt.

49426 For RS&I/S&I, see 75989.

Revision of peritoneal-venous shunt.

49427 For shunt patency test, use 78291.

Injection peritoneal-venous shunt.

For RS&I/S&I, see 75809, 78291.

PERCUTANEOUS GASTROENTERIC TUBE PROCEDURES

All initial placements, conversion or replacements of gastroenteric tubes include all
fluoroscopic guidance and contrast injections to complete the procedure, as well
as the placement of a nasogastric or orogastric tube to insufflate the stomach prior
to percutaneous gastric tube placement, when performed. Do not report 43752 in
combination with the codes below.

49440 Place gastrostomy tube, percutaneous, under fluoroscopic guidance

including contrast injection(s).

(For conversion to a gastrojejunostomy tube at the time of initial

gastrostomy tube placement, report code 49446 in addition to 49440).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 87

49441 Place duodenostomy or jejunostomy tube, percutaneous, under

fluoroscopic guidance including contrast injection(s).

(For conversion of gastrostomy tube to gastrojejunostomy tube, use 49446).

49442 Place cecostomy or other colonic tube, percutaneous, under fluoroscopic

guidance including contrast injection(s).

49446 Change gastrostomy tube to gastrojejunostomy tube, percutaneous,

under fluoroscopic guidance including contrast injection(s).

43762 Replacement of gastrostomy tube, percutaneous, includes removal,

when performed, without imaging or endoscopic guidance; not requiring
revision of gastrostomy tract.

43763 Replacement of gastrostomy tube, percutaneous, includes removal, when

performed, without imaging or endoscopic guidance; requiring revision
of gastrostomy tract.

To report percutaneous gastrostomy tube replacement using

fluoroscopic guidance, use 49450.

49450 Replace gastrostomy or cecostomy (or other colonic) tube,

percutaneous, under fluoroscopic guidance including contrast
injection(s).

49451 Replace duodenostomy or jejunostomy tube, percutaneous, under

fluoroscopic guidance including contrast injection(s).

49452 Replace gastrojejunostomy tube, percutaneous, under fluoroscopic

guidance including contrast injection(s).

49460 Mechanical removal of obstructive material from gastric tube, any type,
any method, under fluoroscopic guidance including contrast injection(s).

(Do not report code 49460 in conjunction with codes 49450–49452,

49465).

49465 Contrast injection(s) for radiological evaluation of existing gastric tube,

any type, from percutaneous approach.

(Do not report code 49465 in conjunction with codes 49450–49460).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 88

PERCUTANEOUS GENITOURINARY INTERVENTIONS

RENAL BIOPSY
50200 Biopsy of kidney, by needle or trocar.

For RS&I, see 77002, 77012, 77021, 76942.

For FNA biopsy see 10005–10012.

URINARY DRAINAGE PROCEDURES (NEPHROSTOMY, URETERAL,

NEPHROURETERAL)
Several revisions and bundled codes have been established to describe image-guided
procedures performed in the genitourinary system. The codes below maybe out of
numeric sequence but are categorized by procedure type. Guidelines have been added
to provide special instructions regarding the intent and use of genitourinary procedure
coding. Most notably, image guidance is no longer separately reportable. Diagnostic or
routine nephrography or ureterography, if performed, is considered inherent in all of
these procedures and not separately reportable unless performed independently.

Throughout these genitourinary code descriptions, the word “catheter” is used to

describe something that is externally accessible (e.g., nephroureteral catheter), while
the word “stent” is used to describe a device that is not externally accessible and is
completely indwelling (e.g., double-J ureteral stent). When the identical procedure is
performed bilateral, use modifier –50 to report the service bilaterally.

Please consult the accompanying introductory language describing the codes and
reporting instructions in the CPT® 2020 Professional Edition codebook.

NEPHROSTOGRAMS AND NEPHROSTOMY CATHETERS

50430 Injection antegrade nephrostogram and/or ureterogram; via a new
access; includes all associated imaging.

50431 Injection antegrade nephrostogram and/or ureterogram; via an existing

access; includes all associated imaging.

50432 Placement of percutaneous nephrostomy catheter, percutaneous;

includes all associated imaging.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 89

Do not report 50432 in conjunction with 50430, 50431, 50433, 50436,

50437, 50694, 50695, 74425 for the same renal collecting system and/
or associated ureter.

(Do not report code 50432 in conjunction with 50436, 50437, for
dilation of the nephrostomy tube tract)

50435 Exchange percutaneous nephrostomy catheter, percutaneous; includes

all associated imaging.

50389 Removal of nephrostomy tube, requiring fluoroscopic guidance (e.g., with

concurrent indwelling ureteral stent).

(Removal of nephrostomy tube not requiring fluoroscopic guidance

is considered inherent to E&M services; report appropriate level E&M
provided).

NEPHROURETERAL CATHETERS
50433 Placement of percutaneous nephroureteral catheter via a new access,
percutaneous; includes all associated imaging.

50434 Convert pre-existing percutaneous nephrostomy catheter to

nephroureteral catheter; includes all associated imaging.

(Code 50387 should be used when exchange of nephroureteral catheter

is performed).

50387 Removal and replacement of nephroureteral catheter (e.g., external/

internal stent) requiring fluoroscopic guidance, including RS&I.

(For exchange of externally accessible ureteral stent via ureterostomy or

ileal conduit, use 50688).

URETERAL STENTS
50693 Placement of percutaneous ureteral stent via pre-existing nephrostomy
tract; includes all associated imaging.

(Includes replacement of existing nephrostomy tube; if performed, do not

report with 50434).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 90

50694 Placement of percutaneous ureteral stent via new access, without

separate nephrostomy catheter; includes all associated imaging.

50695 Placement of percutaneous ureteral stent via new access, with separate
nephrostomy catheter; includes all associated imaging.

50382 Exchange (via snare/capture) of ureteral stent via percutaneous

approach, includes all associated imaging.

50384 Removal (via snare/capture) of ureteral stent via percutaneous approach,

includes all associated imaging.

(Do not report 50382, 50384 in conjunction with 50436, 50437).

(For removal of an internally dwelling ureteral stent via a transurethral

approach, use 50386).

50684 Injection for ureter x-ray via indwelling ureteral catheter.

For RS&I/S&I, see 74425.

INDWELLING URETERAL STENT, VIA TRANSURETHRAL APPROACH

Codes 50385 and 50386 should be used when a transurethral approach is used without
the use of cystoscopy.

50385 Exchange (via snare/capture) of ureteral stent via transurethral

approach, includes all associated imaging.

50386 Removal (via snare/capture) of internally dwelling ureteral stent via

transurethral approach, includes all associated imaging.

URETERAL STENT, VIA ILIEAL CONDUIT

50688 Change of ureterostomy tube or externally accessible ureteral stent via
ileal conduit.

For RS&I/S&I, see 75984.

50690 Injection for ileal conduit and/or ureterography.

For RS&I/S&I, see 74425.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 91

OTHER GENITOURINARY SERVICES

50390 Needle puncture for aspiration or injection, renal cyst or renal pelvis, for
injection.

For RS&I/S&I, see 74425, 74470, 77002, 77012, 76942, 77021.

For antegrade nephrostogram and/or antegrade pyelogram, see 50430,

50431.

#50436 Percutaneous dilation of existing tract for an endourologic procedure

including imaging guidance (e.g., ultrasound and/or fluoroscopy)
and all associated radiological supervision and interpretation, with
postprocedure tube placement, when performed

#50437 including new access into the renal collecting system

(Do not report 50436, 50437 with 50080, 50081, 50382, 50384,
50430–50433, 52334, 74485)

50396 Manometric studies (e.g., measure kidney pressure [Whitaker]) through

nephrostomy catheter

For RS&I/S&I, see 74425.

50686 Manometric studies (e.g., measure ureteral pressure [Whitaker]) through

ureteral catheter.

50391 Instillation of therapeutic agent into an established nephrostomy or

ureterostomy tube (e.g., anticarcinogenic, antifungal).

(For injection of sclerosing agent into renal cyst, see code 49185).

+50606 Endoluminal biopsy of ureter and/or renal pelvis, any method, non-
endoscopic; includes all associated imaging.

(List separately in addition to code for primary procedure).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 92

+50705 Ureteral embolization or occlusion; includes all associated imaging. (List

separately in addition to code for primary procedure).

+50706 Balloon dilation, ureteral stricture; includes all associated imaging. (List
separately in addition to code for primary procedure).

PERCUTANEOUS GENITOURINARY INTERVENTIONS

URETERAL
STENT WITH
URETERAL STENT
WITHOUT SEPARATE SEPARATE
NEPHROSTOMY NEPHROURETERAL NEPHROSTOMY NEPHROSTOMY
CATHETER CATHETER CATHETER CATHETER
Placement/
Introduction 50432 50433 50694 50695
(via new access)
Placement/
Introduction 50434 50693
(via existing access)
Exchange
50435 50387 50382
(remove & replace)
Removal 50389 50389 50384

PERCUTANEOUS RENAL TUMOR ABLATION

As different modes of imaging may be used depending on the patient’s specific clinical
circumstances, imaging for the guidance and monitoring of the percutaneous renal
tumor ablation procedure is separately coded. The modality-specific imaging codes
for the guidance and monitoring of parenchymal tissue ablation are 76940, 77013 and
77022 (ultrasound, computed tomography and magnetic resonance, respectively).

50592 Percutaneous, radiofrequency ablation, renal tumor(s), unilateral.

(For imaging guidance and monitoring, see codes 76940, 77013, 77022).

50593 Percutaneous, cryoablation, renal tumor(s), unilateral.

(For imaging guidance and monitoring, see codes 76940, 77013, 77022).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 93

BLADDER PROCEDURES
51100 Aspiration of bladder, via needle.

(For imaging guidance, see 76942, 77002, 77012).

51101 Aspiration of bladder (via trocar or intracatheter).

(For imaging guidance, see 76942, 77002, 77012).

51102 Aspiration of bladder with insertion of suprapubic catheter.

(For imaging guidance, see 76942, 77002, 77012).

51600 Injection for bladder x-ray or voiding urethrocystography.

For RS&I/S&I, see 74430, 74455.

51610 Injection for retrograde urethrocystography.

For RS&I/S&I, see 74450.

51700 Irrigation of bladder simple.

51701 Insert non-indwelling bladder catheter (e.g., straight cath).

51702 Insert temporary bladder catheter (e.g., Foley).

51703 Insert bladder catheter, complicated (fractured catheter, balloon).

51705 Change of bladder catheter, simple.

For RS&I/S&I, see 75984.

51710 Change of bladder catheter, complicated.

For RS&I/S&I, see 75984.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 94

INTRACRANIAL AND EXTRACRANIAL ENDOVASCULAR

INTERVENTIONS
BALLON OCCULSION TESTING (BOT)
61623 Endovascular temporary vessel occlusion (BOT), head or neck.

Code 61623, endovascular temporary balloon arterial occlusion (BOT), head or neck
(extracranial/intracranial), includes:

1. Selective catheterization of vessel to be occluded

2. Positioning and inflation of occlusion balloon

3. Concomitant neurological monitoring

4. RS&I/S&I of all angiography for balloon occlusion and post occlusion

Selective catheterization for vessel occluded, RS&I/S&I, neurologic monitoring and post
occlusion angiography are not separately reportable when performed in conjunction
with BOT (code 61623). However, if selective catheterization and angiography of
arteries other than the artery to be occluded is performed, appropriate catheterization
and RS&I/S&I codes are reported. Additionally, RS&I/S&I for full and complete pre-
procedural diagnostic angiography of vessel occluded is reportable, as is catheterization
and diagnostic RS&I/S&I of all other vessels studied. Catheterization coding for these
scenarios follows established coding guidelines (see CPT® 2020 Professional Edition
manual). Because codes 61623 and 61624 vary significantly in what is included in the
work described by each code, special attention must be paid to use each of these codes
correctly.

EMBOLIZATION AND OCCLUSION PROCEDURES

Component coding conventions are retained with codes 61624 and 61626. For
RS&I/S&I services, code 75894 for embolization and code 75898 for postembolization
arteriography. Associated diagnostic angiography with selective catheterization codes
are also reportable, see codes 36222–36228.

Embolization is performed in one operative field. Even if the embolization is

accomplished through multiple vessels, 61624 and 61626 are reported only once.
Multiple operative fields (e.g., bilateral AVMs, multiple tumors) should be coded as many
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 95

times as there are separate operative fields treated. Documentation should be clear and
support the separate operative fields.

61624 Transcatheter permanent occlusion or embolization (e.g., for tumor

destruction, to achieve hemostasis, to occlude a vascular malformation),
percutaneous, central nervous system.

For radiological supervision and interpretation, use 75894. For

postembolization angiography, use 75898.

For non–central nervous system and non–head or neck embolization, see

37241–37244.

61626 Transcatheter permanent occlusion or embolization, percutaneous,

non–central nervous system, head or neck (extracranial, brachiocephalic
branch)

For radiological supervision and interpretation, use 75894. For

postembolization angiography, use 75898.

For non–central nervous system and non–head or neck embolization, see

37241–37244.

INTRACRANIAL DILATION, ANGIOPLASTY AND STENT

Codes 61630–61642 were established to report intracranial angioplasty, stent placement
and balloon dilation. These codes include all ipsilateral selective vascular catheterization
and diagnostic angiography of the target vascular family, and all associated imaging.

When diagnostic arteriogram (including imaging and selective catheterization) confirms

the need for angioplasty or stent placement, diagnostic angiography of the target
vascular family is not reported in addition to 61630 and 61635. If angioplasty or stenting
are not indicated, then the appropriate codes for selective catheterization and imaging
(36222–36228) should be reported in lieu of 61630 and 61635.

Code 61630 is used to report intracranial percutaneous endovascular balloon

angioplasty. Code 61635 is used to report intracranial percutaneous endovascular stent
placement and includes concurrent angioplasty when performed.

61630 Balloon angioplasty, intracranial (e.g., atherosclerotic stenosis),

percutaneous.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 96

61635 Transcatheter placement of intravascular stent(s), intracranial (e.g.,

atherosclerotic stenosis), including balloon angioplasty, if performed.

Do not report 61630 or 61635 in conjunction with 61645 for the same
vascular territory.

Codes 61640–61642 are used to report intracranial endovascular balloon dilation. This
code set includes a primary code for the dilation of the initial vessel (61640) and two
add-on codes for dilation of each additional vessel in the same vascular family (61641)
and each additional vessel in a different vascular family from the initial dilation (61642).

61640 Balloon dilation of intracranial vasospasm, percutaneous; initial vessel.

+61641 Balloon dilation of intracranial vasospasm, percutaneous; each additional

vessel in same vascular territory (List separately in addition to code for
primary procedure).

+61642 Balloon dilation of intracranial vasospasm, percutaneous; each additional

vessel in different vascular territory (List separately in addition to code
for primary procedure).

(Use 61641 and 61642 in conjunction with 61640).

Do not report 61640, 61642 in conjunction with 61650 or 61651 for the
same vascular territory.

Codes have been established to describe endovascular intracranial interventions. Code

61645 has been established to describe percutaneous endovascular revascularization
of cerebral vessels occluded by thrombus or embolus. Codes 61650 and 61651 have
been established to describe prolonged intracranial arterial continuous infusion of
pharmacologic agents. Please consult the accompanying introductory language
describing these codes and reporting instructions in the CPT® 2020 Professional Edition
codebook.

These codes are described and reported by vascular territory. For the purposes of these
codes, the intracranial arteries are divided into three vascular territories: right carotid
circulation, left carotid circulation and the vertebrobasilar circulation. They include all
selective catheterization and diagnostic and completion angiography for the treated
territory. However, diagnostic angiography of a nontreated vascular territory may be
reported separately.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 97

Code 61645 describes endovascular revascularization of thrombotic/embolic

occlusion of intracranial arteries; this code describes any method of revascularization
(e.g., mechanical retrieval device, aspiration catheter or the administration of any
thrombolytic agents). Code 61645 is reported once for vascular territory treated.

61645 Intracranial arterial mechanical thrombectomy and/ or infusion for

thrombolysis, intracranial, any method, including pharmacological
thrombolytic injection(s); includes all associated imaging.

To report venous mechanical thrombectomy and/or thrombolysis, see

37187, 37188, 37212, 37214.

Do not report 61645, 61650 or 61651 in conjunction with 36221–36226,

37184 or 37186 for the treated vascular territory.

Do not report 61645 in conjunction with 61650 or 61651 for the same
vascular distribution.

Codes 61650, 61651 describe the cerebral endovascular continuous or intermittent

therapeutic prolonged administration of any non-thrombolytic agent(s) (e.g.,
spasmolytics or chemotherapy) into an artery to treat non-iatrogenic central nervous
system diseases or sequelae thereof. These codes should not be used to report
administration of agents (e.g., heparin, nitroglycerin, saline) usually administered during
endovascular interventions. These codes are used for prolonged administrations (i.e., of
at least 10 minutes continuous or intermittent duration).

61650 Endovascular intracranial prolonged administration of pharmacologic

agent(s) other than for thrombolysis, arterial, initial vascular territory;
includes all associated fluoroscopy and angiography.

+61651 Endovascular intracranial prolonged administration of pharmacologic

agent(s) other than for thrombolysis, arterial, each additional vascular
territory; includes all associated fluoroscopy and angiography.

Use 61651 in conjunction with 61650.

Do not report 61650 or 61651 in conjunction with 36221–36226,

61640,61641, 61642, 61645 for the same vascular territory.

Do not report 61650 or 61651 in conjunction with 96420, 96422, 96423,

96425 for the same vascular territory.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 98

LUMBAR PUNCTURE
62270 Lumbar puncture, diagnostic;
62328 with fluoroscopic or CT guidance

Do not report 62270, 62328 with 77003, 77012

For ultrasound or MRI guidance see codes 76942, 77021

62272 Lumbar puncture, therapeutic (by needle or catheter to drain CSF);

62329 with fluoroscopic or CT guidance

Do not report 62272, 62329 with 77003, 77012

For ultrasound or MRI guidance see codes 76942, 77021

MYELOGRAPHY
There are four codes (62302–62305) that bundle the injection and image guidance
for myelography procedures. The current injection and radiologic supervision and
interpretation codes (72240–72270) for myelography are retained to allow correct
reporting when only one component of the service is provided (e.g., injection only is
performed for MR myelography and radiographic myelography is not performed). The
components may also be reported when two separate providers perform the surgical
and radiological components. However, even though the existing component codes
were retained, they should not be reported together. When the same provider performs
both components, the bundled codes should be reported.

62284 Injection procedure for myelography and/or computed tomography,

lumbar.

(Do not report 62284 in conjunction with 62302, 62303, 62304, 62305,
72240, 72255, 72265, 72270).

(When both 62284 and 72240, 72255, 72265, 72270 are performed
by the same physician or other qualified health care professional for
myelography, see 62302, 62303, 62304, 62505).

(For injection procedure at C1–C2, use 61055).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 99

62302 Myelography via lumbar injection, including RS&I; cervical.

(Do not report 62302 in conjunction with 62284, 62203, 62304, 62305,
72240, 72255, 72265, 72270).

62303 Myelography via lumbar injection, including RS&I; thoracic.

(Do not report 62303 in conjunction with 62284, 62302, 62304, 62305,
72240, 72255, 72265, 72270).

62304 Myelography via lumbar injection, including RS&I; lumbosacral.

62305 Myelography via lumbar injection, including RS&I; two or more regions
(e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/
thoracic/cervical).

Do not report 62305 in conjunction with 62284, 62302, 62303, 62304,

72240, 72255, 72265, 72270.

(For myelography lumbar injection and imaging performed by different

physicians or other qualified health care professionals, see 62284 or
72240, 72255, 72265, 72270).

(For injection procedure at C1–C2, use 61055).

Injection(s) of diagnostic or therapeutic substance(s) codes 62310, 62311,

62318, 62319 have been deleted.

62320 Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic,

antispasmodic, opioid, steroid, other solution), not including neurolytic
substances, including needle or catheter placement, interlaminar epidural
or subarachnoid, cervical or thoracic; without imaging.

62321 With imaging guidance (i.e., fluoroscopy or CT). Do not report 62321 with
77003, 77012, 76942.

62322 Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic,

antispasmodic, opioid, steroid, other solution), not including neurolytic
substances, including needle or catheter placement, interlaminar epidural
or subarachnoid, lumbar or sacral (caudal); without imaging.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 100

62323 With imaging (i.e., fluoroscopy or CT).

Do not report 62323 with 77003, 77012, 76942.

62324 Injection(s), including indwelling catheter placement, continuous infusion

or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g.,
anesthetic, antispasmodic, opioid, steroid, other solution), not including
neurolytic substances, interlaminar epidural or subarachnoid, cervical or
thoracic; without imaging.

62325 With imaging (i.e., fluoroscopy or CT).

Do not report 62325 with 77003, 77012, 76942.

62326 Injection(s), including indwelling catheter placement, continuous infusion

or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g.,
anesthetic, antispasmodic, opioid, steroid, other solution), not including
neurolytic substances, interlaminar epidural or subarachnoid, lumbar or
sacral (caudal); without imaging.

62327 With imaging (i.e., fluoroscopy or CT).

Do not report 62327 in conjunction with 77003, 77012, 76942.

Report 01996 for daily hospital management of continuous epidural or

subarachnoid drug administration performed with 62324, 62325, 62326,
62327.

DESTRUCTION BY NEUROLYTIC AGENT (E.G., CHEMICAL,

THERMAL, ELECTRICAL OR RADIOFREQUENCY),
CHEMODENERVATION–SOMATIC NERVES
Several changes have been made recently in the neurolysis/chemodenervation codes
to provide greater granularity. Readers should refer to the AMA CPT® 2020 Professional
Edition manual for the guidelines, language and instructional parenthetical notes that
inform users about appropriate code selection when reporting these services.

Some existing codes have been revised to provide clarity on reporting these procedures
and codes 64613 and 64614 have been deleted. Six codes, 64642–64647, specify
reporting chemodenervation of extremity and trunk muscles.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 101

Codes 64642–64644 are reported for chemodenervation of extremity, one to four

muscles and five or more muscles. Codes 64645–64647 are to report chemodenervation
of trunk, one to five muscles and six or more muscles.

64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve,

unilateral (e.g., for blepharospasm, hemifacial spasm).

64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve,

unilateral (e.g., for blepharospasm, hemifacial spasm).

64615 Chemodenervation of muscle(s) innervated by facial, trigeminal, cervical

spinal and accessory nerves, bilateral (e.g., for chronic migraine).

Report 64615 only once per session.

Do not report 64615 in conjunction with 64612, 64616, 64617, 64642–

64647.

For guidance, see 95873, 95874. Do not report more than one guidance
code for 64615.

64616 Chemodenervation of neck muscle(s), excluding muscles of the larynx,

unilateral (e.g., for cervical dystonia, spasmodic torticollis).

(For chemodenervation guided by needle electromyography or muscle

electrical stimulation, see 95873, 95874).

Do not report more than one guidance code for any unit of 64616 (64614
has been deleted; to report, see 64642, 64643, 64644, 64645, 64646,
64647).

64617 Chemodenervation of larynx, unilateral, percutaneous (e.g., for

spasmodic dysphonia), includes guidance by needle electromyography,
when performed.

For diagnostic needle electromyography of the larynx, use 95865.

For chemodenervation of the larynx performed with direct laryngoscopy,

see 31570, 31571.

Do not report 64617 in conjunction with 95873, 95874.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 102

64620 Destruction by neurolytic agent, intercostal nerve.

64624 Destruction by neurolytic agent, genicular nerve branches including

imaging guidance, when performed.

64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with

image guidance (ie, fluoroscopy or computed tomography)

64630 Destruction by neurolytic agent, pudendal nerve, includes imaging

guidance.

64632 Destruction by neurolytic agent, digital nerve, includes imaging guidance.

64633 Destruction by neurolytic agent, paravertebral facet joint, cervical or

thoracic, single facet joint, includes imaging guidance.

(For bilateral procedure, report 64633 with modifier –50)

+64634 Each additional cervical or thoracic facet joint, includes imaging

guidance.

(Use 64634 in conjunction with 64633)

For bilateral procedure, report 64634 twice. Do not report modifier –50
in conjunction with 64634)

64635 Destruction by neurolytic agent, paravertebral facet joint, lumbar or

sacral, single facet joint, includes imaging guidance.

+64636 Each additional lumbar or sacral facet joint, includes imaging guidance.

Report 64642, 64643, 64644, 64645 once per extremity. Codes

64642–64645 can be reported together up to a combined total of four
units of service per patient when all four extremities are injected. Report
only one base code 64642 (or 64643) per session. Report one or more
units of additional extremity code(s) 64643 or 64645 for each additional
extremity injected.

Report 64646 or 64647 for chemodenervation of muscles of the trunk.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 103

Trunk muscles include the erector spinae and paraspinal muscles, rectus
abdominus, and obliques. All other somatic muscles are extremity
muscles, head muscles, or neck muscles.

For chemodenervation guided by needle electromyography or muscle

electrical stimulation, see 95873, 95874. Do not report more than one
guidance code for each corresponding chemodenervation of extremity or
trunk code.

Do not report modifier –50 in conjunction with 64642–64647.

64642 Chemodenervation of one extremity; one to four muscle(s).

+64643 Each additional extremity, one to four muscle(s). (List separately in

addition to code for primary procedure).

Use 64643 in conjunction with 64642, 64644.

64644 Chemodenervation of one extremity; five or more muscle(s).

+64645 Each additional extremity, five or more muscle(s). (List separately in

addition to code for primary procedure).

Use 64645 in conjunction with 64644.

64646 Chemodenervation of trunk muscle(s); one to five muscle(s).

64647 Six or more muscle(s).

Report either 64646 or 64647 only once per session.

64680 Destruction by neurolytic agent of celiac plexus, with or without

radiologic monitoring.

64681 Destruction by neurolytic agent of superior hypogastric plexus, with or

without radiologic monitoring.

(For destruction by neurolytic agent of sympathetic chain, use unlisted code.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 104

Radiological supervision and

interpretation codes
SPINE AND PELVIS
72240 Myelography (cervical).

72255 Myelography (thoracic).

72265 Myelography (lumbosacral).

72270 Myelography (two or more regions).

(Use 72240–72270 when RS&I is performed by separate physician from

injection procedure).

(Do not report 72240, 72255, 72265 and/or 72270 in conjunction with
62284, 62302, 62303, 62304 or 62305).

See CPT® 2020 Professional Edition manual for revisions of exclusionary parenthetical
notes.

72275 Epidurography, RS&I.

72285 Cervical or thoracic discography, RS&I (for injection procedure, see

62291).

72295 Lumbar discography, RS&I (for injection procedure, see 62290).

UPPER EXTREMITIES
73040 Shoulder arthrography, RS&I (includes S&I for needle placement unless
CT/MR arthrography is only procedure; 77002 excluded by the NCCI).

73085 Elbow arthrography, RS&I (includes S&I for needle placement unless CT/
MR arthrography is only procedure; 77002 excluded by the NCCI).

73115 Wrist arthrography, RS&I (includes S&I for needle placement unless CT/
MR arthrography is only procedure; 77002 excluded by the NCCI).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 105

LOWER EXTREMITIES
73525 Hip arthrography, RS&I (includes S&I for needle placement unless CT/MR
arthrography is only procedure; 77002 excluded by the NCCI).

73580 Knee arthrography, RS&I (includes S&I for needle placement unless CT/
MR arthrography is only procedure; 77002 excluded by the NCCI).

73615 Ankle arthrography, RS&I (includes S&I for needle placement unless CT/
MR arthrography is only procedure; 77002 excluded by the NCCI).

GASTROINTESTINAL TRACT
(For percutaneous placement of gastrostomy tube, see 49440).

74300 Cholangiography, or pancreatography, intraoperative, RS&I.

74363 Percutaneous transhepatic biliary duct dilation, with or without

placement of stent, RS&I. (For procedure, see 47555, 47556).

URINARY TRACT
74420 Retrograde urography.

74425 Urography, antegrade (e.g., pyelogram, nephrostogram, loopogram),

RS&I.

74430 Cystography, three views minimum, RS&I.

74485 Dilatation of ureter(s) or urethra, RS&I

(Do not report 74485 with 50436, 50437)

(For dilation of a nephrostomy tract for endourologic procedure, see

50436, 50437)

VASCULAR SYSTEM
75600 Aortography, thoracic, single shot, RS&I.

75605 Aortography, thoracic, serialographic, RS&I.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 106

75625 Aortography, abdominal, serialographic, RS&I.

75630 Aortography, abdominal plus bilateral iliofemoral lower extremity

angiography, RS&I.

If the abdomen and lower extremity vessels are examined as a

continuous examination (e.g., stepping table top or long leg changer),
then 75630 describes the total examination. If a full and complete
examination of the abdominal aorta (in one or several views) is
obtained and then the catheter is repositioned and a full and complete
examination of the iliofemoral and lower extremity arteries is performed,
then 75625 should be coded in conjunction with 75716 for bilateral lower
extremity.

75635 CT angiography, abdominal aorta and bilateral iliofemoral lower

extremity runoff, with contrast material(s), including noncontrast images,
if performed, and image postprocessing.

75658 Angiography, retrograde brachial, RS&I.

75705 Angiography, spinal selective, RS&I.

75710 Angiography, extremity, upper or lower, unilateral RS&I.

75716 Angiography, extremity, upper or lower, bilateral.

75726 Visceral angiography, selective, including flush aortogram if performed,

RS&I. For example, the superior mesenteric artery constitutes a
basic examination. The inferior mesenteric artery constitutes a basic
examination. The hepatic artery constitutes a basic examination. For
further selective catheterizations within an evaluated vessel, please
see 75774. For example, if the common hepatic artery were studied, it
would be described by the RS&I code 75726. If selective studies of the
right and left hepatic artery were subsequently performed, each of these
radiology tests would be described by the RS&I code 75774 in addition
to appropriate procedural codes. The celiac axis would have a similar
relationship to the hepatic artery and the splenic artery if all three vessels
were injected and studied.

75731 Angiography, adrenal, unilateral RS&I.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 107

75733 Angiography, adrenal, bilateral RS&I.

75736 Angiography, pelvis, selective or supraselective, RS&I.

This code should be used for each selective pelvic (e.g., internal iliac or
median sacral artery) artery completely studied. Therefore, if bilateral
internal iliac vessels are catheterized and studied, then 75736 would
be used twice. If, following an internal iliac catheterization, there was
separate catheterization of several branches of that vessel, then 75774
would be used to describe the RS&I/S&I work of each of these further
selective branch catheterizations.

75741 Angiography, pulmonary, unilateral, selective, RS&I.

75743 Angiography, pulmonary, bilateral, selective, RS&I.

75746 Angiography, pulmonary, nonselective, RS&I.

75756 Angiography, internal mammary, RS&I.

+75774 Artery x-ray, each vessel (each additional selective after basic exam).
Code 75774 is used to report each additional selective or subselective
vessel studied after the basic examination. Use of this code requires
selective catheterization of the additional vessel studied (with selective
catheterization separately reportable according to the selective
catheterization coding conventions; see AMA CPT® 2020 Professional
Edition manual for discussion of these coding conventions).

VEINS AND LYMPHATICS

(For injection procedure for lymphatic system, see 38790).

75801 Lymphangiography, extremity, unilateral, RS&I.

75803 Lymphangiography, extremity, bilateral, RS&I.

75805 Lymphangiogram, pelvic/trunk, unilateral, RS&I.

75807 Lymphangiogram, pelvic/trunk, bilateral, RS&I.

75809 Nonvascular shunt x-ray (e.g., LeVeen), RS&I.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 108

75810 Splenoportography, RS&I.

75820 Venography, extremity, unilateral, RS&I.

75822 Venography, extremity, bilateral, RS&I.

75825 Inferior vena cavography, RS&I.

75827 Superior vena cavography, RS&I.

75831 Venography, renal unilateral, selective, RS&I.

75833 Venography, renal bilateral, selective, RS&I.

75840 Venography, adrenal unilateral, selective, RS&I.

75842 Venography, adrenal bilateral, selective, RS&I.

75860 Venography, venous sinus or jugular, RS&I.

75870 Venography, superior sagittal, RS&I.

75872 Venography, epidural, RS&I.

75880 Venography, orbital, RS&I.

75885 Venography, portal (perc transhepatic with pressures), RS&I.

75887 Venography, portal (perc transhepatic without pressures), RS&I.

75889 Venography, hepatic (with pressures), RS&I.

75891 Venography, hepatic (without pressures).

TRANSCATHETER PROCEDURES
75893 Venous sampling by catheter, with or without angiography, per organ
sampled, RS&I. (For procedure, see 36500).

75894 Transcatheter therapy (embolization), RS&I. (For procedure, see 61624 or

61626).

Do not use 75894 in combination with 36909, 37241–37244, 50705.

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 109

75898 Follow-up angiogram through existing catheter, during embolization or

thrombolysis, RS&I.

Do not report 75898 in conjunction with 37211–37214, 37241–37244,

61645, 61650 or 61651.

75901 Removal CVA device obstruction, RS&I. (For procedure, see 36595).

75902 Remove CVA intraluminal obstruction, RS&I. (For procedure, see 36596).
75952, 75953, 75954 have been deleted. To report, see 34701–34711,
34718).

ENDOVASCULAR ABDOMINAL AND THORACIC AORTA REPAIR

75956 Endovascular repair of descending thoracic aorta (e.g., aneurysm,
pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma or
traumatic disruption); involving coverage of left subclavian artery origin,
initial endoprosthesis plus descending thoracic aortic extension(s), if
required, to level of celiac artery origin, RS&I.

(For placement of endovascular graft, use 33880).

75957 Not involving coverage of left subclavian artery origin, initial

endoprosthesis plus descending thoracic aortic extension(s), if required,
to level of celiac artery origin, RS&I.

(For placement of endovascular graft, use 33881).

75958 Placement of proximal extension prosthesis for endovascular repair of

descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, intramural hematoma or traumatic disruption), RS&I
(Report 75958 for each proximal extension).

(For placement of proximal endovascular extension, see 33883, 33884).

75959 Placement of distal extension prosthesis(es) (delayed) after endovascular

repair of descending thoracic aorta, as needed, to level of celiac origin, RS&I.

(Do not report 75959 in conjunction with 75956, 75957).

(Report 75959 once, regardless of number of modules deployed).

(For implantation of distal endovascular extension, use 33886).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 110

BIOPSY AND DRAINAGE CATHETER

X-ray, CT and ultrasound codes for biopsy and drainage and aspiration do not include a
full examination of the organ or area. The RS&I code only describes the work inherent in
the actual guidance and interpretation of images obtained during the intervention. If a
diagnostic study is performed in addition, this should be separately coded.

75970 Transcatheter biopsy, RS&I.

75984 Change of percutaneous tube or drainage catheter with contrast

monitoring (e.g., GI, GU or abscess), RS&I.

(For percutaneous placement of G-, J-, G-J, cecostomy, or other colonic

tube, see 49450–49452).

75989 Radiologic guidance, abscess drainage, CT, fluoroscopy, or ultrasound,

RS&I.

(Do not report 75989 in conjunction with 10030, 32554, 32555, 32556,
32557, 47490, 49405, 49406, 49407).

IMAGING GUIDANCE
76000 Fluoroscopy (separate procedure), up to one hour physician time, other
than cardiac fluoroscopy.

(Do not report 76000 in conjunction with 33274, 33275, 33957–33959,

33962–33964, 0515T–0520T).

76001 has been deleted.

76080 Fistulogram, abscessogram, sinogram, RS&I. (See codes 20501 and

49424).

76376 3D rendering with interpretation and reporting of computed tomography,

magnetic resonance imaging, ultrasound or other tomographic modality;
with image postprocessing under concurrent supervision not requiring an
independent workstation.

(Use 76376 in conjunction with code[s] for base imaging procedure[s]).

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 111

(Do not report 76376 in conjunction with 31627, 34839, 70496, 70498,
70544–70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706,
73725, 74174, 74175, 74185, 74261–74263, 75557, 75559, 75561, 75563,
75565, 75571–75574, 75635, 76377, 77046–77049, 77061, 77062,
77063, 78012–78999, 93355, 0523T, 0559T–0562T).

76377 Requiring image postprocessing on an independent workstation.

(Use 76377 in conjunction with code[s] for base imaging procedure[s]).

(Do not report 76377 in conjunction with 34839, 70496, 70498, 70544,
70544–70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706,
73725, 74174, 74175, 74185, 74261–74263, 75557, 75559, 75561, 75563,
75565, 75571–75574, 75635, 76376, 77046–77049, 77061, 77062,
77063, 78012–78999, 93355, 0523T, 0559T–0562T, for which 3D
reconstruction postprocessing is considered inherent).

Code 76376 is used to report 3D imaging, ultrasound or other tomographic modality

not requiring image postprocessing on an independent workstation. Code 76377 is used
to report 3D rendering with interpretation and reporting of computed tomography,
magnetic resonance imaging, ultrasound or other tomographic modality requiring image
postprocessing on an independent workstation. (76376, 76377 require concurrent
supervision of image postprocessing 3D manipulation of volumetric data set and image
rendering).

The 2D reformatting/3D rendering code 76375 was deleted in 2006, as it no longer

described current technology. Codes 76376 and 76377 cannot be reported in
conjunction with those MRA, CTA and PET codes.

ULTRASOUND GUIDANCE
76936 Ultrasound-guided compression repair arterial pseudoaneurysm (includes
DX evaluation, compression of lesion, imaging).

+76937 Ultrasound guidance for vascular access requiring ultrasound evaluation

of potential access sites, documentation of selected vessel patency,
concurrent real-time ultrasound visualization of vascular needle entry,
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 112

with permanent recording and reporting. (List separately in addition to

code for primary procedure).

(Do not use 76937 in conjunction with 76942).

(If extremity venous noninvasive vascular diagnostic study is performed

separate from venous access guidance, use 93970 or 93971).

It may be necessary to utilize ultrasound guidance to achieve vascular

access in performing interventional radiology procedures. This service
represents additional physician work, utilizing a different imaging
modality, and is separately reportable. Code 76937 was created to report
this service when performed in conjunction with any other surgical or
imaging service where the modality of ultrasound imaging is not inherent.
The use of a handheld device to ease vascular access without evaluation
of potential access sites, documentation of selected vessel patency,
concurrent real-time ultrasound visualization of vascular needle entry,
and permanent recording/reporting is not reportable using code 76937.

76940 US guidance and monitoring, parenchymal tissue ablation.

(For ablation, see 32998, 47370–47382, 47383, 50592, 50593).

Liver, kidney and lung tissue are considered “parenchymal” tissue. Imaging services
provided for the guidance and monitoring of tissue ablation of these organs is accurately
reported using the modality specific imaging codes. If more than one imaging modality
is utilized for ablation guidance and monitoring only the predominant modality is
reported. This coding convention is inconsistent with and not applicable to most other
interventional radiology imaging codes.

76942 Ultrasound guidance for needle placement (e.g., biopsy, aspiration,

injection, localization device) imaging S&I x-ray, CT, ultrasound and MR
guidance codes for biopsy, drainage and aspiration procedures do not
include a full examination of the organ or area. The imaging code only
describes the work inherent in the actual guidance and interpretation
of images obtained during the intervention. If a diagnostic evaluation is
performed in addition, this should be separately coded.

(Note: Code 76942 should not be used to report ultrasound guidance for
vascular access; see code 76937).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 113

(Do not report 76942 in conjunction with 10004, 10005, 10006, 10021,
10030, 19083, 19285, 20604, 20606, 20611, 27096, 32554–32557,
37760, 37761, 43232, 43237, 43242, 45341, 45342, 46948, 55874,
64479, 64480, 64483, 64484, 64490, 64491, 64493, 64494, 64495,
76975, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0228T, 0229T,
0230T, 0231T, 0232T, 0481T, 0582T)

FLUOROSCOPIC GUIDANCE
+77001 Fluoroscopic guidance for CVA device placement, replacement or
removal.

Includes fluoroscopic guidance for vascular access, fluoroscopic

guidance for catheter manipulation, any necessary contrast injections
through access site or catheter with related venography RS&I/S&I, and
radiographic documentation of final catheter position.

(Do not report 77001 in conjunction with 33957–33959, 33962–33964,

77002).

(If formal extremity venography is performed from a separate venous

access and separately interpreted, use 36005 and 75820, 75822, 75825
or 75827).

(For ultrasound guidance for vascular access, see code 76937; please
note the documentation requirements associated with code 76937).

Not all venous access procedures necessitate the use of imaging guidance. Therefore,
when imaging services are provided in conjunction with the placement, partial/complete
replacement, or removal of CVA these services are separately reportable.

In 2017, fluoroscopic guidance codes 77002 and 77003 were changed from stand-alone
procedures to add-on codes. See the CPT® 2020 Professional Edition manual for a listing
of appropriate primary procedure codes with which 77002 may be reported.

+77002 Fluoroscopic localization for needle placement (e.g., biopsy, aspiration,

injection or fine needle aspiration) X-ray, CT, ultrasound and MR codes
for biopsy and drainage and aspiration do not include a full examination
of the organ or area. The guidance code only describes the work inherent
in the actual guidance and interpretation of images obtained during the
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 114

intervention. If an evaluation or localization is performed in addition, this

should be separately coded.

(Do not report 77002 in conjunction with 10030, 19081–19086, 19281–

19288, 20982, 20983, 32554, 32555, 32556, 32557, 70332, 73040,
73085, 73115, 73525, 73580, 73615, 0232T).

+77003 Fluoroscopic guidance and needle localization for spine injection procedures.

Contrast injection is included in codes 62270–62273, 62280–62282.

Use 77003 with these codes when fluoroscopy guidance is required. For
facet joint injections, see codes 64470–64476.

Use for epidurography injections, see codes 64479–64484. Use for

neurolytic destruction, see codes 64600–64680.

For SI joint arthrography, see codes 27096.

If formal arthrography is not performed, recorded, and a formal radiographic

report is not issued, use 77003 for fluoroscopy guidance for SI joint injections.

For myelography codes 72240–72270 fluoroscopy guidance included;

77003 is not coded additionally.

Use 77003 with these codes when fluoroscopy guidance is required. For
facet joint injections, see codes 64470–64476.

CT GUIDANCE
77012 CT guidance for needle placement (e.g., biopsy, aspiration, injection or
localization device) RS&I

77013 CT guidance for, and monitoring of, parenchymal tissue ablation. Liver,
kidney and lung tissue are considered “parenchymal” tissue and imaging
services provided for the guidance and monitoring of ablation of tissue
of these organs is accurately reported using these modality-specific
imaging codes. If more than one imaging modality is utilized for ablation
guidance and monitoring, only the predominant modality is reported.
This coding convention is inconsistent with and not applicable to most
other interventional radiology imaging codes.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 115

MR GUIDANCE
77021 MR imaging guidance for needle placement (e.g., injection, localization,
Bx, aspiration), RS&I/S&I.

(Do not report 77021 in conjunction with 10011, 10012, 10030, 19085,
19287, 32554, 32555, 32556, 32557, 0232T, 0481T).

X-ray, CT, ultrasound and MR for biopsy and drainage and aspiration
do not include a full examination of the organ or area. The RS&I/S&I
code only describes the work inherent in the actual guidance and
interpretation of images obtained during the intervention. If an evaluation
or localization is performed in addition, this should be separately coded.

77022 MR imaging guidance for, and monitoring of, parenchymal tissue

ablation.

(Do not report 77022 in conjunction with 0071T, 0072T, 20982, 20983,
32994, 32998).

Liver, kidney and lung tissue are considered “parenchymal” tissue.

Imaging services provided for guidance and monitoring of tissue ablation
of these organs is accurately reported using the modality specific
imaging codes. If more than one imaging modality is utilized for ablation
guidance and monitoring, only the predominant modality is reported.

This coding convention is inconsistent with and not applicable to most

other interventional radiology imaging codes.

(For percutaneous ablation, see, 47382, 47383, 50592, 50593).

(For focused ultrasound ablation treatment of uterine leiomyomata, see

Category III codes 0071T, 0072T).

(To report stereotactic localization guidance for breast biopsy or for

placement of breast localization device[s], see 19081, 19283).

(To report mammographic guidance for placement of breast localization

device[s], use 19281).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 116

RADIOPHARMACEUTICAL ADMINISTRATION
79445 Intra-arterial administration of particulate for radiopharmaceutical
therapy.

Code 79445 was created to capture the work of prescribing, handling, and administering
the radioactive agent added to the embolization agent. Procedural and RS&I/S&I
services performed prior to radiopharmaceutical therapy are reported separately.

CEREBROVASCULAR ARTERIAL STUDIES, ULTRASOUND

93880 Extracranial study (imaging, complete bilateral).

93882 Extracranial study (unilateral or limited study).

93886 Intracranial study (transcranial, complete).

93888 Intracranial study (limited study).

EXTREMITY ARTERIAL STUDIES, ULTRASOUND

93922– Extremity study (for nonimaging, noninvasive physiologic studies of
93924 upper or lower extremity arteries). These codes describe increasing levels
of service. If ultrasound imaging of extremity arteries is performed, use
93925–93931.

93925 Lower extremity study (duplex imaging arterial, complete bilateral

arteries or grafts).

93926 Lower extremity study (duplex, unilateral or limited study).

93930 Upper extremity study (duplex imaging arterial, complete bilateral

arteries or grafts).

93931 Upper extremity study (duplex, unilateral or limited study).

93970 Extremity study (duplex imaging, venous bilateral, complete).

93971 Extremity study (duplex, unilateral or limited study).

93975 Visceral vascular study (duplex imaging arterial/venous abdomen, pelvic

and/or retroperitoneum, complete).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 117

93976 Visceral vascular study (duplex, limited study).

93978 Visceral vascular study (duplex imaging aorta, IVC, iliacs, grafts,
complete).

93979 Visceral vascular study (duplex, unilateral or limited study).

93980– Penile vascular study (duplex, complete or limited study).

93981

EXTREMITY ARTERIAL-VENOUS STUDIES

93990 Duplex scan of hemodialysis access (including arterial inflow, body of
access and venous outflow)

93985 Duplex scan of arterial inflow and venous outflow for preoperative vessel
assessment prior to creation of hemodialysis access; complete bilateral
study

93986 Duplex scan of arterial inflow and venous outflow for preoperative vessel
assessment prior to creation of hemodialysis access; complete unilateral
study

CHEMOTHERAPY ADMINISTRATION
96420 Chemotherapy administration, intra-arterial (see CPT for 96425
differentiation).

There is greater caution and additional physician work in the handling and administration
of a chemotherapy agent as compared to that of an embolic agent. Due to the increased
physician work and intensity, this service is separately reportable using code 96420
(chemotherapy administration, intra-arterial, push technique) in those cases where the
interventional radiologist determines the dose, prescribes and personally administers the
chemotherapeutic agent in conjunction with the embolic agent.

Code 96420 is an “Incident To” code and will not be paid by the Medicare program
when performed in the hospital setting. The CPT® 2020 Professional Edition manual
states on page 734: “Codes 96360–96379, 96401, 96402, 96409–96425, 96521–96523
are not intended to be reported by the physician in the facility setting.”
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 118

Time-based moderate sedation

See AMA CPT® 2020 Professional Edition manual for specific criteria, which must be met
to report this service.

99151 Moderate sedation services provided by the same physician performing

the diagnostic or therapeutic service under 5 years of age; first 15
minutes intra-service time.

99152 Moderate sedation services provided by the same physician performing

the diagnostic or therapeutic service over 5 years of age; first 15 minutes
intra-service time.

+99153 Each additional 15 minutes intra-service time. (Use 99153 in conjunction

with 99151, 99152).

99155 Moderate sedation services provided by a physician or other qualified

health care professional other than the physician performing the
diagnostic or therapeutic service that the sedation supports, under 5
years of age; first 30 minutes intraservice time.

99156 Initial 15 minutes of intraservice time, 5 years or older.

+99157 Each additional 15 minutes intra-service time. (List separately in addition

to code for primary service).

(Use 99157 in conjunction with 99155, 99156).

MR-GUIDED FOCUSED ULTRASOUND ABLATION

Currently, there are three Category III codes to describe two of the FDA-approved
applications for MR-guided focused ultrasound (MRgFUS); uterine fibroid and
intracranial movement disorder.

0071T Focused ultrasound ablation of uterine leiomyomata, including MR

guidance; total leiomyomata volume less than 200 cc of tissue.

0072T Focused ultrasound ablation of uterine leiomyomata, including MR

guidance; total leiomyomata volume greater than or equal to 200 cc of
tissue.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 119

0398T MRgFUS, stereotactic ablation of an intracranial lesion for movement

disorder.

Other applications for MRgFUS, such as pain palliation in the setting of bone metastasis,
have been FDA approved; however, they do not have a corresponding listed CPT code.
Therefore, SIR recommends the use of the appropriate unlisted code for the body part
that this treated. See codes 22899 (spine), 22999 (abdomen, MSK), 23999 (shoulder),
24999 (humerus/elbow), 25999 (forearm/wrist), 27299 (pelvis/hip joint) and 27899
(leg/ankle).

Category III codes

Use of Category III codes to report services for which FDA approval has not been
granted require the prior arrangement of an institutional investigational device
exemption (IDE) number to recognize the site as one approved for research into
applicability of new procedures and techniques.

Category III codes do not go through the RUC valuation process and CMS does not
establish RVUs for these procedures. Providers are urged to contact their local carrier in
advance of providing any Category III code services to ascertain the coverage, reporting
and reimbursement policies for these procedures.

Like unlisted codes, Category III codes do not have a set relative value and thus payment
for procedures is considered on an individual basis. In fact, considerable latitude is
given to carrier medical directors (CMDs) to pay for these procedures on a case-by-
case basis. For this reason, it is crucial that the CMDs have access to information about
the procedure(s) being reported using a Category III code. Supporting documentation
including literature, an estimate of physician work, appropriate indications and, if
appropriate, cost savings associated with the procedure should be submitted to the
CMD for consideration. It would also behoove providers and their institutions to develop
a list of standard supplies, equipment costs and nonphysician clinical staff requirements
to facilitate consideration of technical component reimbursement.

Your local radiology societies and Carrier Advisory Committee members can be
excellent resources for approaching CMDs due to their frequent access. For additional
information regarding the Carrier Advisory Committee and guidance in contacting your
representatives, please see the SIR website at [Link] and the ACR website at [Link].
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 120

SACRAL AUGMENTATION WITH CAVITY CREATION

Category III codes 0200T and 0201T for percutaneous sacral augmentation
include imaging guidance and bone biopsy to align with the services included in
the comprehensive percutaneous vertebral augmentation codes. An exclusionary
parenthetical has been added restricting the use of codes 0200T and 0201T in addition
to bone biopsy code 20225, when performed at the same level, as this procedure is now
inclusive of these services.

0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s),

including the use of balloon or mechanical device, one or more needles,
includes imaging guidance and bone biopsy, when performed.

0201T Percutaneous sacral augmentation (sacroplasty), bilateral injections,

including the use of balloon or mechanical device, two or more needles,
includes imaging guidance and bone biopsy, when performed.

ATHERECTOMY PROCEDURES ABOVE THE

INGUINAL LIGAMENT
0234T Transluminal peripheral atherectomy, open or percutaneous, including
radiological supervision and interpretation; renal artery.

0235T Visceral artery (except renal), each vessel.

0236T Abdominal aorta.

0237T Brachiocephalic artery trunk and branches, each vessel.

0238T Iliac artery, each vessel.

Category III codes 0234T–0238T were implemented on Jan. 1, 2011, to describe arterial
atherectomy above the inguinal ligaments performed percutaneously and/or through
open surgical exposure. These codes include the work of performing the atherectomy
and the RS&I of the atherectomy procedure.

Unlike the atherectomy codes below the inguinal ligaments (37225, 37227, 37229,
37231, 37233, 37235), codes 0234T–0238T do not include the work of accessing and
selectively catheterizing the vessel, traversing the lesion, embolic protection if used,
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 121

other intervention used to treat the same or other vessels, or closure of the arteriotomy
(by any method).

Therefore, it is appropriate to report separately the catheterization codes, any diagnostic

studies and any other interventions performed during the same session. There are no
atherectomy codes for use in veins including AV dialysis accesses.

RENAL DENERVATION
0338T Transcatheter renal sympathetic denervation, percutaneous approach
including arterial puncture, selective catheter placement(s) renal
artery(ies), fluoroscopy, contrast injection(s), intraprocedural
roadmapping and radiological supervision and interpretation, including
pressure gradient measurements, flush aortogram and diagnostic renal
angiography when performed; unilateral.

0339T Bilateral.

(Do not report 0338T, 0339T in conjunction with 36251, 36252, 36253,
36254).

UTERINE FIBROID RADIOFREQUENCY ABLATION

0404T Transcervical uterine fibroid(s) ablation with ultrasound guidance,
radiofrequency.

CRYOABLATION OF NERVE PAIN

0440T Percutaneous cryoablation, including imaging guidance, upper extremity
distal/peripheral nerve.

0441T Lower extremity distal/peripheral nerve.

0442T Nerve plexus or other truncal nerve (brachial plexus, pudendal nerve.

0505T Endovenous femoral-popliteal arterial revascularization, with

transcatheter placement of intravascular stent graft(s) and closure by
any method, including percutaneous or open vascular access, ultrasound
guidance for vascular access when performed, all catheterization(s)
and intraprocedural roadmapping and imaging guidance necessary to
complete the intervention, all associated radiological supervision and
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 122

interpretation, when performed, with crossing of the occlusive lesion in

an extraluminal fashion.

0505T includes all ipsilateral selective arterial and venous catheterization,

all diagnostic imaging for ipsilateral, lower extremity arteriography, and
all related radiological supervision and interpretation).

Do not report 0505T in conjunction with 37224, 37225, 37226, 37227,

37238, 37239, 37248, 37249 within the femoral-popliteal segment).

(Do not report 76937 in conjunction with 0505T for ultrasound guidance
for vascular access).

Four new Category III codes have been created for anatomic model 3D printing.

0559T Anatomic model 3D-printed from image data set(s); first individually
prepared and processed component of an anatomic structure

+0560T each additional individually prepared and processed component of

an anatomic structure (List separately in addition to code for primary
procedure).

(Use 0560T in conjunction with 0559T).

(Do not report 0559T, 0560T in conjunction with 76376, 76377).

0561T Anatomic guide 3D-printed and designed from image data set(s); first
anatomic guide.

+0562T each additional anatomic guide (List separately in addition to code for
primary procedure).

(Use 0562T in conjunction with 0561T).

(Do not report 0561T, 0562T in conjunction with 76376, 76377).

0581T Ablation, malignant breast tumor(s), percutaneous, cryotherapy,

including imaging guidance when performed, unilateral.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 123

Frequently asked questions

EVALUATION AND MANAGEMENT (E&M) PROCEDURES
Q: What are the defining factors that would allow for use of these interprofessional
telephone/internet/electronic health record consultation codes 99446–99449,
99451?

A: When the patient’s treating or primary physician requests a consultation from a

specialty physician, who has not yet had face-to-face contact with the patient, the
consultant should use codes 99446–99449 or 99451 to report interprofessional
telephone/internet/electronic health record consultation. These codes should be used
when greater than 50% of the time for the interprofessional consultation is spent in
performing data review and/or analysis of the patient’s record.

The patient must be a new patient to the consultant or an established patient with a new
problem or exacerbation of an existing problem. The consultant should not have seen
the patient in a face-to-face encounter within the last 14 days. If the telephone/internet/
electronic health record consultation leads to transfer of care or face-to-face service,
surgery, hospital visit or scheduled office evaluation for the patient within the next 14
days or next available appointment date of the consultant, 99446–99449, 99451 are
not reported.

Do not report codes 99446–99449, 99451 more than once in a 7-day interval for the
same patient.

Communications and time with the patient and/or family related to these services is not
reported with codes 99446–99449. To bill for these services, see telephone services
codes 98966–98969 and Evaluation and Management services 99441–99443. Code
99444 has been deleted. See codes 99421–99423.

Q: What are the requirements for reporting Interprofessional telephone/internet/

electronic health record consultations (99446–99449, 99451)?

A: The written or verbal request, including the reason for the telephone/internet/
electronic health record consultation from the treating, requesting physician must be
documented in the patient’s medical record.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 124

Codes 99446–99449 must conclude with a verbal opinion report and written report
from the consultant to the treating/requesting physician. Code 99451 concludes with a
written report only.

The time spent reviewing laboratory studies, pertinent medical records, imaging studies,
medications, pathology specimens is included in the telephone/internet/electronic
health record consultation and not separately reported with 99446–99449, 99451.

Telephone/internet/electronic health record consultations of less than 5 minutes are

not reportable. However, cumulative time may be counted toward a single code if the
consultation requires more than one date of service during the seven-day period.

Verbal patient consent must be documented in the patient’s medical record for each
consultation and include assurance that the patient is aware of applicable cost-sharing.

Q: What are the requirements for the treating, requesting physician for reporting time
spent requesting and/or communicating with the specialist consultant (99452)?

99452 Interprofessional telephone/internet/electronic health record referral service(s)

provided by a treating/requesting physician or other qualified health care professional,
30 minutes

A: The treating, requesting physician must spend 16–30 minutes in a service day
preparing the referral and/or communicating with the consultant to report code 99452
for the interprofessional telephone/internet/electronic health record referral service.

Code 99452 is allowed to be reported once in a 14-day period.

If the time exceeds 30 minutes, and the patient is present and accessible to the treating,
requesting physician, prolonged service codes 99354–99357 may be reported for time
spent on interprofessional telephone/internet/electronic health record discussion with
the specialist.

If the patient is not present in front of the treating, requesting physician and the
interprofessional telephone/internet/electronic health record assessment and
management service exceeds 30 minutes in a day, non-face-to-face prolonged service
codes 99358, 99359 may be reported by the treating, requesting physician.

Please consult the 2020 AMA CPT® Professional Edition for complete instructions on
reporting all evaluation and management/non-face-to-face services.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 125

Virtual check-ins

CMS has also introduced a new HCPCS code, (procedures and professional services
principally used to be reimbursed for new technology) for “virtual check-ins” with
patients who are unsure if their symptoms warrant an in-office visit. HCPCS code G2012,
allows physicians to be reimbursed for “virtual check-ins that may be “audio-only” (e.g.,
a telephone call between the patient and the physician or qualified health care provider)
or live two-way audio with video. If the virtual check-in does not lead to an in-office visit
and does not occur within 7 days of a prior E&M service by the billing practitioner, it may
be billed as a standalone service.

G2012 Brief communication technology-based service, e.g. virtual check-in, by a

physician or other qualified health care professional who can report evaluation and
management services, provided to an established patient, not originating from a related
E&M service provided within the previous 7 days nor leading to an E&M service or
procedure within the next 24 hours or soonest available appointment; 5–10 minutes of
medical discussion

CENTRAL VENOUS ACCESS PROCEDURES

Q: What is the code for removal of a PICC line?

A: There is no code for removal code of nontunneled catheters as this work is

considered inherent to an E&M service. Report appropriate level of E&M as supported by
documentation. A tunneled PICC line removal is coded as 36589.

Q: How do you code for placement of a tunneled PICC line?

A: The term “tunneled PICC” is commonly being used to describe the placement of a
small-bore catheter, tunneled into the internal jugular vein. Correct coding for insertion
of a central venous access device is dependent on the device site, device type and
patient age. The placement of a small-bore central venous access catheter tunneled into
the internal jugular vein would be considered centrally placed and would be reported
using code 36557 for patients under 5 years of age or 36558 for patients 5 years of
age and older. If ultrasound guidance is necessary to garner vascular access (and the
documentation requirements met as detailed in the code descriptor), code 76937 is
also reported. The use of fluoroscopic guidance for the placement of the central venous
access device is reported using code 77001.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 126

Q: Can the venous angioplasty codes be used to report fibrin sheath disruption during
a central venous catheter procedure?

A: No. Dilating a clot or macerating fibrin sheath with a balloon is not considered to be
dilating a vessel stricture and is not considered to be an angioplasty service. If balloon
fibrin sheath maceration is performed from a separate access, the accurate code to
describe the service is 36595 (mechanical removal of pericatheter obstructive material
[e.g., fibrin sheath] from the central venous device via separate access). See CPT code
75901 for corresponding RS&I.

Q: If multiple obliquities of the target vessel being studied are obtained during
angiography, how are these extra views coded?

A: Multiple views are not separately coded when multiple obliquities of the target
vessel being studied are obtained during angiography. The code for a full and complete
examination includes all necessary views unless otherwise stated. If multiple areas are
examined, however, then these are separately coded. For example, if the abdominal
aorta is studied in an additional lateral projection, only 75625 is coded.

Q: Must one be successful in order to code for a service?

A: No. If one attempts in a serious and bona fide manner to perform a service and is
unsuccessful but has in the attempt performed a lesser service, then the lesser service
is coded. As an example, consider an unsuccessful attempted aortic access from a right
femoral approach (failed because of an iliac occlusion); the service should be coded as
36140 rather than 36200. If an angioplasty of an occlusion is unsuccessful because the lesion
cannot be crossed, then the appropriate access and/or selection only should be coded.
On the other hand, if the lesion is crossed and the angioplasty is performed but with an
unacceptable outcome, then the angioplasty is coded since all the work of the angioplasty
was done. If significant portions of a procedure are performed, but the procedure must be
terminated prematurely due to extenuating circumstances or those that threaten the well-
being of the patient, a –53 modifier (discontinued service) may be used.

Q: How should one report vascular catheterization services when these are performed
through a sheath already placed by another physician?

A: One may still use the coding conventions described in this Update but should use the
modifier –52 to delineate a decreased level of service for the primary access or selection
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 127

code. All codes should not be at a decreased level of service since access is only
achieved once during the typical case, whether performed by the operating physician or
already in place.

Q: How do you code for hybrid angiography-CT systems (CT fluoroscopy)?

A: The CT capabilities of the new hybrid imaging systems are commonly being employed
to garner diagnostic CT imaging studies, as well as to provide imaging guidance for
interventions. Coding will depend on the procedure/service being provided and most
often for diagnostic studies performed, the existing CT CPT codes will be applicable.

When images are obtained for diagnostic purposes, one would report the applicable
anatomic-specific diagnostic CT code. These are differentiated by the use of contrast
with specific codes for studies performed with, without or both “with and without”
contrast. Any diagnostic CT exam provided using these hybrid systems will be expected
to be performed and documented within established clinical standards and guidelines.

The ACR has issued various documents detailing the clinical standards for the
performance of diagnostic CT studies of the brain, head, chest, abdomen and pelvis,
which can be obtained via the ACR website.

For limited or focused diagnostic CT studies, often code 76380 (computed tomography,
limited or localized follow-up study) will be applicable. Code 76380 would typically only
be reported once regardless of the number of localized diagnostic CT studies obtained
during a single therapeutic intervention.

There are also several existing CT guidance codes applicable for describing imaging
guidance and monitoring of an intervention performed using a hybrid fluoroscopy-CT
system when the CT imaging guidance capabilities are evoked, such as the following:

77012 Computed tomography guidance for needle placement (e.g., biopsy,

aspiration, injection, localization device), radiological supervision and
interpretation.

77013 
Computerized tomography guidance for, and monitoring of, tissue
ablation.

75989 
Radiological guidance (e.g., fluoroscopy, ultrasound or computed
tomography) for percutaneous drainage (e.g., abscess, specimen
collection), with placement of catheter, radiological supervision and
interpretation.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 128

For interventions, if fluoroscopy and CT guidance capabilities are used intermittently,

only the most intensive intraprocedural guidance code is reported, which is typically
the CT guidance code. For example, one would not code 75989 two times when both
fluoroscopy and CT imaging guidance are provided in conjunction with placement of
an individual catheter to drain a single abscess. Despite the intermittent use of both
modalities of imaging, 75989 would only be reported once in this scenario.

If both fluoroscopy and CT guidance were used for the placement of a needle, one would
not report 77002 (fluoroscopic guidance for needle placement [e.g., biopsy, aspiration,
injection, localization device]) in addition to 77012; rather, only 77012 is reported.

Additionally, when 3D rendering is indicated and performed that is not considered

inherent to the primary procedure* being reported, use of one of the 3D codes may be
applicable.

76376 
3D rendering with interpretation and reporting of computed tomography,
magnetic resonance imaging, ultrasound or other tomographic modality;
not requiring image post-processing on an independent workstation.

(Use 76376 in conjunction with code[s] for base imaging procedure[s]).

76377 Requiring image postprocessing on an independent workstation.

(Use 76377 in conjunction with code[s] for base imaging procedure[s]).

*Note: 3D rendering is considered inherent to the following codes and

76376/76377 cannot be additionally reported.

(Do not report 76376 or 76377 in conjunction with 31627, 34839, 70496,
70498, 70544–70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225,
73706, 73725, 74174, 74175, 74185, 74261–74263, 75557, 75559, 75561,
75563, 75565, 75571–75574, 75635, 77046–77049, 77061–77063,
78012–78999, 93355, 0523T, 0559T–0562T).

 or CT services provided for which there is not an existing code that accurately
F
describes the service/procedure, the use of an unlisted CPT code may be warranted
(76497—unlisted computed tomography procedure [e.g., diagnostic, interventional]).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 129

Q: Can you charge for 3D rendering with image postprocessing on an independent

workstation (76377) when performing carotid or cerebral angiography?

A: The short answer is yes, you can charge for 3D rendering with image postprocessing
if performed on a separate workstation (76377) when performing carotid or cerebral
angiography. Code 76377 is used to report 3D rendering with interpretation and
reporting of ultrasound, CT or MRI. It is important to note that the images have to be
saved, and all of the criteria for concurrent supervision must be met. This code is not
meant to describe the work done by a technologist without a separate workstation or
the need to take a scanner offline for image processing.

76377 can only be reported once per procedure and medical necessity should
be documented. This code cannot be reported in conjunction with CTA and MRA
procedures since 3D rendering is considered an inherent component of these studies. It
should also not be reported with CT colonography, PET imaging or any nuclear medicine
study. See the parentheticals following codes 76376 and 76377 in the CPT® 2020
Professional Edition codebook for a complete listing of procedures that do not permit
the separate reporting of 3D renderings.

ARTERIAL ACCESS
Q: If the catheter is positioned in the contralateral external iliac for contralateral
leg arteriogram, and then pulled back into the ipsilateral iliac for ipsilateral leg
arteriogram, should it be coded 75710–50 or 75716?

A: 75716 would be the appropriate code for the RS&I, if there is medical necessity and
documentation of that medical necessity to perform a bilateral lower extremity exam.
Selective catheter placement would be coded with the single code 36246, as only one
vascular family was selected.

Q: Do I need to see all the way to the toes to code 75716 when performing a leg
angiogram?

A: The entire leg does not need to be imaged for the bilateral extremity angiography
code (75716) to apply as long as intent is to image beyond the common femorals. One
does not need to use reduced services modifier –52 if imaging is only done to the knees.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 130

Q: How do I code for an arch aortogram, when performed with a thoracic aortogram?

A: One would use codes 36221 and 75605 to report the services described above. Since
CPT code 36221 includes catheter placement of the catheter in the aorta, 36200 would
not be reported.

Q: How do I report imaging and catheterization of a horseshoe kidney?

A: The horseshoe kidney is two kidneys that have fused. There may be five or more
renal arteries in this situation. For coding purposes, if both the right and left halves are
studied, a horseshoe kidney is coded using the bilateral code 36252. The unilateral code
36251 would be reported if only the right or the left half is studied.

Q: How do I code for selective catheterizations (e.g., internal maxillary and facial
arteries) off of the external carotid artery, as in during an embolization for epistaxis?

A: All selective catheterizations, as well as imaging, performed within the external

carotid vascular family are included in the work and value of code 36227. There are
no additional codes to report in this scenario. If bilateral external carotid arteries were
selectively catheterized, one should report 36227–50 (depending on carrier preference).

Q: CPT code 36225 is used when the subclavian or innominate is selected and
imaging of the vertebral circulation is performed. How would one code for selective
catheterization of the subclavian or innominate artery for the purpose of visualizing
the proximal vessel of the extremity only?

A: If selective catheterization is performed of the subclavian or innominate artery, but

imaging is performed of the proximal vessel, then CPT code 75710 with appropriate
selective catheterization code 36215 or 36216 should be used. Code 36225 is specific for
imaging the vertebral circulation and should only be used when vertebral circulation is
imaged.

Q: Can you help me understand the introductory language added to the

cervicocerebral codes?

A: Clarification was made for 2015 that highlights two points for the cervicocerebral
codes: It is now acceptable to use CPT codes 36223 and 36225, in addition to 36224
and 36226, as the base or initial codes for the add-on code 36228 in instances when
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 131

superselective microcatheter angiograms are performed following the lesser selective,

base catheter angiogram.

It is now acceptable to use the CPT codes 75774 and 36218 in the scenario when
additional arteries of the upper extremities and other vascular beds of the neck
are performed in the same session as vertebral angiography. For example, if the
costocervical artery is selected in addition to the vertebral artery, it would be
appropriate to use the bundled code 36226 (for the vertebral) and component codes
36218 and 75774 (for the costocervical artery).

Q: Is abdominal aortogram, CPT 75625, included in the visceral angiography codes for
the celiac and superior mesenteric arteries?

A: Yes, an abdominal aortogram (75625) is included in visceral angiography (75726

angiography, visceral, selective or supraselective [with or without flush aortogram],
radiological supervision and interpretation) when it is performed, and is not separately
reportable.

Q: When I select and perform angiograms of the following arteries in order, how is
it coded: celiac artery (first order), common hepatic artery (second order), right
hepatic or left hepatic artery (third order) and subselective arteriography (beyond)?
I know that the CPT codes for visceral angiography are 36245–36248. If I select and
document arteriography for each successive artery, do I code for each or just the
highest level?

A: Selective and supraselective catheterization codes include catheterization of lesser

order branches in the same vascular family. The hepatic arterial system is considered
a “vascular family” with the parent being the celiac artery. Assuming all vessels were
selectively catheterized, and injections were made in each vessel (celiac, common
hepatic, right or left hepatic, and supraselective branches) in the same session,
one third-order code (36247) plus one visceral angiography S&I code (75726) are
reported for this service. The add-on CPT code 75774 would be reportable for the
additional selective angiograms if they are diagnostic in nature and supported in
your documentation. The add-on CPT code 36248 is used when additional second-
or third- order branches are selected within the same vascular family. For example,
if you selected the right and left hepatic branches, then 36247 and 36248 would be
reportable. The number of times 36248 and 75774 can be reported together depends on
actual number of vessels selectively catheterized, injected and documented both in the
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 132

medical record and in the image archive. Note that documentation of the catheterization
includes description of the catheter location in the operative note and the S&I includes
imaging archival and an interpretation of the angiographic images (description of what
the angiographic images demonstrated) in the medical record. If either documentation
requirement is absent, then the respective code may not be reported.

VENOUS
Q: Are selective catheter placements and venography reportable when performing
bilateral main renal vein renin samples with venography and peripheral sampling?

A: No, selective catheter placements and venography are not reportable when
performing bilateral main renal vein samples with venography and peripheral sampling.
The NCCI edits exclude billing for a selective venous catheterization access code when
using 36500. Therefore, 36011 should not be billed. Likewise, RS&I codes associated
with diagnostic venogram (75831 or 75833 for renal venography) should not be
reported. The procedural code for renal vein renin sampling (36500) should be used for
each organ selected but is not used for nonselective sampling from the IVC. The RS&I
code for venous sampling (75893) is likewise used for each selective organ sampled and
includes venography. Code 36500 is not coded multiple times when multiple samples
are obtained from the same organ through the same access site. When separate and
distinct samples from separate organs are obtained, code 36500 should be used for
each organ sampled.

DIALYSIS CIRCUIT
Q: What if I am asked to perform a dialysis circuit evaluation on a patient who is
coming to me directly from the dialysis unit with needles already in place within the
graft?

A: Report code 36901 with modifier –52 when a dialysis A-V circuit evaluation is
performed through existing access that has been placed outside of the angiography
suite (e.g., if the patient presents from dialysis with needles placed within the graft or
fistula, and contrast is injected through the needle to image the graft and its outflow).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 133

Q: How do I code for a dialysis circuit evaluation (shuntogram, graftogram) when

performed in conjunction with an intervention to treat a thrombosed or jeopardized
hemodialysis access graft?

A: CPT code 36904 includes the work of all punctures into the thrombosed graft
or fistula, as well as the imaging to the central outflow vein performed during the
procedure. This code also includes all methods of percutaneous removal of a clot from
the dialysis access to restore patency: any type of mechanical thrombectomy, Fogarty
maneuver and use of thrombolytic agents within the circuit, regardless of the technique
for infusion such as “lyse and wait,” pulse spray, bolus injections and prolonged
infusions.

It also includes all means of removing the arterial plug by any method. The thrombolysis
codes (37211–37214) would only be used if the patient left the department with lysis
catheter in place.

Q: Through two separate arteriovenous fistula or graft accesses, a physician diagnosed

and treated two different obstructions—one at the arterial anastomosis and one in the
subclavian vein. Is this reported with two percutaneous transluminal angioplasties
(PTAs)—one arterial and one venous—or only a venous PTA? For coding purposes,
where is the transition between artery and vein in an arteriovenous dialysis access?

A: Extensive guidance is provided in the CPT Professional Edition that addresses coding
of the dialysis circuit. For the purposes of AV access interventions, the AV access is
divided into two vessel segments; the peripheral dialysis segment and the central
dialysis segment. The peripheral dialysis segment is the portion of the circuit that begins
at the arterial anastomosis and extends through the axillary or cephalic veins.

Furthermore, the perianastomotic region (the short segment of the circuit immediately
adjacent and encompassing a short segment of the parent artery) is also included
within the peripheral segment of the circuit. The central dialysis segment includes the
subclavian and innominate veins through the SVC. Therefore, in the scenario above,
CPT code 36902 would be reported to account for the PTA at the arterial anastomosis
(which includes all PTA performed in the peripheral segment). In addition, the add-on
code 36907 would be reported for the PTA for the subclavian vein. The current coding
conventions would not allow for separate reporting of arterial PTA code (new CPT
code 37247) in this scenario. Only when a stenosis within the native arterial system is
identified and treated would reporting of 37247 be appropriate.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 134

Q: A patient presents with poor right upper arm dialysis graft function. Access
towards the arterial and venous anastomoses is obtained and an arteriovenous circuit
evaluation is performed. To further examine arterial inflow, a catheter is advanced
beyond the arterial anastomosis into the axillobrachial artery and angiography is
performed. Is the catheterization of the native artery considered a part of the initial
access code 36901?

A: In this scenario, because the catheter is advanced beyond the arterial anastomosis/
perianastomotic region, the selective catheterization of the native artery is reported
separately. It is appropriate to report code 36215 for selective catheterization of the
upper extremity or 36245 for selective catheterization of the lower extremity in addition
to CPT code 36901.

Q: A patient presents with increased pulsatility of a right upper arm arteriovenous

fistula. Direct fistula access towards the venous outflow is obtained and diagnostic
fistulogram is performed revealing superior vena cava (SVC) stenosis. The size of
the balloon needed to treat this lesion requires a sheath too large to safely place into
the current fistula access. Subsequently, access into the right internal jugular vein is
achieved and SVC angioplasty is performed. How should this be coded?

A: CPT code 36901 would be reported to account for the direct access and diagnostic
fistulogram performed. It is also appropriate to report CPT code 36010 to account for
catheter or device placement into the SVC since it is via a separate access site, as well as
the CPT code for venous angioplasty, 37248. A modifier may be necessary to indicate to
the payer that a distinct procedure was performed. The use of the add-on code 36907
would not be appropriate in the scenario because the angioplasty was not performed
through the dialysis circuit.

Q: The CPT® Professional Edition states that the work of all catheterizations during
dialysis AV shunt are included in CPT code 36901 but also goes on to explain some
exceptions. Are the selective catheterizations of multiple side branches performed
during an embolization reportable?

A: No. CPT code 36901 includes catheterization of additional venous side branches or
accessory veins. If embolization is performed, then the add-on code 36909 would be
reported in conjunction with 36901. 36909 is reported once per session, regardless of
the number of branches embolized.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 135

VASCULAR INTERVENTIONS
Q: How would the following be coded? A diagnostic aortogram and runoff angiogram
of the left lower extremity is performed via retrograde puncture of the right common
femoral artery. Based on diagnostic angiographic findings, an antegrade left femoral
puncture for SFA recanalization followed by SFA angioplasty and stenting is then
performed.

A: In this scenario, the first (retrograde) access that was obtained was for diagnostic
purposes and is separately reportable with the appropriate modifier: 36246–59 for
this case. Additionally, if full and complete diagnostic angiograms are performed and
appropriately documented, the RS&I codes 75625–59 and 75710–59 would be reported
as well as the appropriate lower extremity revascularization code (37226 in this case).
Code 37226 includes catheter placement; therefore, the antegrade left femoral access
would not be reported.

Q: How would I code for the following? Diagnostic arch aortogram and bilateral
selective common carotid angiograms are performed, supporting indication for, and
performance of, right cervical carotid stent placement using an embolic protection
device.

A: Code 37215 would be used for the cervical carotid stent placement code, which
includes the following services for the vessel being treated:

• Selective carotid catheterization

• All road-mapping angiograms (including arch angiogram, if necessary to repeat,

and intracranial views) and all radiologic supervision and interpretation related to
the ipsilateral carotid angiogram and stent placement

• All angioplasties within the stent target zone

• Preparation and deployment of the stent

• Placement, deployment and retrieval of embolic protection device

The diagnostic study and catheterization of the vessel not being stented is separately
reportable when clinically necessary and when no recent previous angiogram is
available. Even though bilateral cervical diagnostic studies were provided, only the
appropriate bundled code for the vessel not being stented is reportable. In this case,
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 136

36222–59 would be coded for the left, which also includes imaging of the aortic arch
when performed. RS&I modifier –59 must be appended to the diagnostic angiography
codes to signify that a separate site other than that of the cervical carotid stent
placement is being examined.

Q: If a diagnostic arch aortogram is performed prior to placing a carotid stent, can I

code 36221?

A: While the carotid stenting codes (37215–37218) include all ipsilateral imaging and
selective catheter placement, it would be appropriate to code for 36221 if a full and
complete diagnostic arch study is performed and reported. It is recommended that one
should append a –52 (reduced service) modifier to CPT code 36221 since it is a bundled
code that includes the work of catheterizing the aorta.

Q: When diagnostic and therapeutic interventional radiology services are provided at

the same session, how is this reported?

A: Clear delineation between diagnostic RS&I services and RS&I services provided during
the therapeutic intervention must be provided.

Page 487 of the 2020 CPT® Professional Edition describes in detail the scenarios in which
diagnostic angiograms are billable with transcatheter therapies. In general, it would be
considered appropriate to bill for the diagnostic angiography in the following scenarios:

1) no prior or recent study is available to guide therapy, 2) the patient’s condition

has changed, 3) the treatment plan may be affected, 4) other vessels may
be identified for treatment, or 5) further establishment of a diagnosis from a
noninvasive study is necessary. In these scenarios, a –59 modifier should be added
to the diagnostic services to identify them as a distinct service.

All services should be documented in the patient’s written record. Therefore, the exact
nature of the procedural (surgical) services should be clearly delineated. If services
are combined into one report, the individual types of services (surgical, radiological,
management) should be clearly separated and identified in the body and impression of
the report. Alternatively, separate reports may be generated for each of the services.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 137

Q: What are the proper codes for a stent-assisted coiling of a right supraclinoid ICA
aneurysm? Are multiple follow-up angiograms billable if performed?

A: If a complete, diagnostic angiogram was performed prior to the embolization, then

assign the appropriate cervicocerebral code; in this case, 36223 or 36224. If prior
imaging was available and diagnostic angiograms are not performed, then report the
catheterization of the right carotid intracranial system with code 36217 for third order
selective catheterization. Coding for the coil embolization of an intracranial aneurysm is
best described as 61624, transcatheter occlusion (tumor destruction, hemostasis, etc.)
CNS; 75894, the RS&I code for embolization, and 75898, the RS&I code for completion
angiography, should also be reported. If appropriately indicated and documented,
multiple follow-up angiograms performed intermittently during embolization of the CNS
are reportable.

Q: If mechanical thrombectomy is performed on a totally occluded synthetic femoral-

popliteal graft, as well as within the native popliteal artery, is this coded once with
37184?

A: In this scenario, CPT codes 37184 (primary thrombectomy, initial vessel) and 37185
(primary thrombectomy, subsequent vessel) would be reported because the native
vessel is considered an additional, separate vessel than graft.

Q: Is catheterization additionally reportable in conjunction with the endovenous

ablation therapy codes, 36475–36476 and 36478–36479?

A: No. Endovenous ablation therapy is performed using specialized catheters and

placement of these catheters is considered inherent. Additionally, ultrasound used to
guide and monitor EVAT is considered an inclusive service and intraoperative ultrasound
(76998) and ultrasound guidance for vascular access (76937) are not separately
reportable. Additionally, one may not report codes 93970–93971 describing extremity
venous duplex imaging for the imaging services associated with the guidance and
monitoring of endovenous ablation.

However, there may be occasions when a patient requires a diagnostic extremity

Doppler ultrasound on the same day as the endovenous ablation. In this case, one should
separately report the diagnostic study using code 93970/93971. CMS requires modifier
use for such claims signifying the provision of a separate and distinct diagnostic service.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 138

Q: Are multiple lesions within the same vessel or a long lesion within the same vessel
treated with angioplasty coded with multiple angioplasty codes?

A: No, any necessary angioplasty within a single vessel is coded with only one procedural
angioplasty and one RS&I angioplasty code. Multiple vessels treated at the same operative
setting are coded separately. In the new lower extremity revascularization (LER) codes,
the femoral and popliteal vessels are one vessel. Similarly, the tibioperoneal trunk is not
considered a separate distinct vessel from the peroneal and PT.

Q: When there are multiple indications for embolization—e.g., a bleeding

gastrointestinal tumor—which code is reported?

A: The code for the most acute indication should be reported. In the example above,
code 37244 would be reported because the most acute indication is hemorrhage.

Q: When a stent is used for embolization or occlusion, is the embolization code or the
stent code reported?

A: Depending on the circumstance, either the embolization code or the stent code is
reported. If stent-assisted coil embolization is performed (the stent is placed to provide a
latticework for subsequent deployment of coils), only the embolization code is reported.

If a covered stent is deployed to exclude a site of extravasation, only the stent code is
reported. For example, treating an aneurysm with stent-assisted coil embolization would
be reported using code 37242, while treating an aneurysm by deploying a covered stent
to prevent flow into the aneurysm would be reported using the appropriate stent code.

Please note that, like the embolization codes, the intravascular stent placement codes
(37236, 37239) include RS&I.

VASCULAR EMBOLIZATION
Q: When several accessory veins of an upper-extremity arteriovenous fistula are
embolized in a single session, are the embolizations considered to be in one or
multiple surgical fields?

A: One upper extremity is considered one surgical field, so whether one or four
accessory veins are embolized, only one embolization code (37241) is reported for this
encounter.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 139

When transcatheter embolizations of the accessory veins are performed, then the
selective catheterizations are reported separately.

Q: Is code 37241 used to report sclerosis of telangiectasia or extremity veins, or to

report endovenous ablation of incompetent extremity veins?

A: No. The embolization codes are not used to report these services. Venous sclerosis
of telangiectasia or extremity veins and endovenous ablation of incompetent extremity
veins are reported using codes 36468, 36470, 36471, 36475–36479.

Q: Is it acceptable to use CPT 37241 for embolization or occlusion of a lymphatic

malformation or other lymphatic (non-extravasating) lesions?

A: Yes, 37241 is acceptable to use for lymphatic malformation embolization. The

introductory language to the embolization codes implies this and it was in the intention
of CPT code 37241. The October 2014 issue of the AMA’s coding reference newsletter,
CPT Assistant, also affirmed coding 37241 for lymphatic malformations.

Q: Is embolization for pelvic congestion considered one or two surgical fields? Also,
how do I code for the diagnostic venograms that are performed during pelvic/gonadal
venography?

A: The answer depends on what veins are embolized to achieve retrograde occlusion
of the pelvic venous system. If bilateral gonadal veins are embolized in the distal
pelvis, closer to where the left and right systems meet, this may be considered one
surgical field (analogous to an embolization for uterine fibroids) and 37241 would be
reported once. However, if the central outflow portion of the bilateral gonadal veins
are embolized, this would be considered two separate surgical fields (analogous to a
bilateral renal artery embolization) and 37241 should be reported twice.

When performing venography assessing female pelvic congestion syndrome, there

is often selective catheterization and study of the iliac, hypogastric and sometimes
femoral veins because these patients often have vulvar, labial, thigh and/or gluteal
varices as well as pelvic symptoms. This procedure is most correctly coded as extremity
venography (75820–75822) with the appropriate catheterization codes.

Selective left gonadal venography should be coded as 36012 and 75831, since the left
gonadal vein in males and females is typically a branch of the left renal vein. Selective
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 140

right gonadal venography is more difficult to code, since the right gonadal vein typically
arises directly from the inferior vena cava (therefore a first-order selective code
36011) and does not typically include a renal venogram; therefore, it does not have a
corresponding RS&I code.

Q: Is code 37242 used to report injection procedures for percutaneous treatment of

extremity pseudoaneurysms (e.g., thrombin injection into an iatrogenic femoral artery
pseudoaneurysm)?

A: No. This service is excluded from code 37242 and is reported using code 36002
(Injection procedures [e.g., thrombin] for percutaneous treatment of extremity
pseudoaneurysm).

Q: Given that code 37210, previously used to report uterine artery embolization, has
been deleted, which of the embolization codes is used to report this service?

A: Code 37243 is now reported for uterine artery embolization. Selective

catheterizations needed to perform the embolization should be reported separately.
Emergent uterine artery embolization, such as in the setting of postpartum hemorrhage,
would be reported with code 37244.

Q: When an osseous metastasis is embolized preoperatively, typically multiple

branches originating from different arteries are embolized on a single session. Are the
embolizations considered to be in one or multiple surgical fields?

A: If one metastasis is located in one surgical field, only one embolization code (37243)
is reported for this encounter regardless of how many branches are embolized. The
selective catheterizations are reported separately.

Q: When chemoembolization is performed (e.g., conventional transarterial

chemoembolization or chemoembolization with drug-eluting beads), what codes are
reported to capture the work of the embolization and of administering chemotherapy?

A: In addition to the embolization code 37243, code 96420 is reported to capture the
work of intra-arterial chemotherapy administration.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 141

Q: Sometimes the diagnostic arteriograms performed prior to hepatic

chemoembolization reveal a vessel at risk for nontarget embolization (e.g.,
cystic artery, GDA). This vessel may be coil embolized prior to proceeding with
chemoembolization. Are two embolization codes (37242 and 37243) reported in this
setting when performed in the same session?

A: No. The code for the most acute indication (tumor chemoembolization) should
be reported (37243). Coil embolizing of the vessel at risk is not separately reported
because it involves an embolization on the same surgical field as the tumor (the area
immediately surrounding and directly involved in a treatment/procedure). However,
selective catheterizations needed to perform the embolizations should be reported
separately.

Q: When radioembolization is performed (e.g., with yttrium-90 [Y-90] resin particles,

Y-90 glass particles), what codes are reported to capture the work of the embolization
and of administering a radioactive source? What about treatment situations where the
IR is not the Authorized User (AU)?

A: Y-90 (radioembolization) procedures include an embolization component and

reporting of this work was affected by the 2014 embolization codes. The actual delivery
of the therapeutic radiopharmaceutical is performed as the terminal event of an
extended clinical and imaging evaluation of the proposed patient. The radioembolization
process typically includes a diagnostic arteriogram for delineating tumor vascularity and
assessing the embolic risk to potential nontarget vascular beds. The nontarget vascular
beds are prophylactically embolized several days prior to potential radiopharmaceutical
administration. High-dose treatment therapy is then simulated by injection of low-dose
Tc-99m MAA. Complex radiation therapy planning, volume calculations and dosimetry
calculations ensue that can be reported separately. Only after all this evaluation is a
decision to treat with radiotherapy made. A final procedure is then performed to deliver
the radiopharmaceutical resin or glass microspheres.

First stage: In a typical scenario, a patient will first be evaluated by conventional

diagnostic angiography to assess tumor vascularity arterial-portal shunting, variant
anatomy and potential nontarget embolization vascular beds. All catheter placements
and diagnostic imaging for this first session are separately reportable with the
appropriate selective catheterization codes (36245–36248) and associated RS&I codes
(75726 and 75774, if appropriate). If the hepatic arterial tree is proven to be conducive
to Y-90 therapy in the future, a decision may be made to embolize vessels like the
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 142

right gastric artery and the gastroduodenal artery to mitigate the risk of nontarget
embolization of subsequently administered Y-90. CPT code 37242 would represent the
work of the embolization in this setting. Note that this embolization is considered to take
place in one “operative field” so even when more than one vessel is embolized, only a
single embolization code is reported. Also note that angiography performed during and
following the embolization is an included service within the new embolization codes and
is not separately billable. This session is completed by intra-arterial administration of Tc-
99m MAA to simulate planned Y-90 therapy (the simulation injection is not considered
an embolization and is separately reportable with CPT 77290).

Second stage: Considerable preparation is required prior to delivery of brachytherapy,

and there are additional codes that can be used by the physician responsible for these
services. Institutions licensed to administer these agents must have a licensed AU. This
physician is responsible for the pre-procedure preparation work and the delivery of
brachytherapy. The complex therapeutic radiology treatment planning CPT code 77263
is reported when the AU utilizes the following data in the planning for dose and timing
of treatment: angiographic studies, cross-sectional imaging, previous treatment, the
Tc-99m MAA scan, as well as 3D reconstruction imaging to plan the treatment of Y-90
delivery. Documentation must include how each of these studies was used in planning
to support the use of code 77263. The AU responsible for safe handling, receipt,
accounting and storage of the Y-90 dose can report code 77790 (supervision and
handling of a radiation source). Per NRC regulations, a record of the Y-90 dose in the
facility or office must be documented and is an included expectation in the 77790 code.

Third stage: When the patient presents for the day of the procedure, the angiograms
performed in the treatment session can simply be confirmatory if no change in
hepatic arterial flow is expected. In this case, the associated RS&I codes should not be
billed since they were performed in the preplanning session. However, in the current
multimodality treatment algorithm, previous systemic chemotherapy and previous
embolization therapy are common; therefore, diagnostic angiography (CPT codes 75726
and 75774, if appropriate) is warranted to identify new vascular flow patterns, the
effect of chemotherapy on vessels and to ensure safe distribution of radioembolization
therapy. Additionally, all selective catheter work performed in this session is separately
billable (36245–36248); note that the single, final catheter placement in each artery
catheterized is reported. Do not report for multiple recatheterizations of the same
vessel in a single setting. Once the appropriate artery selection is achieved, the Y-90
dose is delivered, monitored with fluoroscopy and angiographic sequences as needed
to document progress and completion of the therapy. This is reported with the
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 143

embolization code 37243 as well as 79445 (intra-arterial particulate administration) to

represent the work of delivering the radiopharmaceutical dose.

IR not the AU: Alternative coding conventions may be appropriate in the scenario when
the IR involved is not an AU to deliver microsphere therapy. A second, licensed physician
(acting as the AU) may be involved in the planning and delivery of the Y-90 dose.

In this two-doctor model of treatment, CPT code 77778 describes the work of
application of an interstitial radiation source (complex). If the second physician—the
AU—has material involvement in the planning, dosimetry and administration of the
microspheres, CPT code 77778 may be used. These codes should not be reported by
an authorized user for intraoperative work with another physician who surgically places
catheters interstitially unless the authorized user also applies the radiation source at the
same patient encounter. Additionally, if the AU is billing 77778, CPT code 79445 should
not be billed in that same encounter.

Q: When a patient is brought for the preparatory radioembolization procedure (e.g.,

phase I, angio-prep), multiple vessels are typically embolized (e.g., gastroduodenal
artery, right gastric artery) to avoid nontarget embolization. Are multiple
embolizations reported in this setting?

A: No. The embolization code (37242) should be reported only once, since all the vessels
embolized are in the same surgical field (i.e., the area immediately surrounding and
directly involved in a treatment/procedure). However, selective catheterizations needed
to perform the embolizations should be reported separately.

Q: If a multitrauma patient presents with bleeding from the pelvis and the spleen, and
both sites are embolized in the same session, are multiple embolizations reported?

A: Yes. In this setting, two embolization codes (37244) are reported with the
appropriate modifier (e.g., modifier –59) because the pelvis and the spleen are two
different surgical fields. The codes for catheter placement are reported separately as
well as any imaging used for diagnostic evaluation.

Q: A patient presents with a lower GI bleed localized by colonoscopy to the region

of the splenic flexure. Superior mesenteric and inferior mesenteric arteriograms are
performed, and the bleeding site is not identified. The operator proceeds to super
select branches of the left colic artery in an attempt to identify the bleed. One of the
superselective arteriograms identifies the bleed, and the branch is coil embolized.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 144

Are the inferior mesenteric arteriogram and all superselective left colic arteriograms
reported separately, or are they bundled into the embolization code?

A: In this scenario, the superior mesenteric arteriogram, inferior mesenteric arteriogram

and superselective arteriograms of left colic branches performed for diagnostic purposes
are reported separately using the corresponding codes with any appropriate modifier
(e.g., modifier –59). Once a decision has been made to treat with embolization, all
subsequent imaging is included in the embolization codes and is considered guidance
for the embolization procedure.

Q: Can I use one the new embolization codes (37241–37244) to report gelfoam
injection for biopsy tract closure?

A: No. Any maneuvers to close a biopsy tract is considered incidental to the biopsy
procedure and should not be separately coded.

MISCELLANEOUS VASCULAR INTERVENTIONS

Q: How would the following be coded? Diagnostic arteriogram of the abdominal
aorta and bilateral lower extremities are performed. Angioplasty of the contralateral
popliteal artery stenosis and recanalization of an occluded tibioperoneal trunk and
posterior tibial artery are performed with atherectomy followed by stent placement in
the tibioperoneal trunk.

A: Use codes 75625–59, 75716–59, 37231, 37224. Diagnostic imaging is not included
in the lower extremity revascularization codes and may be separately reported as long
as the requirements set out by CPT are met. Those requirements are described in detail
under the above codes in this coding update.

In this case, an aortogram (75625) and the bilateral lower extremity arteriogram (75716)
are performed and interpreted. The decision to perform an intervention is then based
on these findings so that the diagnostic procedure is separate and distinct from the
intervention and, therefore, the –59 modifier is necessary. The interpretation of the
arteriogram and the justification for the intervention should be clearly defined in the
report. If the same access was used for the intervention and the diagnostic arteriogram,
no additional catheter code is used. However, if the intervention is performed from an
access separate from the diagnostic arteriogram access, the appropriate catheterization
code for the diagnostic study would also be reported with a –59 modifier. Code 37224 is
used for the angioplasty of the popliteal artery lesion. If stent placement was performed
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 145

at the popliteal segment, then the angioplasty would not be coded separately, but only
the stent placement (37226) would be coded.

Code 37231 includes all the interventions performed to recanalize the tibioperoneal
trunk and posterior tibial artery, including the atherectomy and stent (and angioplasty if
performed). No additional codes if distal embolic protection is employed.

Q: When using the Category III codes for atherectomy of the iliac artery (0238T),
the catheter placement is separately reportable. If we perform a common iliac artery
angioplasty (CPT code 37220) in combination with atherectomy in the same iliac
vessel, are we allowed to charge for the catheter placement?

A: If performed in the same vessel and through the same access site, the answer would
be no, the catheter placement is not separately reportable. However, if the interventions
are performed in opposite iliac arteries, via separate access sites or if a more selective
catheter placement was obtained to perform the atherectomy, then the appropriate
catheter placement code would be billable. Keep in mind that the use of a modifier may
be necessary to avoid denials.

Q: How are selective catheterizations of the renal veins to delineate anatomy during
IVC filter placement coded?

A: Selective catheterizations of the renal veins to delineate anatomy during intravascular

vena cava filter placement are not separately reportable and this service would be
reported using CPT code 37191. Vascular access and vessel selection are included in
code 37191.

Q: What code should be reported to describe the placement of IVC filters when placed
in a duplicated IVC?

A: Report code 37191 twice to describe the placement of two vena cava filters in a
duplicate IVC system. Use modifier –59 with the second code to denote to the payer
that this is a separate and distinct study and to ensure appropriate reimbursement.

Q: Can you define “initial treatment day” for the thrombolytic therapy codes that were
introduced in 2013 (CPT codes 37211 and 37212)?
 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 146

A: The definition of “initial day” is a calendar day; therefore, if a patient is brought back
to the suite within the same calendar day, the second setting is not billable.

Q: I know that TIPS is a bundled procedure, but is embolization separately billable if

performed during a TIPS procedure?

A: Yes, one would code the appropriate embolization code. See codes 37241 or 37244,
depending on the indication for the embolization.

ENDOVASCULAR ANEURYSM REPAIR

Q: Can I code for stenting an external iliac outflow stenosis during an endovascular
abdominal aneurysm repair?

A: Yes, with the proper documentation, CPT code 37221 (iliac stent, including
angioplasty) could be used in this scenario because the stenosis is outside of the
treatment zone and unrelated to the repair of the aneurysm.

Q: How do I code for internal iliac artery embolizations at the time of EVAR?

A: Embolization performed at the time of an endovascular repair of an aneurysm

(thoracic endovascular aortic repair [TEVAR] and endovascular aneurysm repair
[EVAR]), including embolization of a hypogastric artery, is separately billable.

Code 37242 and typically 36245 are both appropriate to report this procedure. Use
of a selective catheter placement code for embolization obviates the use of 36200 for
placing a catheter in the aorta under coding convention rules. Typically, a second aortic
catheter placement is performed via a separate access site, which is reportable.

Q: If I place two extension cuffs in the same vessel to treat endoleak of an AAA
endoprosthesis, after initial endograft placement, how many times can I report 34709?

A: Cuff placement services are reported per vessel treated, not per cuff or device
placement, therefore 34709 would be reported once. However, if extensions are placed
in separate vessels (for example, the right and left iliac arteries), then would be reported
also. See codes 34710 and 34711 for extensions placed in a delayed setting.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 147

NONVASCULAR INTERVENTION
Q: How do I code for the dilatation of distal ureter?

A: Dilation of ureter is reported using the add-on code 50706. This code should be used
in conjunction with 50382, 50384, 50385, 50386, 50387, 50389, 50430, 50431, 50432,
50433, 50434, 50435, 50684, 50688, 50690, 50693, 50694, 50695, 51610.

Q: How does one code for a percutaneous transhepatic cholangiogram with external
biliary drain placement?

A: Code 47533 describes the work of external biliary drain placement and includes
diagnostic cholangiography and imaging guidance.

Q: When a patient returns at a later date for conversion of their external biliary drain to
an internal-external drain, is this coded as an exchange?

A: Code 47535 describes the conversion of an external biliary drain to an internal-external

biliary drain. This code includes diagnostic cholangiography and imaging guidance.

Q: How do I code for tunneled pleural or peritoneal catheter placement?

A: These tunneled, cuffed catheters are used for vacuum bottle assisted removal of fluid
from either the pleural or peritoneal spaces. After placement, this subsequent removal
can be performed by the physician, nurse or even properly instructed patient.

Placement of a tunneled cuffed catheter is typically coded as follows:

Tunneled peritoneal catheter placement: Code 49418 is used to report the initial
placement of a tunneled peritoneal catheter and it includes all imaging guidance.
Code 49422, removal of permanent peritoneal catheter, should be used to report
the subsequent removal of a tunneled peritoneal catheter.

Tunneled pleural catheter placement: Code 32550, insertion of indwelling

tunneled pleural catheter with cuff, along with 75989 when imaging is performed,
should be used to report the initial placement of a tunneled pleural catheter. Code
32552, removal of indwelling tunneled pleural catheter with cuff, should be used to
report the incisions and subcutaneous dissection of the indwelling cuff to remove a
tunneled pleural catheter. Subsequent encounters in which fluid is removed by the
physician should be reported with the appropriate E&M codes.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 148

Q: How do I code for paravertebral facet joint injections at L2-L3 and L3-L4 performed
under fluoroscopic guidance?

A: Code 64493 accounts for the first level performed and includes the imaging guidance
used for the procedure. Code 64494 accounts for the second level performed and also
includes the imaging guidance. Code 64494 is an add-on code and can only be used
when 64493 is used as well. Moderate sedation is reported separately when performed.

Q: What are the appropriate codes to report for sclerotherapy of nonvascular

structures, such as seromas, cysts, lymphoceles or abscesses?

A: Code 49185 was introduced in 2016 for sclerotherapy of fluid collections, such as
those mentioned above. This code does not include placement of the catheter within
the collection, which should be separately billed. Note that there is a difference between
lymphocele and lymphatic malformations, this code is not intended for use highly
complex lymphatic malformations.

Q: What are the appropriate codes to use when microwave ablation is the energy
source used for liver, lung or renal lesions?

A: The existing CPT codes for tumor ablation are defined for radiofrequency ablation.
This definition has led to some confusion, occasionally resulting in the use of unlisted
procedure codes for microwave ablation. SIR does not recommend the use of unlisted
procedure codes for microwave ablation of kidney, lung or liver tumors. Microwave is
part of the radiofrequency spectrum and uses a different part of the radiofrequency
spectrum to generate heat energy to destroy abnormal soft tissue. Microwave ablation
equipment is substantially comparable to operate in practice, which is also reflected
in the FDA approval of microwave devices under the 510(K) clearance process as
equivalent to radiofrequency. As such, SIR recommends that CPT codes 32998, 47382,
and 50592 be used for both microwave and radiofrequency ablation in their respective
anatomic locations, in conjunction with the appropriate imaging guidance code, if
imaging is separately reportable.

47382 
Ablation, one or more liver tumor(s) percutaneous, radiofrequency; with
appropriate image guidance code: 77013 (CT), 77022 (MRI), 76940 (US).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 149

32998 
Ablation therapy for reduction or eradication of 1 or more pulmonary
tumor(s) including pleura or chest wall when involved by tumor
extension, percutaneous, radiofrequency including imaging guidance
when performed, unilateral; radiofrequency.

(Do not report 76940, 77013, 77022 in conjunction with 20982, 20983,
32994, 32998).

50592 
Ablation, one or more renal tumor(s), percutaneous, unilateral,
radiofrequency; with appropriate image guidance code: 77013 (CT),
77022 (MRI), 76940 (US).

Q: How many times should a biopsy code be used when multiple passes are made to
obtain tissue from a lesion?

A: If only core biopsies are obtained, then a single core biopsy code for the lesion
in question should be used. If core and aspiration biopsies are performed, then the
appropriate core biopsy code should be used together with the appropriate aspiration
biopsy code. If two separate lesions in two different organs are sampled during the
same patient encounter, then multiple biopsy codes should be used corresponding with
the number of different organs investigated. If multiple lesions within a single organ are
sampled (such as multiple liver lesions) then one might consider appending the modifier
–22 to the code (47000 for a core liver biopsy).

Q: Do you have to leave a catheter in place with the abscess drainage codes (10030,
49405–49407)?

A: Yes, the intention of the codes 10030, 49405–49407 was that a catheter would be
secured and remain in place when the patient left the imaging suite. These codes should
not be used when a catheter (e.g., Yueh or Skater) is placed and removed in the same
setting. These codes include all imaging guidance that is used in the placement of the
drainage catheter.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 150

Q: There were new myelogram codes introduced for 2015, but the old codes weren’t
deleted. Why?

A: It is believed there is still a need for the ability to report injection and the imaging
supervision when these are separately performed by two different physicians. Therefore,
the component coding remained. If both the injection and the imaging guidance are
performed by the same provider, then that provider must report the bundled codes
(62302–62305).

Q: Does code 50693 include the replacement of the existing nephrostomy tube
following the placement of the ureteral stent?

A: Yes. CPT code 50693 includes all drainage catheter manipulations and exchanges
(when performed), as well as diagnostic nephrostograms and/or ureterograms (when
performed), imaging guidance (e.g., ultrasonography and/or fluoroscopy) and all
associated radiological supervision and interpretation. Do not report code 50435 in
conjunction with 50693.

Q: Can I report 50706 for ureteral dilation for each lesion dilated in the ureter?

A: No, this code should only be reported once per ureter, regardless of the number of
treated lesions within the ureter.

Q: How does one code for the initial placement of a ureteral stent via an ileal conduit?

A: Retrograde ureteral stent placement via an ileal conduit access is atypical to be

performed without cystoscopic guidance. Therefore, when this procedure is performed
using fluoroscopic guidance, the unlisted procedure code 53899 should be used to
report this service.

Q: We do contrast injection for each epidural steroid injection we perform just to

confirm we are in the epidural space. Is this formal epidurography and should we be
coding 72275 for all of these injections?

A: When performing contrast injection only to confirm location of the needle, one
should not code for formal epidurography. In these instances, it is appropriate to code
62321, 62323, with imaging guidance (i.e., fluoroscopy or CT). Do not report 62323
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 151

in conjunction with fluoro guidance (77003), CT guidance (77012) or US guidance

(76942). 62310 and 62311 have been deleted.

Formal epidurography, rather, is coded with 72275, which includes 77003. Therefore,
77003 should not be additionally coded when performing formal epidurography. 72275
should only be used when an epidurogram is performed for diagnostic purposes (e.g.,
assessing flow of contrast to assess area[s] of scarring, nerve constriction or possible
nerve inflammation, images are documented, and a radiologic report is issued describing
the findings of the epidurogram).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 152

Individual coverage request sample

letters
The following are examples of a few common coverage request letters. The examples
include letters for coverage for radiofrequency ablation of pulmonary tumor(s), ovarian
vein embolization for pelvic congestion syndrome and MRI imaging of the uterus prior
to uterine fibroid embolization. These templates include data, arguments for need and
benefits and can save you considerable work. Please contact SIR staff to provide you
with easily editable versions of these letters.

Ovarian vein embolization to treat pelvic congestion syndrome

MRI of pelvis for UFE

Percutaneous cryoablation for pulmonary tumor(s)

Mechanochemical venous ablation

SAMPLE LETTERS START ON NEXT PAGE

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 153

LETTER FOR OVARIAN VEIN EMBOLIZATION TO TREAT

PELVIC VENOUS CONGESTION SYNDROME
[CARRIER MEDICAL DIRECTOR]:

On [INSERT DATE OF PRECERTIFICATION/COVERAGE REQUEST DENIAL], notice

was received from your company that ovarian vein embolization (OVE) is considered
experimental and investigational and, therefore, a noncovered service. This is a formal
request for individual consideration to extend coverage for OVE for [PATIENT NAME],
who is suffering from pelvic congestion syndrome (PCS).

[PATIENT NAME] has presented with symptoms consistent with PCS, which is a
well-defined condition. Namely, she has experienced longstanding [LIST RELEVANT
SYMPTOMS: cyclical pelvic pain and pressure that correlates with her menses, pain
during/after sexual intercourse, pelvic pain worse upon standing/sitting/walking]. She
has been seen by [PHYSICIAN, MD] and has undergone a rigorous clinical evaluation
to determine the cause of her symptoms. Both Dr. [REFERRING MEDICINE PHYSICIAN
NAME]’s and my findings are consistent, confirming that [PATIENT NAME] has physical
findings that are commonly found with PCS, including recurrent varicose veins in the
lower extremity(ies) [ADD OTHER RELEVANT SIGNS: vulvar varices, hemorrhoids].

Additionally, [LIST RELEVANT DIAGNOSTIC STUDY(IES)-FOR EXAMPLE-an MR

venogram of the pelvis shows large ovarian and pelvic veins/an ultrasound of the
pelvis has been performed, which demonstrated enlarged pelvic varicosities, more
prominent on the left than the right], supporting a diagnosis of PCS for this patient.
OVE has been found to be an effective minimally invasive procedure to treat the
symptoms of PCS and is recommended for this patient.

PCS symptoms

[PATIENT NAME] is not alone in suffering from the symptoms of PCS. It has been
estimated that almost 40 percent of all women will experience chronic pelvic pain
during their lifetime and that 15 percent of all women between the ages of 18–50
experience chronic pelvic pain. Of note, 15 percent of all hysterectomies and 35 percent
of all diagnostic laparoscopies are performed due to chronic pelvic pain. Ovarian vein
incompetence has been shown to occur in approximately 10 percent of women. This
phenomenon can lead to PCS and its associated symptoms in 60 percent of these
patients. Despite this incidence, PCS is significantly underdiagnosed. It typically results
in pelvic pain that is often described as dull and aching. The pain is typically worse in an
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 154

upright position and becomes more severe with walking and postural changes. It may be
associated with dyspareunia or a postcoital ache.

These symptoms of PCS are typically caused by the development of varicosities in

the infundibulopelvic and broad ligaments within the pelvis. The exact reason for the
development of these varicosities is unknown, but one important factor is the absence
or incompetence of valves in the ovarian veins. Anatomy may also play a role: the
left ovarian vein is more frequently incompetent than the right. Since the left ovarian
vein drains vertically into the high-pressured left renal vein, it may be more prone to
reflux than the right ovarian vein, which enters directly into the side of the inferior
vena cava. Accordingly, symptoms can be more common or more severe on the left,
as seen with [PATIENT NAME]. Hormones may also contribute since PCS mainly
affects premenopausal women. Rarely, left-sided ovarian vein reflux can be caused by
“nutcracker syndrome,” in which the left renal vein is compressed between the superior
mesenteric artery and the aorta. The back pressure in the renal vein is transmitted to the
renal venules and ovarian vein, resulting in hematuria and pelvic congestion respectively.
The pain associated with pelvic congestion syndrome has been directly attributed to the
presence of these dilated veins within the pelvis.

OVE treatment plan for PCS

Once a patient such as [PATIENT NAME] has been diagnosed with PCS, it is important
to direct treatment towards eliminating retrograde flow in the abnormal ovarian vein(s).
Doing so reduces pressure in the pelvic veins, which in turn alleviates or improves
symptoms.

OVE, a percutaneous, catheter-based procedure that results in occlusion of the abnormal

ovarian vein(s), effectively eliminates retrograde flow in the ovarian vein. For the past 15
years, this treatment has been associated with good clinical outcomes in most women
suffering from the symptoms of PCS. The procedure is technically successful in almost
100 percent of patients. Symptomatic improvement tends to be seen in >80 percent of
patients undergoing OVE.

The largest study with the longest follow-up was just completed in Europe; Laborda et
al. (2013) prospectively followed 202 patients over 5 years and showed an astounding
93.9 percent clinical success rate and a significant reduction in the visual analog pain
scale from 7.3 (out of 10) to 0.8. Gandini et al. (2008) demonstrated statistically
significant improvement in pelvic pain, dyspareunia, urinary urgency and menstrual pain
in 38 women treated with OVE. Kim et al. (2006) demonstrated an 83 percent success
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 155

rate in 127 patients treated with OVE, with an impressive 4-year follow-up. Kwon et al.
(2007) reported symptomatic improvement in 82 percent of 67 patients treated with
OVE. Venbrux et al. (2002) reported symptomatic improvement in 96 percent of the 56
patients 12 months after being treated with OVE. Other reports by Mowatt et al, Capasso
et al, Sichlar et al, Tarazov et al, Maleux et al, and Cordts et al. have reported similar
data to the studies outlined above. In select patients with the “nutcracker” syndrome
described above, a less than 50 percent stenosis of the renal vein may be safely treated
with OVE to relieve the pelvic pain caused by reflux into the ovarian vein. In summary,
patients who present with clinical signs and symptoms as well as imaging findings
consistent with PCS are excellent candidates for OVE.

OVE is performed on an outpatient basis. The OVE procedure begins with an ovarian
venogram to confirm that retrograde flow is present. If reflux and retrograde flow is
identified within the left and/or right ovarian vein, the vein is embolized to eliminate this
reflux and reduce the pressure within pelvic varicosities.

Body of scientific literature supporting OVE as an effective treatment for PCS

Enclosed is a comprehensive listing of the scientific literature available that supports

OVE as an effective treatment for PCS (see Attachment A). Also enclosed is a table
(see Attachment B) summarizing the scientific articles available supporting ovarian vein
embolization as an effective treatment for pelvic congestion syndrome. Of note, many
of these articles support embolization of additional pelvic veins to maximize therapeutic
benefit.

OVE emerged because of its safety, efficacy and noninvasiveness compared with
surgery; in a Korean study, in which patients with documented PCS were randomized to
hysterectomy (with either oopherectomy of ovary on the side of an incomplete gonadal
vein or bilateral oopherectomy) or OVE, OVE demonstrated significantly better results
than surgery.

Equitable coverage sought for equivalent treatments for comparable

syndromes found in men and women

Painful dilated veins in the scrotum of men, caused by a refluxing testicular vein,
result in varicoceles that are successfully treated with gonadal vein embolization.
Painful dilated veins of the uterus and pelvis in women results in PCS. These are
comparable syndromes with a common etiology. Given that the safety and efficacy of
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 156

embolotherapy for both conditions are well supported by the literature and that male
varicocele is routinely covered, it would not be fair to deny women coverage for the
same condition. As such, we respectfully request that you reconsider and reverse this
inappropriate determination. Please extend coverage to [PATIENT NAME] for ovarian
vein embolization to treat pelvic congestion syndrome.

I hope that you will find this information helpful in reversing the previous denial [FOR
PREAUTHORIZATION/OF COVERAGE]. Please feel free to contact me if you require any
further information.

Sincerely,

[SIR MEMBER NAME], MD CC: [PATIENT NAME]

[STATE INSURANCE COMMISSIONER]

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 157

LETTER FOR MRI OF THE PELVIS FOR UFE

To Whom It May Concern:

I am writing this letter to appeal your decision to deny coverage for an MRI of the pelvis
for [PATIENT NAME], (DOB: [INSERT DATE OF BIRTH]; [PATIENT ID]) prior to a uterine
artery embolization (UAE) procedure to treat symptomatic uterine fibroids.

As you know, UAE is a uterine-sparing procedure that effectively treats the symptoms
associated with uterine fibroids and reduces both uterine and fibroid volume due to
fibroid infarction. Prior to UAE, the interventional radiologist performing the procedure
needs to be certain that the procedure is being performed for an appropriate indication.
When fibroids were treated exclusively with hysterectomy, pre-procedure imaging was
not critical to gynecologists because the uterus, in its entirety, was being removed.

As a result, a pathologic evaluation performed on the uterus after surgery was the
primary means of determining the etiology of the presenting symptoms. Uterine artery
embolization is different. Since the uterus is remaining in its anatomic position and the
fibroids are not being removed, it becomes incumbent upon the physician responsible
for performing this procedure to obtain definitive imaging of the pelvis prior to the
procedure.

The standard imaging modality used to evaluate patients with suspected uterine fibroids
is ultrasound. In fact, almost all patients presenting in consultation for UAE have been
evaluated previously with a pelvic ultrasound that has demonstrated fibroids.

While ultrasound is certainly a good test to evaluate patients for fibroids, it is an

operator-dependent imaging modality that has recognized limitations when it comes
to evaluating patients specifically for UAE. Omary et al. (J Vasc Interv Radiol 2002;
13:1149–1153) evaluated the importance of imaging prior to UAE and recommended that
MRI be considered in all patients prior to this procedure. They did this by evaluating
the diagnostic confidence and anticipated treatment plan both before and after
performance of a pelvic MRI. They found that MRI significantly increased diagnostic
confidence. In addition, they found that MRI changed the initial diagnosis in 18 percent
of patients and the immediate clinical management in 22 percent of patients. Overall,
19 percent of women who were anticipated to undergo UAE prior to MRI did not
undergo that procedure as a result of the findings on MRI, which most often included
abnormalities other than fibroids. MRI has also been shown to potentially predict the
response to UAE and can therefore be helpful with patient selection for this procedure.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 158

An MRI can accurately determine the location and size of fibroids within the uterus. As
described by

Cura et al. (Acta Radiol 2006; 47:1105–1114), UAE may not be the appropriate therapy
if a patient’s symptoms do not correlate with the size and location of their fibroids. For
example, a small subserosal fibroid is not likely to be responsible for abnormal bleeding
so UAE may not be indicated in this particular type of patient. In addition, MRI is helpful
in differentiating degenerated fibroids from cellular fibroids, which is important since
cellular fibroids typically have the best response to UAE.

Cellular fibroids have characteristic MRI findings with high signal intensity on T2
weighted images and enhancement after contrast administration (Yamashita et al,
Radiology 1993; 189:721–725) so fibroids with these characteristics may be expected
to respond best to UAE. This has been supported by Burn et al. (Radiology 2000;
214:729–734), who reported on the good response of fibroids with high signal intensity
on T2-weighted images, and by Jha et al. (Radiology 2000; 217:228–235), who reported
that hypervascular fibroids which enhanced after contrast administration had a greater
response to UAE. Therefore, an MRI can help determine which patients are appropriate
candidates for UAE on the basis of size, location, signal characteristics and degree of
enhancement after contrast administration. The findings on MRI can also help determine
if vessels other than the uterine arteries provide arterial supply to the fibroids. Kroencke
et al. (Radiology 2006; 241:181–189) determined that contrast-enhanced MRI can help
predict the presence of ovarian arterial supply to uterine fibroids. This information is
important to have prior to UAE because if these vessels are not recognized, the ability
of this procedure to induce infarction within the treated fibroids becomes significantly
limited. In addition, knowing that ovarian arteries may need to be treated during a UAE
procedure is something that is important to discuss with a patient prior to UAE since
treating these vessels could increase the possibility of postprocedure amenorrhea.

Finally, MRI is very helpful in determining if patients are potentially at risk for
complications after UAE. For example, pedunculated submucosal fibroids are potentially
at risk for transcervical expulsion or infection and pedunculated subserosal fibroids
can potentially separate from the uterus and result in intraperitoneal complications.
Pelvic MRI is able to define the morphology of pedunculated fibroids far better than
ultrasound and therefore help determine which patients are potentially at risk for these
complications. This was well described by Verma et al. (AJR 2008; 190:1220–1226),
who reported on the utility of MRI in defining the interface between pedunculated
submucosal fibroids and the endometrium. They found that this helps define the risk of
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 159

fibroid migration into the endometrial cavity with subsequent transcervical expulsion
after UAE.

In summary, an MRI of the pelvis provides the information that is necessary for an
interventional radiologist to determine if a patient with symptomatic uterine fibroids
is a suitable candidate for uterine artery embolization. It can potentially provide
information regarding the cellular morphology of fibroids, the presence or absence
of other pathology that could explain a patient’s symptoms, the contribution of other
blood vessels responsible for the arterial supply of fibroids, and the potential risk of
complications associated with pedunculated fibroids.

As a result, MRI has been shown to potentially change the treatment plan in a significant
number of patients, underscoring its importance as a pre-procedure imaging test. It
is my hope that this information will help support a reversal of your decision to deny
coverage to [PATIENT NAME] for an MRI of the pelvis prior to her planned uterine artery
embolization procedure.

Sincerely,

[SIR MEMBER NAME], MD CC: [PATIENT NAME]

[STATE INSURANCE COMMISSIONER]

2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 160

LETTER FOR PERCUTANEOUS CRYOABLATION OF

PULMONARY TUMOR(S)
[DATE]

[CARRIER MEDICAL DIRECTOR]

[CARRIER NAME]
[COVERAGE RECONSIDERATION DEPARTMENT]
[CARRIER ADDRESS]
Sub:

[PATIENT NAME]
[PATIENT ID]
[GROUP NO.]
[CLAIM NO.]

Request for coverage for percutaneous cryoablation of pulmonary tumor(s)

[CARRIER MEDICAL DIRECTOR]:

On [INSERT DATE OF REQUEST DENIAL], an insurance coverage denial notice was

received from your company that cryoablation of [TYPE OF PULMONARY TUMOR] is
considered experimental and medically unnecessary, hence not covered by insurance.
This is a formal request to extend coverage for cryoablation of pulmonary tumor(s) for
[PATIENT NAME], who has been diagnosed with [INSERT DIAGNOSIS: lung cancer, lung
metastases, lung malignancies, including stage].

[PATIENT NAME] has been seen and evaluated by a [SELECT REFERRING PHYSICIAN
TYPE: thoracic surgeon/oncologist/oncology physician team] who [is/are] in
agreement that pulmonary tumor cryoablation is the best treatment option for
management of this lung tumor.

This letter is an appeal for approval of cryoablation for treatment of lung [and pleural
metastatic disease] to be rendered at [CENTER]. The use of radiofrequency ablation
(RFA) ablative techniques for treatment of lung cancer and metastasis has already been
established. Once a candidate is deemed eligible for ablation, the choice of ablation
modality should lie with the performing physician to be able to use the modality to best
serve the patient with comparable efficacy and equal safety.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 161

This letter will describe in limited detail the technique of cryoablation for lung cancer or
metastasis therapy and review the literature on efficacy and safety of cryoablation.

Technique

Cryoablation is a controlled interventional technique that implements high-pressure

argon and helium gas for freezing and thawing, respectively on basis of the Joule-
Thompson principle. Naturally, cells of targeted tissue die when exposed to subzero
temperatures of -20 degrees centigrade achieved by the cryoprobe based on two
modes of destruction: immediate postthaw freeze rupture (primary) and longer-term
coagulative necrosis and apoptosis (secondary).1

Advantages over other ablative modalities

Cryoablation has already established itself as an alternative for treatment of prostate

cancer, bone tumors, renal cell carcinoma, hepatocellular carcinoma and fibroadenoma
of the breast. The interest in use of cryoablation in lung tumors arises from advantages
in holds over other heat-based ablative modalities.

Unlike heat-based modalities, which destroy the tissue architecture, cryoablation

preserves the collagenous and other cellular architecture of virtually any frozen tissue,
which is particularly beneficial in lung tumor ablations when treating lesions adjacent to
the tracheobronchial tree and mediastinum.2–5 The ice ball formed by freezing correlates
well with the pathologic zone of ablation, and because the low-attenuating ice ball is
visible by CT as it covers soft tissues during the freezing cycle, the operator is able to
control the ablation zone with more precision than can be obtained with heat-based
modalities.6–10

While RF ablation in the lung is hindered by the cooling effect of circulating air,
cryoablation is relatively resistant to the cold-sink effects of ventilation.11

The ability to precisely control the ablation zone makes cryoablation especially
advantageous for treating tumors that are relatively close to the mediastinum, chest
wall or blood vessels, whereas RFA risks causing mechanical or thermal injury to these
structures.12

Cryoablation is reported to have less procedure-associated pain than RF due to the

analgesic effect of cold on the intercostal nerves.13–18
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 162

Safety

As with the emergence of any rapidly evolving technology and its application, early
published literature regarding the clinical application of lung cryoablation consists of
technical descriptions, case series and early procedural outcomes. Cryoablation has now
matured enough with significant accumulated data to support a safe procedure with
comparable and even better efficacy to RFA.

• Wang H et al. performed more than 200 cryoablations of the thorax on primary
lung cancer (88 percent) and metastasis (12 percent) in nonsurgical candidates.
Cases were followed up for 12 months to evaluate the post-cryoablation response.
By 6 months, 86 percent of treated areas were smaller or stable than the original
tumor. The study was too short to determine long-term benefit, but patients
did experience palliative benefits—their general health, appetite and weight
gain improved, and their Karnofsky Performance Status increased significantly
(p<0.01).19

• Kawamura M et al. evaluated the safety and efficacy of cryoablation in 35 tumors

in 20 patients and showed 1-year survival of 89.4 percent. In this group only 25
percent of the nodules were lung cancer and the remaining 75 percent were
metastatic disease. The most common complication was pneumothorax in 50
percent of the procedures and required chest tube placement in only 4.5 percent
of the cases. Self-limited hemosputum was seen in 41 percent of patients. None
of the patients died of the procedure. There were no treatment-related deaths or
conversion to surgical intervention.20

• Inoue et al. (2012) evaluated feasibility and safety during cryoablation of 396 lung
tumors in 117 patients (104 with metastatic disease) in 193 sessions, with a mean
follow-up period of 899 ± 778 days. All patients tolerated the procedure well,
with minimal pain. No CTCAE grade 4 or 5 events and only three grade 3 events
were observed. The most common complication was pneumothorax, which was
observed in 61.7 percent of the treatment sessions. Of these, 10.9 percent of the
cases required chest tube insertion, comparable to that associated with RF ablation.

These percentages included delayed and recurrent pneumothorax that occurred

in 15 of the treatment sessions, resulting in 17 chest tube insertions. Inoue et al.
concluded that percutaneous cryoablation is minimally invasive and associated with
improved safety.21
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 163

• Bang et al. (2012) used cryoablation on 10 patients with colorectal lung metastases
(33 tumors) and, during 2 years of follow-up, only 6 out of 33 tumors recurred. The
authors also concluded that the cryoablation was safe and cost-effective.22

• Pusceddu et al. (2013) performed cryoablation on 32 patients (34 tumors)—11 with

NSCLC and 21 with pulmonary metastases (15 from colorectal cancer) with only
minor complications. At 6 months, complete ablation was confirmed in 91 percent
of the cases.23

• In a multicenter clinical trial, “Evaluating Cryoablation of Metastatic Lung/Pleura

Tumors in Patients—Safety and Efficacy (ECLIPSE) trial”, (JVIR 2015) 40 patients
(24 men and 16 women) with 60 lung metastases less than 3.5 cm in size treated
during 48 cryoablation sessions, with a minimum of 12 months of follow-up. One-
year overall survival rate was 97.5 percent. There were three Common Terminology
Criteria for Adverse Events (CTCAE) grade-3 procedural complications during the
immediate follow-up period (pneumothorax requiring pleurodesis, noncardiac
chest pain and thrombosis of an arterio-venous fistula), with no grade 4 or 5
complications. The authors concluded that percutaneous cryoablation for the
treatment of lung metastases of 3.5 cm or less is safe and early local tumor control
rates are promising.24

• Recently, Moore et al. (JVIR 2015) published their 5-year survival on 47 T1N0M0
NSCLCs in 45 consecutive patients between 2006 and January 2011. Major
complications occurred in only 6.4 percent of patients, including two cases of
hemoptysis and a prolonged placement of a chest tube requiring mechanical
sclerosis in one patient. There were no deaths in the first 30 days after treatment. In
their conclusion, cryoablation is associated with a good overall long-term survival
with minimally significant complications.25

Efficacy

Many studies have now shown that cryoablation does produce benefits equivalent to RF
ablation in the short and longer term (2–5 years).

Kawamura et al. (2006) treated 20 patients with 35 lung tumors with cryoablation
and followed them for up to 28 months (median 21 months for 18 patients). The
primary endpoint of this study was the early outcome and feasibility of cryoablation
for metastatic tumors <3 cm. The secondary endpoint was tumor control. There were
no treatment-related deaths or conversion to surgical intervention. Two patients had
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 164

complete response, eight had partial response, eight had stable disease and two had
progressive disease, thus resulting in a 50 percent response rate with 90 percent tumor
control rate. The overall tumor recurrence rate was 54.3 percent. During the 9–12 month
period, seven of the 18 (35 percent) patients developed a local recurrence of seven (20
percent) tumors. Five patients underwent additional cryoablation treatments without
complication or local recurrence. Pneumothorax was reported in 50 percent of the
cases, 27 percent experienced pleural effusion, 41 percent hemosputum and 4.5 percent
phrenic nerve palsy. The Kaplan Meier survival was 89.4 percent at 1 year and 83 percent
at 28 months.26

• Yamauchi et al. (2011) reported the use of percutaneous cryoablation for colorectal
pulmonary metastases in 24 patients with 55 tumors during 30 treatment sessions.
Follow-up scans were performed every 3–4 months after treatment. Pneumothorax
was reported in 19 sessions with only 1 session requiring insertion of a chest tube.

A small amount of pleural effusion occurred in 21 sessions, none of which required

a chest tube. The 1- and 3-year local progression-free intervals were 90.8 percent
and 59 percent, respectively, and the 1- and 3-year overall survival rates were 91
percent and 59.6 percent.27

• Yamauchi et al. (2012) reported on 22 patients with inoperable stage 1 NSCLC

who were treated with cryoablation. At 3-years post-procedure, local tumor-free
progression was 91 percent, overall survival 88 percent, and disease-free survival
67 percent. Yashiro et al. (2013) reported that after cryoablation of 210 pulmonary
tumors (11 NSCLC and 199 metastases) in 71 patients, 68 percent of patients
were free from local progression at 3 years. Again, size of the target lesion was
an important prognostic factor; freedom from local progression was greater (84
percent at 3 years) if the ablated lesions were £ 20 mm.28

• Chou et al. (2015) reported midterm results of CT-guided cryoablation of 45

malignant lung tumors in 26 patients; 12 patients had primary lung cancer, and the
other 14 had pulmonary metastases from a variety of primary cancers, including
colon cancer. Although there were some immediate and short-term complications,
only two (2.4 percent) were CTCAE grade 3, and none were grade 4 or 5. The
overall survival rates for 1, 2 and 3 years were 96 percent, 88 percent and 88
percent, respectively. For curative intent, local tumor control rates for 1, 2 and 3
years were 75 percent, 72 percent and 72 percent.29
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 165

• At least two studies have directly compared outcomes for cryoablation of lung
tumors with other ablative technologies or surgery. Choe et al. (2009) carried out
76 ablative procedures in 65 patients with NSCLC (stages I-IV); 67 procedures
were RF ablations and 9 were percutaneous cryoablations. Efficacy was judged
by contrast CT immediately after the procedure, 1 month later and at 3-month
intervals. Complete ablation was attained for 43 percent of the RF ablation patients
and 67 percent of the cryoablation patients. For both modalities complete ablation
was more likely for smaller tumors. Complete RF ablation was 76 percent for
tumors < 3 cm and 28 percent for tumors > 3 cm; cryoablations were complete
for 86 percent of tumors < 3 cm and 0 percent for 2 tumors > 3 cm. Patients
undergoing cryoablation had no pain after the day of the procedure, but 37 percent
of patients undergoing RF ablation experienced pain for longer. Survival rates were
not reported separately for the two modalities. For all patients 1-, 2- and 3-year
overall survival rates were 67 percent, 46 percent and 27 percent. For patients
whose tumors were completely ablated, 1- and 2-year progression-free survival
rates were 72 percent and 39 percent, respectively, compared to 1- and 2-year rates
of 31 percent and 16 percent for patients with partial ablations.30

• Zemlyak et al. (2010) treated 64 patients with stage 1 NSCLC; 25 underwent single
lobe lung resection (SLR), 12 had tumors treated with RF ablation (RFA) and 27
with percutaneous cryoablation (PCT). The probability of 3-year survival for the
SLR, RFA and PCT groups of 87 percent, 88 percent and 77 percent, respectively,
was not significantly different (p > 0.05). The 3-year cancer-specific and cancer-
free survival for SLR, RFA and PCT groups was 91 percent and 61 percent versus 88
percent and 50 percent versus 90 percent and 46 percent, respectively, indicating
that cryoablation is as effective as RF and nearly as effective as lung resection.31

• In the ECLIPSE (Evaluating Cryoablation of Metastatic Lung/Pleura Tumors in

Patients—Safety and Efficacy) Trial, 40 patients (24 men and 16 women) with
60 lung metastases less than 3.5 cm in size were treated during 48 cryoablation
sessions, with a minimum of 12 months of follow-up. The most common primary
cancers were colon (40 percent), kidney (23 percent) and sarcomas (8 percent).

Metastases size was 1.4±0.7 cm [0.3–3.4]. Metastases were bilateral in 20 percent

of cases. Cryoablation was performed under general anesthesia (67 percent) or
conscious sedation (33 percent). Local tumor control rates were 56/58 (96.6
percent) and 49/52 (94.2 percent) at 6 and 12 months, respectively. Patient quality
of life was unchanged over the follow-up period. One-year overall survival rate
 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 166

was 97.5 percent. Two-year follow-up data are currently being gathered, and data
collection will continue for 60 months.32

• Recently, Moore et al. published their 5-year survival on 47 T1N0M0 NSCLCs in 45

consecutive patients between 2006 and January 2011. The 5-year survival rate was
67.8 percent ± 15.3, the cancer-specific survival rate at 5 years was 56.6 percent
±16.5, and the 5-year progression-free survival rate was 87.9 percent ± 9. The
combined local and regional recurrence rate was 36.2 percent. In their conclusion,
cryoablation was associated with a good overall long-term survival with minimally
significant complications. Cryoablation is a potentially curative, viable therapeutic
option for patients with stage I NSCLC who are deemed medically inoperable.33

Thus, multiple peer-reviewed articles indicate efficacy comparable to RF ablation and,

notably, none of the studies suggest that pulmonary cryoablation is less effective than
RF ablation, which is approved by Medicare and insurance companies.

Thus, it is in this regard that this appeal is written for reconsideration and ultimate
reversal of the decision of ineligibility for cryoablation rendered by the [INSURANCE
COMPANY]. Please contact me directly for questions and concerns at [CONTACT
INFORMATION].

Sincerely,

[PHYSICIAN’S NAME]

References:
1. Girard P, Baldeyrou P, Le Chevalier T et al. Surgery for pulmonary metastases. Who are the 10-year survivors? Cancer 1994; 74:2791–2797.
2. Inoue M, Nakatsuka S, Yashiro H, Ito N, Izumi Y, Yamauchi Y, Hashimoto K, Asakura K, Tsukada N, Kawamura M, Nomori H, and Kuribayashi S. 2012.
Percutaneous cryoablation of lung tumors: feasibility and safety. J Vasc Interv Radiol. 23: 295–302.
3. McTaggart R and Dupuy D. 2007. Thermal ablation of lung tumors. Tech Vasc Interventional Rad. 10:102–113.
4. Petre EN, Jia X, Thornton RH, Sofocleous CT, Alago W, Kemeny NE, and Solomon SB. 2013. Treatment of pulmonary colorectal metastases by radiofrequency
ablation. Clin Colorectal Cancer 12: 37–44.
5. Sonntag PD, Hinshaw JL, Lubner MG, Brace CL, and Lee FT Jr. 2011. Thermal Ablation of Lung Tumors. Surg Oncol Clin N Am. 20: 369–387.
6. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, and Brace CL. 2014. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what
should you use and why? Radiographics. 34: 1344–1362.
7. Jones GC, Kehrer JD, Kahn J, Koneru BN, Narayan R, Thomas TO, Camphausen K, Mehta, MP, and Kaushal A. 2015. Primary treatment options for high risk/
medically inoperable early stage NSCLC patients. Clin Lun Cancer, in press. Available online [Link]/10.1016/[Link].2015.04.001.
8. Inoue M, Nakatsuka S, Yashiro H, Ito N, Izumi Y, Yamauchi Y, Hashimoto K, Asakura K, Tsukada N, Kawamura M, Nomori H, and Kuribayashi S. 2012.
Percutaneous cryoablation of lung tumors: feasibility and safety. J Vasc Interv Radiol. 23: 295–302.
9. Roberton BJ, Liu D, Power M, Wan JM, Stuart S, Klass D, and Yee J. 2014. Pulmonary ablation: a primer. Can Assoc Radiol J. 65:177–85.
10. Sonntag PD, Hinshaw JL, Lubner MG, Brace CL, and Lee FT Jr. 2011. Thermal Ablation of Lung Tumors. Surg Oncol Clin N Am 20: 369–387.
11. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, and Brace CL. 2014. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what
should you use and why? Radiographics. 34: 1344–1362.
12. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, and Brace CL. 2014. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what
should you use and why? Radiographics. 34: 1344–1362.
 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 167

13. Alexander ES and Dupuy DE. 2013. Lung cancer ablation: technologies and techniques. Semin Intervent Radiol. 30: 141–150.
14. Choe YH, Kim SR, Lee KS, Lee KY, Park SJ, Jin GY, and Lee YC. 2009. The use of PTC and RFA as treatment alternatives with low procedural morbidity in non-
small cell lung cancer. Eur J Cancer. 45: 1773–1779.
15. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, and Brace CL. 2014. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what
should you use and why? Radiographics. 34: 1344–1362.
16. Inoue M, Nakatsuka S, Yashiro H, Ito N, Izumi Y, Yamauchi Y, Hashimoto K, Asakura K, Tsukada N, Kawamura M, Nomori H, and Kuribayashi S. 2012.
Percutaneous cryoablation of lung tumors: feasibility and safety. J Vasc Interv Radiol. 23: 295–302.
17. Jones GC, Kehrer JD, Kahn J, Koneru BN, Narayan R, Thomas TO, Camphausen K, Mehta, MP, and Kaushal A. 2015. Primary treatment options for high risk/
medically inoperable early stage NSCLC patients. Clin Lun Cancer, in press. Available online [Link]/10.1016/[Link].2015.04.001.
18. McTaggart R and Dupuy D. 2007. Thermal ablation of lung tumors. Tech Vasc Interventional Rad 10:102–113.
19. Wang H, Littrup P, Duan Y et al. Thoracic Masses Treated with Percutaneous Cryotherapy: Initial experience with more than 200 procedures. Radiology
2005;235: 289–298.
20. Kawamura M, Izumi Y, Tsukada N, Asakura K, Sugiura H et al. Percutaneous cryoablation of small pulmonary tumors under computed tomographic guidance
with local anesthesia for nonsurgical candidates. J Thoracic and Cardiovascular Surgery. 2006;131:1007–1013.
21. Inoue M, Nakatsuka S, Yashiro H, Ito N, Izumi Y, Yamauchi Y, Hashimoto K, Asakura K, Tsukada N, Kawamura M, Nomori H, and Kuribayashi S. 2012.
Percutaneous cryoablation of lung tumors: feasibility and safety. J Vasc Interv Radiol. 23: 295–302.
22. Bang HJ, Littrup PJ, Currier BP, Goodrich DJ, Choi M, Heilbrun LK, and Goodman AC. 2012. Percutaneous cryoablation of metastatic lesions from colorectal
cancer: efficacy and feasibility with survival and cost-effectiveness. ISRN Minim Invasive Surg 2012: Article ID 942364.
23. Pusceddu C, Sotgia B, Fele RM, and Melis L. 2013. CT-guided thin needles percutaneous cryoablation (PCA) in patients with primary and secondary lung
tumors: a preliminary experience. Eur J Radiol. 82:e246–53.
24. de Baere T1, Tselikas L2, Woodrum D3, Abtin F4, Littrup P5, Deschamps F1, Suh R6, Aoun HD5, Callstrom M3. Evaluating Cryoablation of Metastatic Lung
Tumors in Patients—Safety and Efficacy: The ECLIPSE trial -Interim analysis at 1-Year. J Thorac Oncol. 2015 Jul 29. [Epub ahead of print]
25. Moore W, Talati R, Bhattacharji P, and Bilfinger T. 2015. Five-year survival after cryoablation of stage I non-small cell lung cancer in medically inoperable
patients. J Vasc Interv Radiol. 26: 312–319.
26. Kawamura M, Izumi Y, Tsukada N, Asakura K, Sugiura H et al. Percutaneous cryoablation of small pulmonary tumors under computed tomographic guidance
with local anesthesia for nonsurgical candidates. J Thoracic and Cardiovascular Surgery. 2006;131:1007–1013.
27. Yamauchi Y, Izumi Y, Kawamura M, Nakatsuka S, Yashiro H, Tsukada N, Inoue M, Asakura K, Ohtsuka T, Kohno M, Kawamura M, and Nomori H. 2011.
Percutaneous cryoablation of pulmonary metastases from colorectal cancer. PLoS One 6:e27086.
28. Yamauchi Y, Izumi Y, Hashimoto K, Yashiro H, Inoue M, Tsukada N, Goto T, Anraku M, and Nomori H. 2012. Percutaneous cryoablation for the treatment of
medically inoperable stage I non-small cell lung cancer. PLoS One 7: e33223.
29. Chou HP, Chen CK, Shen SH, Sheu MH, Wu MH, Wu YC, Chang CY. 2015. Percutaneous cryoablation for inoperable malignant lung tumors: midterm results.
Cryobiology 70: 60–65.
30. Choe YH, Kim SR, Lee KS, Lee KY, Park SJ, Jin GY, and Lee YC. 2009. The use of PTC and RFA as treatment alternatives with low procedural morbidity in non-
small cell lung cancer. Eur J Cancer 45: 1773–1779.
31. Zemlyak A, Moore WH, and Bilfinger TV. 2010. Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. J
Am Coll Surg. 211: 68–72.
32. de Baere T1, Tselikas L2, Woodrum D3, Abtin F4, Littrup P5, Deschamps F1, Suh R6, Aoun HD5, Callstrom M3. Evaluating Cryoablation of Metastatic Lung
Tumors in Patients -Safety and Efficacy: The ECLIPSE trial -Interim analysis at 1-Year. J Thorac Oncol. 2015 Jul 29. [Epub ahead of print]
33. Moore W, Talati R, Bhattacharji P, and Bilfinger T. 2015. Five-year survival after cryoablation of stage I non-small cell lung cancer in medically inoperable
patients. J Vasc Interv Radiol. 26: 312–319.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 168

LETTER FOR MECHANOCHEMICAL VENOUS ABLATION

[DATE]

[CARRIER MEDICAL DIRECTOR]

[COVERAGE and POLICY DEPARTMENT]
[CARRIER NAME]

[CARRIER ADDRESS]
[CARRIER CITY, STATE ZIP]

RE: [PATIENT NAME]

[PATIENT ID]

SUBJECT: Request for coverage and reimbursement for mechanochemical venous

ablation

Dear Colleague:

I am writing this letter to request [PRE-AUTHURIZATION/APPEAL] for coverage for

mechanochemical venous ablation for patient [PATIENT’S NAME] (DOB: [INSERT DATE
OF BIRTH]; [PATIENT ID].

We respectfully ask you to reconsider your designation of mechanochemical venous

ablation (MOCA) as investigational. Marketed in the United States as the ClariVein®
system, the efficacy, safety and resultant improvement in quality-of-life that results from
the use of this FDA-approved device is supported by a number of publications in peer-
reviewed journals.

Procedure and mechanism of action

Endovenous MOCA is a procedure that is used to close refluxing saphenous veins and
their primary tributaries utilizing a mechanism of direct intimal injury within the lumen
of the vein which purposefully abrades the intima and causes venospasm to allow for
better efficacy of the sclerosant which is simultaneously injected. Since this ablation
method does not use thermal energy, the potential for saphenous or sural nerve damage
is minimized.

Following ultrasound imaging and marking of the patient’s anatomy on the skin and a
sterile prep and draping of the patient’s extremity, a disposable catheter connected to
a disposable motor drive is inserted into the target vein and advanced to just below the
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 169

deep vein junction. As the catheter is slowly pulled back, a wire rotates at 3500 rpm
within the lumen of the vein, abrading the intima. At the same time, a liquid sclerosant
(sodium tetradecyl sulfate) is infused near the rotating wire. It has been demonstrated
that the combination of the mechanical and chemical effect results in vein closure
better1 than either method alone. The closure occurs with less pain2 and reduced risk of
saphenous or sural nerve injury (since there is no heat to injure the nerves) without the
need for the tumescent anesthesia used with thermal endovenous ablation techniques
(radiofrequency ablation [RFA] and endovenous laser treatment [EVLT]).

In terms of evidence supporting MOCA, I would submit that the published data has
demonstrated a high rate of success and low complication rate, and the procedure has
some advantages over some of the alternate available treatments. ClariVein® achieved
FDA clearance through the 510(k) process in March 2008.

Supporting data

Supporting publications include a randomized controlled trial for treatment of the

refluxing great saphenous vein (GSV), comparing MOCA with radiofrequency ablation
procedure that has been approved by the FDA since 2000.2 Several additional publications
also support the safety and high rate of success of MOCA, similar to that following thermal
ablation.3–12 I present below a summary of some of the highlights of this literature.

Bootun et al.2 conducted a randomized, controlled trial to assess intra-operative pain

between MOCA and RFA in 117 patients/119 limbs (MOCA: 59; RFA: 60). Pain scores were
measured using a validated 100 mm visual analogue scale (VAS) with mean maximum
results being 19.3 mm for MOCA and 34.5 mm for RFA. The study demonstrated
less intraprocedural pain for MOCA with equivalent improvement in clinical and
patient-reported quality of life measures at one month with similar occlusion rates as
documented by Duplex US. MOCA showed a faster return to work and normal activities.
MOCA was associated with no adverse events, while RFA patients had a 3.4 percent
incidence of thrombophlebitis and 1.7 percent incidence of nonocclusive popliteal vein
deep vein thrombosis.

A number of comparative trials and prospective cohort studies have drawn similar
conclusions. Among these studies was one by Ozen3 which looked at the 2-year results
for MOCA treatment of the refluxing great saphenous vein. At that time interval, the
saphenous occlusion rate was 95 percent, which was seen along with a significant
decrease in a physician derived score of the severity of venous disease in the treated
limb (venous clinical severity score or VCSS).
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 170

Boeersma5 demonstrated the safety and efficacy of MOCA in the small saphenous vein as
well, with a 94 percent 1-year occlusion of the treated vein with no major complications
and decrease in the VCSS and patient reported pain score.

Vun et al.12 assessed procedural pain for MOCA, RFA and endovenous laser ablation
(EVLA) in 127 patients/147 veins (MOCA: 57; RFA: 50; EVLA: 40). Pain scores were
collected by a nurse, blinded to the procedure, using VAS. Median pain scores were
as follows: MOCA-1, RFA-5, EVLA-6. Technical success as evidenced by occlusion was
similar for all three modalities with no major complications reported.

Van Eekeren et al.10 studied postoperative pain and early quality of life after RFA and
MOCA in 68 patients (34 to each group). Occlusion rates were over 90 percent in each
group. Pain was assessed with a 100 mm VAS and found mean procedural pain to be 22
mm for MOCA and 27 mm for RFA. Postoperative pain was measured at days 3 and 14
with MOCA mean pain to be 6.2 mm and 4.8 mm, while RFA mean pain was 20.5 mm and
18.6 mm. This demonstrated a 74 percent comparative reduction in postoperative pain at
day 14. RFA patients were shown to use postoperative analgesics for 2.8 days on average
compared to 0.5 days for MOCA patients. The median VCSS at week 6 showed a decrease
from 3.0 to 1.0 for MOCA, while the RFA group decreased from 4.0 to 3.0. Quality of life
outcomes were measured using the Aberdeen Varicose Vein Questionnaire (AVVQ) at 6
weeks and showed a change for the MOCA group from 7.1 to 5.0, and 9.5 to 4.5 in the RFA
group. The authors stated that this was not clinically significant. MOCA and RFA patients
returned to normal activities in one day, but the RFA group tended to take an extra day
before returning to work. There were no major complications in either group.

Finally, I would like to note that the Society of Interventional Radiology, in partnership
with the Society of Vascular Surgery and the American College of Phlebology, presented
supportive testimony at the October 2015 CPT panel meeting for this procedure. The
AMA CPT panel decided that mechanochemical procedures (MOCA) met the criteria for
a CPT Category I code, and two new codes describing MOCA went into effect in 2017.

Thanks for the courtesy of your review of this request, and I am available to go into
further detail at your convenience.

Respectfully,

[SIR MEMBER’S NAME]

 2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 171

Selected bibliography
1. Tal MG, Dos Santos SJ, Marano JP, Whiteley MS. Histologic findings after mechanochemical ablation in a caprine model with use of ClariVein Journal of
Vascular Surgery: Venous and Lymphatic Disorder; 3 (1):81–85.
2. Bootun R, Lane TRA, Dharmarajah B, Lim CS, Najem M, Renton S, Sritharan K, Davies AH. Intra-procedural pain score in a randomized controlled trial
comparing mechanochemical ablation to radiofrequency ablation: The Multicenter Venefit versus ClariVein for varicose veins trial. Phlebology 2014, DOI:
10.1177/0268355514551085.
3. Ozun Y, etal. Mechano-Chemical Endovenous Ablation of Great Saphenous Vein Insufficiency: Two-Year Results. Daer cer Derg 2014;23(3). doi: 10.9739/
uvcd.2014-41766.
4. Bishawi M, Bernstein R, Boter M, Draughn D, Gould C, Hamilton C et al. Mechanochemical ablation in patients with chronic venous disease: A prospective
multicenter report. Phlebology 2013 Jul 12; Epub ahead of print.
5. Boersma D et al., Mechanochemical Endovenous Ablation of Small Saphenous Vein Insufficiency Using the ClariVein Device: One-year Results of a Prospective
Series, European Journal of Vascular and Endovascular Surgery (2012). [Link]/10.1016/j. ejvs.1012.12.004.
6. Deijen CL, Schreve MA, Bosma J, de Nie A, Leijdekkers V, van den Akker, Vahl A. ClariVein mechanochemical ablation of the great and small saphenous vein:
Early treatment outcomes of two hospitals. Phlebology. 2015 Aug 24. pii: 0268355515600573. [Epub ahead of print]
7. Elias and Raines. “Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial.” Phlebology 2012; 27(2): 67–72.
8. Elias S. Mechanochemical ablation: MOCA. 2 year follow up, lessons learned. SVS Annual Meeting. Washington, DC, June 2012
9. Ozen Y, Cekmecelioglu D, Sarikaya S, Rabus MB, Aydin E, Dedemoglu M, Kirali K. Mechano-Chemical Endovenous Ablation of Great Saphenous Vein
Insufficiancy: Two Year Results. Damar Cer Derg 2014;23(3):176–9
10. Van Eekeren Ramon R.J.P., Boersma Doeke, Elias Steven, Holewijn Suzanne, Werson Debbie A.B., de Vries Jean-Paul P.M., Reijnen Michel M.J.P. Postoperative
pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins. J Vasc Surg
2013; 57: 445–50.
11. Van Eekeren Ramon R.J.P., Boersma Doeke, Elias Steven, Holewijn Suzanne, Werson Debbie A.B., de Vries Jean-Paul P.M., Reijnen Michel M.J.P. Mechanical
endovenous ablation for the treatment of great saphenous vein insufficiency. J Vasc Surg: Venous and Lym Dis 2014;2:282–8.
12. Vun SV, Rashid ST, Blest NC, Spark JI, Lower pain and faster treatment with mechanico-chemical endovenous ablation using ClariVein. Phlebology. 2015
Dec;30(10):688-92. doi: 10.1177/0268355514553693.
2 0 2 0 INTERVENTIONAL RADIOLOGY CODING UPDATE 172

Charge sheets
Patient Radiologist
Date Technologist
Referring Physician Fluoroscopic Time
Diagnosis Moderate Sedation Time
Provided By Same Phy
SPINAL PROCEDURES Provided By Others
CPT S&I ARTHROGRAMS
Puncture Shunt Tubing 61070 75809 CPT S&I
Cervical Puncture w/o Inj. 61050 77003 Ankle 27648 73615
Lumbar Puncture Diagnostic 62270 X No image Elbow 24220 73085
Lumbar Puncture Diagnostic w/ Fluoro or CT 62328 Included Hip w/ anesthesia 27095 73525
Lumbar Puncture Therapeutic 62272 X No image Hip w/o anesthesia 27093 73525
Lumbar Puncture Therapeutic w/ Fluoro or CT 62329 Included Knee Inj. (for arthrogram or CT/MRI arthro) 27369 73580
Inj. Epidural Blood or Clot Patch 62273 77003 Shoulder 23350 73040
Diskography (Lumbar) Ea. Level 62290 X 72295 X SI Joint Inj. (CT or Fluoro is included) 27096 Included
Diskography (Cerv/Thoracic) Ea. Level 62291 X 72285 X Temporomandibular Joint (TMJ) 21116 70332
Aspiration Nucleus Pulposus 62267 77003 Wrist 25246 73115
Celiac Nerve Block 64530 77003
Sinogram Diagnostic 20501 76080 ARTHROCENTESIS/ASPIRATION/INJECTION
Sinogram Therapeutic 20500 76080 CPT S&I
Inj. Diag or Therapeutic, Cerv/Thor w/o Image 62320 No image Fluoroscopic Guidance 77002
Inj. Diag or Therapeutic, Cerv/Thor w/ Image 62321 Included Ultrasound Guidance 76942
Inj. Diag or Therapeutic, Lumb/Sac w/o Image 62322 No image Computed Tomography Guidance 77012
Inj. Diag or Therapeutic, Lumb/Sac w/ Image 62323 Included Magnetic Resonance Guidance 77021
Inj. Indwelling Cath, Cerv/Thor w/o Image 62324 No image Small Joint or Bursa; w/o US 20600 By modality except US
Inj. Indwelling Cath, Cerv/Thor w/ Image 62325 Included Small Joint or Bursa; w/ US 20604 Includes US
Inj. Indwelling Cath, Lumb/Sac w/o Image 62326 No image Intermediate Joint or bursa; w/o US 20605 By modality except US
Inj. Indwelling Cath, Lumb/Sac w/ Image 62327 Included Intermediate Joint or bursa; w/ US 20606 Includes US
Nerve Root Blk/Transforaminal C/T w/Image 64479 Included Major Joint or Bursa; w/o US 20610 By modality except US
Nerve Root Blk/Transforaminal C/T Ea. Add +64480 X Included Major Joint or Bursa; w/ US 20611 Included
Nerve Root Blk/Transforaminal L/S w/Image 64483 Included Ganglion Cyst(s) Any Location 20612 By modality
Nerve Root Blk/Transforaminal Ea. Add. +64484 X Included Bone Cyst 20615 By modality
Facet Inj Cerv/Thor 1st W/Imaging 64490 Included
Facet Inj Cerv/Thor 2nd W/Imaging +64491 Included MYELOGRAM
Facet Inj Cerv/Thor 3rd & More +64492 Included CPT S&I
Facet Inj Lumb/Sac 1st W/Imaging 64493 Included Cisternal/lateral C1-C2 puncture w/o inj 61050*
Facet Inj Lumb/Sac 2nd W/Imaging +64494 Included Cisternal/lateral C1-C2 puncture w/ inj 61055*
Facet Inj Lumb/Sac 3rd & More +64495 Included Injection for myelogram, Lumbar 62284*
Neurolytic Inj/Inf Subarachnoid 62280 77003 Cervical myelogram, via lumbar inj. 62302 Included
Neurolytic Inj/ Cerv. Or Thor 62281 77003 Thoracic myelogram, via lumbar inj. 62303 Included
Neurolytic Inj/Inf Single Epidural 62282 77003 Lumbosacral myelogram, via lumbar inj 62304 Included
Intercostal Nerve Block, Single 64420 77003 Myelogram, two or more regions 62305 Included
Intercostal Nerve Block, Multiple 64421 77003 *For radiological supervision and interpretation, see the
Stellate Ganglion Block (Cervical) 64510 77003 Radiology section in CPT.
Trig Pt Inj Sing/Multi 1-2 Muscles 20552 77002
Trig Pt Inj Sing/Multi 3or > Muscles 20553 77002 VERTEBROPLASTY/ VERTEBRAL AUGMENTATION
Sphenopalatine Inj with Fluoro 64505 77002 CPT S&I
Destruction cerv/thor facet jnt; single 64633 Included Vertebroplasty (Cervicothoracic) 22510 Included
Destruction cerv/thor facet jnt; each add'l +64634 Included Vertebroplasty (Lumbosacral) 22511 Included
Destruction lumbar/sacral facet jnt; single 64635 Included Vertebroplasty ea add. C/T or L/S 22512 Included
Destruction lumbar/sacral facet jnt; each add'l +64636 Included Sacroplasty, unilateral (1 or more needles) 0200T Included
Injection, paravert w/US; cerv/thoracic single 0213T Included Sacroplasty, bilateral (2 or more needles) 0201T Included
Injection, paravert w/US; cerv/thor 2nd level +0214T Included Kypho Thoracic One Vert Body 22513 Included
Injection, paravert w/US; cerv/thor 3rd + level +0215T Included Kypho Lumbar One Vert Body 22514 Included
Injection, paravert w/US; lumbar/sacral 0216T Included Kypho Eac add T or L Vert Body 22515 Included
Injection, paravert w/US; lumb/sac 2nd level +0217T Included
Injection, paravert w/US; lumb/sac 3rd + level +0218T Included + = Add-on code
Paravertebral block (PVB); thoracic 64461 Included
PVB; 2nd & any additional injection site(s) +64462 Included
PVB; thoracic; continuous infusion by catheter 64463 Included
Patient Radiologist
Date Technologist
Referring Physician Fluoroscopic Time
Diagnosis Moderate Sedation Time
Provided By Same Phy
BIOPSY PROCEDURES Provided By Others
CPT S&I ABLATION PROCEDURES
Fluoroscopic Guidance 77002 CPT S&I
Ultrasound Guidance 76942 Computed Tomography Guidance 77013
Computed Tomography Guidance 77012 Magnetic Resonance Guidance 77022
Magnetic Resonance Guidance 77021 Ultrasound Guidance 76940
Abdomen/Retroperitoneal Perc 49180 By modality Bone Tumor(s), Cryoablation, Perc. 20983 Included
Bone, Deep 20225 By modality Bone Tumor(s), RFA, Perc. 20982 Included
Bone, Superficial, Percutaneous 20220 By modality Breast Tumor(s), RFA, Perc. 19499 By Modality
Diagnostic bone marrow; aspiration(s) 38220 By modality Liver Tumor(s), Cryoablation, Perc. 47383 By Modality
Diagnostic bone marrow; biopsy(ies) 38221 By modality Liver Tumor(s), RFA, Perc. 47382 By Modality
DX bone marrow: biopsy(ies) and aspiration(s) 38222 By modality Liver Tumor(s), RFA, Open, US guide 47380* 76940
Liver 47000 By modality Inj. Ablative Agent, Liver 47399 By Modality
Lung, Percutaneous or Medastinum 32405 By modality Lung Tumor(s), RFA, Perc., Unilateral 32998 Included
Lymph nodes Sup. percutaneous 38505 By modality Lung Tumor(s), Cryoablation, Perc., Unilateral 32994 Included
Muscle, Percutaneous 20206 By modality Renal Tumor(s), Cryoablation, Perc. 50593 By Modality
Pancreas Percutaneous 48102 By modality Renal Tumor(s), RFA, Perc. 50592 By Modality
Parotid Bx / Salivary Gland 42400 By modality Renal Tumor(s), Cryo, Open, w/ US 50250* Included
Pleura, Percutaneous 32400 By modality Peripheral nerve, Upper extr distal, Cryoablation 0440T Included
Prostate 55700 By modality Peripheral nerve, Lower extr distal, Cryoablation 0441T Included
Renal. Percutaneous 50200 By modality Nerve plexus or other truncal, Cryoablation 0442T Included
Spinal Cord 62269 By modality *Use modifier -62 when service is provided by co-surgeons.
Thyroid, percutaneous 60100 By modality Inpatient Only Procedures
Transcatheter Biopsy 37200 75970
DRAINAGE PROCEDURES ENDOVASCULAR VARICOSE VEIN TREATMENTS
CPT S&I CPT S&I
Fluoroscopic Guidance 77002 Inj of non-compounded foam sclerosant, single extr. truncal vein 36465 Included
Ultrasound Guidance 76942 Inj of non-compounded foam sclerosant, multi extr. truncal veins, same leg 36466 Included
Computed Tomography Guidance 77012 Endovenous ablation by transcath delivery of a chemical adhesive, first vein 36482 Included
Magnetic Resonance Guidance 77021 Endovenous ablation by transcath delivery of a chemical adhesive, subseq veins 36483 Included
Abscessogram (Tube Check) 49424 76080 RFA extremity, perc., 1st vein 36475 Included
Asp Abscess, Bulla, or Cyst, by needle 10160 By modality RFA ext. perc., 2nd & [Link](s) +36476 Included
Asp. of Bladder by Intracatheter 51101 By modality Laser EVAT, extrem., perc., 1st vein 36478 Included
Asp. of Bladder w/ Insert Suprapubic Cath. 51102 By modality Laser EVAT, perc., 2nd & [Link](s) +36479 Included
Aspiration of Bladder by Needle 51100 By modality Endovenous mechanochemical; first vein 36473 Included
Change of Abscess Drain 49423 75984 Endovenous mechanochemical; ea. addtl vein(s) +36474 Included
Drain Spinal Cord Cyst 62268 By modality Catheterization is considered inherent to EVAT
Drainage by Cath, Peritoneal or Retroperitoneal 49406 Included
Drainage by Catheter, Soft Tissue 10030 Included OTHER VARICOSE VEIN TREATMENTS
Drainage by Catheter, Visceral 49405 Included CPT S&I
Fistula or Sinus Tract Study/Sinogram 20501 76080 Inj. of sclerosing sol.-spider vein, limb/trunk 36468 N/A
FNA Bx w/o Imaging, first lesion 10021 No image Inj of sclerosant, single vein other than spider vein 36470 76942
FNA Bx w/o Imaging, ea addt'l +10004 No image
FNA Bx w/ Ultrasound, first lesion 10005 Included Inj. of sclerosant - multi veins, same leg, other than spider veins 36471 76942
FNA Bx w/ Ultrasound, ea addt'l +10006 Included
FNA Bx w/Fluoro, first lesion 10007 Included Stab phleb of var veins; 1 extremity; 10-20 37765 N/A
FNA Bx w/Fluoro, ea addt'l +10008 Included
FNA Bx w/CT, first lesion 10009 Included Stab phleb of var veins; 1 extremity; 21+ 37766 N/A
FNA Bx w/CT, ea addt'l +10010 Included
FNA Bx w/MR 10011 Included Do not report 36470, 36471 in conjunction with 37241 in
FNA Bx w/MR, ea addt'l +10012 Included
Insert Indwelling Tunneled Pleural 32550 75989 the same surgical field
Pericardiocentesis including imaging 33016 Included
Pericardial drainage w/indwelling cath, (6 yrs or older) 33017 Incl. Fluoro/US
Pericardial drainage w/indwelling cath, (Child < 6) 33018 Incl. Fluoro/US
Pericardial drainage w/indwelling cath 33019 Incl. CT
Insert Peritoneal Tunneled Cathw/Imaging 49418 Included
Para/Peritonecentesis w/ Imaging 49083 Included + = Add-on code
Para/Peritonecentesis w/o Imaging 49082 No image
Peritoneal Lavage 49084 Included
Pleural Drainage w/ tube w/o Imaging 32556 No image
Pleural Drainage w/ tube with Imaging 32557 Included
Renal Cyst Aspiration w/ Needle 50390 By modality
Sclerotherapy of a fluid collection 49185 Included
Thoracentesis with Imaging 32555 Included
Thoracentesis without Imaging 32554 No image
Wire Localization of soft tissue 10035 Included
Wire Localization of soft tissue, ea. add. 10036 Included

CPT Only Copyright 2018 American Medical Association. All Rights Reserved.
All RightsCopyright
Reserved.2018
Copyright
Society2019
of Interventional
Society of Interventional
Radiology. All
Radiology
Rights Reserved
All Rights Reserved.
Patient Radiologist
Date Technologist
Referring Physician Fluoroscopic Time
Diagnosis Moderate Sedation Time
Provided By Same Phy
GASTROINTESTINAL PROCEDURES Provided By Others
CPT S&I ERCP
G-Tube Placement, Perc. 49440 Included ERCP Biliary Ducts RS&I 74328
J-Tube Placement, Perc. 49441 Included ERCP Pancreatic Ducts RS&I 74329
Cecostomy or other Colonic Tube 49442 Included ERCP Pancreatic and Biliary Ducts RS&I 74330
Convert G-Tube to G-J Tube 49446 Included ERCP 43260 See above
Gastro Tube Change (with fluoro) 49450 Included ERCP w/ biopsy 43261 See above
Replacement Dislodged J-Tube 49451 Included ERCP for Spincterotomy/Papillotomy 43264 See above
Replacement GJ Tube, Perc. 49452 Included ERCP calculus/calculi Removal 43265 See above
Repl. GJ Tube, Perc. incl remove w/o img,/w/o revision tract 43762 N/A ERCP calculus/calculi Destruction 43266 See above
Repl. GJ Tube, Perc. incl remove w/o img/w revision tract 43763 N/A ERCP Duct Stent Placement 43274 See above
Repo. Naso or Oro-Gastric FeedingTube 43761 76000 ERCP Remove Foreign Body/Stent from duct(s) 43275 See above
Contrast Inj. for any GI Tube 49465 Included ERCP Stent Exchange with Dilation 43276 See above
Esophageal Dilation Over Guide Wire 43453 74360 ERCP Dilation or Duct(s) or Ampulla, ea. Duct 43277 See above
Nasogastric Tube Placement 43752 Included Esophagus Dilation 43453 74360
Mech. Removal Obstructed Material 49460 Included
Inj. of air or contrast into peritoneal cavity 49400 74190 OTHER INTRODUCTION (INJECTION, CHANGE,
REMOVAL) CPT S&I
BILIARY PROCEDURES Chg of ureterostomy tube/ureteral stent 50688 75984
CPT S&I Whitaker Test 50396 74425
Percutaneous Cholecystostomy 47490 Included Nephrostolithotomy <2cm 50080 See note**
Inj. for Cholangiogram, Existing Access 47531 Included Nephrostolithotomy >2cm 50081 See note**
Inj. for Cholangiogram, New Access 47532 Included Ileoconduit Injection 50690 74425
Perc. Placement Billiary Drainage (Ext.) 47533 Included Inj. Cystogram/Voiding Urethrocystogram 51600 See note***
Perc. Plcmt Billiary Drainage (Int.-Ext.) 47534 Included Cystography/VCU w/Chain 51605 74430
Convert Ext. Biliary Drainage to Int-Ext 47535 Included Urethrocystogram, Retrograde 51610 74450
Exchange of Biliary Drainage Catheter 47536 Included Change Cystostomy Tube, Simple 51705 75984
Removal of Biliary Drainage Catheter 47537 Included Change Cystostomy Tube, Complex 51710 75984
Plcmt Bile Duct Stent(s), Existing Access 47538 Included
Plcmt Bile Duct Stent(s), New w/o drainage 47539 Included FALLOPIAN DILATATION
Plcmt Bile Duct Stent(s), New w/drainage 47540 Included CPT S&I
Plcmt access thru biliary tree, perc; new access 47541 Included Hysterosalpingogram (HSG) 58340 74740
Balloon dilation biliary duct/ampulla, perc. +47542 Included HSG, w/ or w/o color flow 58340 76831
Endoluminal Bx of biliary tree, perc +47543 Included Fallopian Dilatation 58345 74742
Removal calculi/debris fr. bile duct(s)/GB +47544 Included
Intraoperative Cholangiogram 74300 TIPS
Intraoperative Cholangiogram Additional +74301 CPT S&I
TIPS 37182 Included
URINARY PROCEDURES TIPS Revision 37183 Included
CPT S&I
Aspiration/inj of renal cyst or pelvis, perc 50390 See note*
Dilation of exist tract, perc., incl img guid 50436 Included Inpatient Only Procedures
Dilation of exist tract, perc., incl img guid; new access 50437 Included
Inj. antegrade nephro/ureterogram; new access 50430 Included
Inj. antegrade nephro/ureterogram; exist access 50431 Included Notes:
Plcmt nephro cath, perc incl. diag nephrogram 50432 Included *Code 50390 for radiological S&I, see 74425, 74470, 76942,
Plcmt nephroureteral cath, perc incl. diag nephro 50433 Included 77002, 77012, 77021
Convert nephrostomy catheter 50434 Included
Exchange nephrostomy catheter 50435 Included **Code 50080 and 50081, for fluoroscopic guidance, see 76000
Remove & replace ext. nephroureteral cath 50387 Included
Endoluminal bx of ureter/ renal pelvis 50606 Included ***Code 51600, For radiological supervision and interpretation,
Plmt of ureteral stent; existing nephrostomy tract 50693 Included see 74430, 74455)
Plmt of ureteral stent;new acc w/o sep nephro cath 50694 Included
Plmt of ureteral stent;new acc w/sep nephro cath 50695 Included + = Add-on code
Ureteral embolization or occlusion +50705 Included
Transurethral destruction of prostate; by radiofrequency 53854 74485
Balloon dilation, ureteral stricture +50706 Included
CPT Only Copyright 2018 American Medical Association. All Rights Reserved. Copyright 2019 Society of Interventional Radiology. All Rights Reserved.
Patient Radiologist
Date Technologist
Referring Physician Fluoroscopic Time
Diagnosis Moderate Sedation Time
Provided By Same Phy
Provided By Others
LOWER EXTREMITY ENDOVASCULAR REVASCULARIZATION

ILIAC VASCULAR TERRITORY

CPT S&I
Percutaneous Transluminal Angioplasty (PTA), unilateral 37220 Included
Stent Placement(s) w/ PTA when performed, unilateral 37221 Included
PTA each add'l ipsilateral iliac vessel 37222 Included
Stent Placement(s) w/ PTA within same vessel when performed, ea. add'l vessel 37223 Included
Endovascular repair of iliac artery bifurcation using bifurcating endograft, incl cath place & RS&I 0254T Included
EVAR iliac artery at the time of aortoiliac artery endograft plcmnt, unilateral +34717 Included
EVAR iliac artery, not associated with plcmnt of an aorto-iliac artery endograft, unilateral 34718 Included

FEMORAL/ POPLITEAL VASCULAR TERRITORY

CPT S&I
Percutaneous Transluminal Angioplasty (PTA), unilateral 37224 Included
Atherectomy w/ PTA within same vessel when performed, unilateral 37225 Included
Stent Placement(s) w/ PTA within same vessel when performed, unilateral 37226 Included
Stent and Atherectomy w/ PTA within same vessel when performed, unilateral 37227 Included

TIBIAL/ PERONEAL VASCULAR TERRITORY

CPT S&I
Percutaneous Transluminal Angioplasty (PTA), unilateral 37228 Included
Atherectomy w/ PTA within same vessel when performed, unilateral 37229 Included
Stent Placement(s) w/ PTA within same vessel when performed, unilateral 37230 Included
Stent and Atherectomy w/ PTA within same vessel when performed, unilateral 37231 Included
PTA, each add'l ipsilateral tibial/peroneal vessel +37232 X_ Included
Atherectomy w/ PTA within same vessel when performed, ea. add'l vessel +37233 X_ Included
Stent Placement(s) w/ PTA within same vessel when performed, ea. add'l vessel +37234 X_ Included
Stent and Atherectomy w/ PTA within same vessel when performed, ea. add'l vessel +37235 X_ Included

ARTHRECTOMY SUPRA-INGUINAL ARTERIES

CPT S&I
Renal Artery 0234T Included
Visceral Artery (except renal) each vessel 0235T Included
Abdominal Aorta 0236T Included
Brachiocephalic Trunk and Branches, each vessel 0237T Included
Iliac Artery, each vessel 0238T Included

Category III codes to describe transluminal atherectomy above Inguinal ligaments percutaneously and/or

though open surgical exposure (includes RS&I)

Inpatient Only Procedures

+ = Add-on code
CPT Only Copyright 2018 American Medical Association. All Rights Reserved. Copyright 2019 Society of Interventional Radiology. All Rights Reserved.
Patient Radiologist
Date Technologist
Referring Physician Fluoroscopic Time
Diagnosis Moderate Sedation Time
Provided By Same Phy
Provided By Others
SELECTIVE CATHETER PLACEMENTS 1st 2nd 3rd Add'l 2nd &
ARTERIAL ORDER ORDER ORDER 3rd Order
Non-selective Aortic Arch Inj w/ all Imaging 36221
Selective Innominate or CCA w/ Cerv Carotid Imaging, uni 36222
Selective Innominate or CCA w/ Cerv/Cerebral Imaging, uni 36223
Selective ICA w/ Cerv/Cerebral Imaging, uni 36224
Selective Innominate or Subclavian w/ Vertebral Imaging, uni 36225
Selective Vertebral w/ Vertebral Imaging, uni 36226
Selective External Carotid Artery w/ Ext. Carotid Imaging +36227* *Do not code 36227 more than once per side
Selective Intracranial Branch of ICA or Vertebral w/ img, ea. add. +36228** **Max 2X per side
Selective extracranial vertebral or subclavian branches +36218*** ***Use in conjunction with 36225 or 36226 respectively
Selective Arterial, Spinal above Diaphragm 36215 36216 36217 +36218
Selective Spinal/Lumbar below Diaphragm 36245 36246 36247 +36248
Celiac 36245 36246 36247 +36248
SMA 36245 36246 36247 +36248
IMA 36245 36246 36247 +36248
Renal, Selective, Unilateral, angiogram included 36251
Renal, Selective, Bilateral, angiogram included 36252
Renal, Superlective (one or more second order or higher renal artery branches); Unilateral 36253
Renal, Superlective (one or more second order or higher renal artery branches); Bilateral 36254
Iliac, Ipsilateral 36245 36246 36247 +36248
Common Iliac, Contralateral 36245 36246 36247 +36248
Common Femoral, Ipsilateral, Retrograde 36245 36246 36247 +36248
Common Femoral, Contralateral N/A 36246 36247 +36248
Right Heart or Pulmonary ,Trunk only 36013 N/A N/A N/A
Left Pulmonary (Includes Pressures) N/A 36014 36015 36015
Right Pulmonary (Includes Pressures) N/A 36014 36015 36015
Bronchial Intercostal Arteries & Branches 36215 36216 36217 36218
Closure Device Placement Vascul G0269

SELECTIVE CATHETER PLACEMENTS 1st 2nd 3rd Add'l 2nd &

VENOUS ORDER ORDER ORDER 3rd Order
Right Renal 36011 36012 36012 36012
Left Renal 36011 36012 36012 36012
Jugular 36011 36012 36012 36012
Left Adrenal N/A 36012 36012 36012
Right Adrenal 36011 36012 36012 36012
Epidural 36011 36012 36012 36012
Portal Venogram 36481
Other Venous Vascular Family 36011 36012 36012 36012
Selective Venous Blood Sampling 36500 75893

NON-SELECTIVE VASCULAR
CATHETERIZATIONS CPT
Aorta Catheter (Femoral, Brach., Axillary) 36200
Extremity Artery, Needle/Intracath. Uni 36140
Arterial Cath. Sampling 36620
Ext. Vein Needle/Intracath, Uni 36005
Aorta (Translumbar) 36160
Carotid/Vertebral, direct puncture 36100
Retrograde Brachial 36120
Superior or Inferior Vena Cava, Catheter 36010
Jugular Vein 36299
Injection; Lymphangiography 38790

MISCELLANEOUS
CPT
Closure Device G0269
CT, limited or localized follow-up 76380
US Guidance for Vascular Access +76937
3D Reconstruction w/o Independent 76376
3D Reconstruction w/ Independent 76377
Anatomic model 3D-printed; 1st anatomic structure 0559T
Anatomic model 3D-printed; each additional anatomic structure +0560T
Anatomic model 3D-printed; 1st anatomic guide 0561T
Anatomic model 3D-printed; each additional anatomic guide +0562T
+ = Add-on code

Notes: CATHETERIZATION CODING CONVENTIONS

1) Code multiple catheterizations in the same vascular family to the highest order
2) Use the "Each Additional" code for each additional second or third order vessel within the same vascular family
3) Code catheterizations of different vascular families separately

CPT Only Copyright 2018 American Medical Association. All Rights Reserved. Copyright 2019 Society of Interventional Radiology. All Rights Reserved
Patient Radiologist
Date Technologist
Referring Physician Fluoroscopic Time
Diagnosis Moderate Sedation Time
Provided By Same Phy
ARTERIOGRAPHY SUPERVISION & INTERPRETATION S&I Provided By Others
Thoracic Aortogram 75605 THROMBOLYSIS AND INFUSION THERAPY CPT S&I
Abdominal Aortogram 75625 Arterial thrombolytic infusion, other than coronary or intracranial 37211 Included
Abdominal Aortogram w/Run Offs 75630 Venous infusion for thrombolysis 37212 Included
Brachial, Retrograde 75658 Continued thrombolytic infusions(s) on subsequent day(s) 37213 Included
Spinal, Intercostal, Lumbar (Selective) 75705 X_ Thrombolytic infusion(s) final day of therapy 37214 Included
Extremity, Unilateral, Upper or Lower 75710 Perc Art Mech Thrombectomy/Infusion for Thrombolysis, intracranial 61645 Included
Extremity, Bilateral, Upper or Lower 75716 Endovasc Intracranial Admin of Pharma agent, non-thrombolysis, initial 61650 Included
Visceral (w or w/o aorta) Ea. Vessel 75726 X_ Endovasc Intracranial Admin of Pharma agent, non-thrombolysis, each add'l +61651 Included
Adrenal Unilateral (Selective) 75731 Thrombolysis, cerebral, by intravenous infusion 37195 Included
Adrenal Bilateral (Selective) 75733
Pelvic, Each Vessel (Selective) 75736 X_ MECHANICAL THROMBECTOMY CPT S&I
Pulmonary, Unilateral (Selective) 75741 Primary Arterial Mech Thromb - initial vessel 37184 Included
Pulmonary, Bilateral (Slelective) 75743 Primary Arterial Mech Thromb -2nd/and all subsequent vessel(s) +37185 Included
Pulmonary, Non-Selective 75746 Secondary Mech Thromb- "rescue", suction, snare basket +37186 Included
Internal Mammary 75756 Venous Mech Thromb - Day 1 37187 Included
Each Add Vessel After Basic +75774 X_ Ven Mech Thromb - repeat thrombectomy on subs. day 37188 X_ Included

VENOGRAPHY SUPERVISION & INTERPRETATION S&I INTRAVASCULAR ULTRASOUND (IVUS) CPT S&I
Extremity, Unilateral 75820 IVUS initial noncoronary vessel +37252 Included
Extremity, Bilateral 75822 IVUS Each additional vessel IVUS +37253 Included
IVC 75825
SVC 75827 PERCUTANEOUS ANGIOPLASTY CPT S&I
Renal, Unilateral (Selective) 75831 Except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit
Renal, Bilateral (Selective) 75833 PTA, initial artery 37246 Included
Adrenal, Unilateral (Selective) 75840 PTA, each additional artery +37247 Included
Adrenal, Bilateral (Selective) 75842 PTA, initial vein 37248 Included
Sinus or Jugular 75860 PTA, each additional vein +37249 Included
Superior Sagittal Sinus 75870
Epidural 75872 EMBOLIZATION (NON-HEAD/NECK) CPT S&I
Orbital 75880 Venous, other than hemorrhage 37241 Included
Hepatic w/Hemodynamic Eval 75889 Arterial, other than hemorrhage 37242 Included
Hepatic Wedge Pressure (no venogram) 75889-52 Tumors, organ ischemia, or infarction 37243 Included
Hepatic w/o Hemodynamic Eval 75891 Arterial or venous hemorrhage or lymphatic extravasation 37244 Included
Transhepatic Portogram/Pressure 75885 Chemotherapy administration, intra-arterial; push technique 96420 N/A
Venous Sampling (eg. Renins) 75893 X_ Radiopharmaceutical therapy, by intra-arterial particulate administration 79445

INTRACRANIAL DILATION, ANGIOPLASTY, STENT CPT EMBOLIZATION (HEAD OR NECK) CPT S&I
Intracranial angioplasty 61630 Cerebral Balloon Occlusion Test (BOT), temporary 61623 Included
Intracranial angioplasty w/ stent 61635 Embolization Central Nervous System (CNS), permanent 61624 75894
Dilatation of intracranial vasospasm; initial vessel 61640 Embolization Non-CNS, head or neck 61626 75894
each add'l vessel same vascular territory +61641 X_ F/U Angio study for transcath therapy, embo or infusion, other than thrombo 75898
each add'l vessel different vascular territory +61642 X_
Includes selective catheterization and all imaging of target vessel DIALYSIS ACCESS INTERVENTIONS CPT S&I
Intro Cath Dialysis Circuit 36901 Included
INTRAVASCULAR STENTS (Non-Coronary/Non-Carotid/ Intro Cath Dialysis Circuit w/ Angioplasty 36902 Included
Non-Vertebral/Non-Intracranial/Non-Lower Ext.) CPT Intro Cath Dialysis Circuit w/ Angioplasty and Stent 36903 Included
Intravascular Stent, open or perc., initial artery 37236 Mech Thrombectomy or Thrombolysis 36904 Included
Intravascular Stent, open or perc., ea. add'l artery +37237 Mech Thrombectomy or Thrombolysis w/ Angioplasty 36905 Included
Intravascular Stent, open or perc, initial vein 37238 Mech Thrombectomy or Thrombolysis w/ Angioplasty and Stent 36906 Included
Intravascular Stent, open or perc, ea. add'l vein +37239 Angioplasty, Central Dialysis Segment +36907 Included
INTRAVASCULAR STENTS (Cervical Carotid) CPT Angioplasty, Central Dialysis Segment w/ Stent +36908 Included
Intravascular Stent w/ distal embolic protection 37215* Dialysis circuit permanent vascular embolization or occlusion +36909 Included
Intravascular Stent w/o distal embolic protection 37216* Extremity Venogram N/A 75820
INTRAVASCULAR STENTS
(Extracranial Vertebral/Intrathoracic Carotid) CPT TRANSCATHETER THERAPY MISC. CPT S&I
Intravascular Stent, open or perc; initial vessel 0075T* Foreign Body Retrieval 37197 Included
Intravascular Stent, open or perc; each addl. vessel +0076T* IVC Filter Insertion 37191 Included
IVC Filter Respositioning 37192 Included
Stent codes include RS&I and angioplasty in the same vessel when performed IVC Filter Retrieval (Removal) 37193 Included
*Includes all ipsilateral selective cath, target vessel angiography and RS&I
Inpatient Only Procedures
+ = Add-on code
2019
CPT Only Copyright 2018 American Medical Association. All Rights Reserved. Copyright 2018 Society
Society of Interventional
of Interventional Radiology.
Radiology. All Rights
All Rights Reserved.
Reserved
Patient Radiologist
Date Technologist
Referring Physician Fluoroscopic Time
Diagnosis Moderate Sedation Time
Provided By Same Phy
Provided By Others
CENTRALLY INSERTED DEVICE CPT S&I
Fluoro guidance for CVA device plcmt/replacement/removal +77001
Ultrasound guidance for vascular access +76937
Non-Tunneled (Child < 5) 36555 By modality(ies)
Non-Tunneled (5 years or older) 36556 By modality(ies)
Tunneled (Child <5) No Port, No Pump 36557 By modality(ies)
Tunneled (5 years or older) No Port, No Pump 36558 By modality(ies)
Tunneled Cath. w/ Port (Child <5) 36560 By modality(ies)
Tunneled Cath. w/ Port (5 years or older) 36561 By modality(ies)
Tunneled Cath. w/ Pump 36563 By modality(ies)
2 Tunneled Cath, 2 Access(no port/pump) (Tesio) 36565 By modality(ies)
2 Tunneled Cath, 2 Access Sites, w/ Port 36566 By modality(ies)

PERIPHERALLY INSERTED DEVICE - WITHOUT IMAGE GUIDANCE CPT S&I

Non-Tunneled PICC w/o img guidance; (Child < 5) 36568 N/A
Non-Tunneled w/o img guidance; (5 years or older) 36569 N/A

PERIPHERALLY INSERTED DEVICE - WITH IMAGE GUIDANCE CPT S&I

Peripherally-inserted central venous catheter, (w/o SQ port/pump) incl all img; (Child < 5) 36572 Included
Peripherally-inserted central venous catheter, (w/o SQ port/pump) incl all img; (5 years or older) 36573 Included

PERIPHERALLY INSERTED DEVICE WITH PORT CPT S&I

Fluoro guidance for CVA device plcmt/replacement/removal +77001
Ultrasound guidance for vascular access +76937
Peripherally-inserted central venous access device (SQ port) (Child < 5 years) 36570 By modality(ies)
Peripherally-inserted central venous access device (SQ port) w/ Port (5 years or older) 36571 By modality(ies)

REPAIR CPT S&I

Tunneled or non-tunneled CVA, w/o port or pump, central or peripheral 36575 N/A
Tunneled or non-tunneled CVA, w/ port or pump, central or peripheral 36576 N/A

REPLACEMENT CPT S&I

Fluoro guidance for CVA device plcmt/replacement/removal +77001
Ultrasound guidance for vascular access +76937
Replace, catheter only, of CVA device, w/ port or pump, central or peripheral 36578 By modality(ies)
Replace, complete, non-tunneled centrally inserted CVC, w/o port or pump, same access 36580 By modality(ies)
Replace, complete, tunneled, centrally inserted CVC, w/o port or pump, same access 36581 By modality(ies)
Replace, complete, tunneled, centrally inserted CVA device, w/ port,same access 36582 By modality(ies)
Replace, complete, tunneled, centrally inserted CVA device, w/ pump, same access 36583 By modality(ies)
Replace, complete, PICC, w/o port or pump, same access, incl all img guide, RS&I 36584 Included
Replace, complete, PICC, w/ port, same access 36585 By modality(ies)

S&I
REMOVAL CPT if performed
Removal non-tunneled, no port no pump E/M N/A
Removal of tunneled central venous catheter, w/o port or pump 36589 +77001
Removal of tunneled central venous access device, w/ port or pump, central or peripheral 36590 +77001

CENTRAL/PERIPHERAL CVA DEVICE MAINTENANCE CPT S&I

Repositioning central venous catheter under fluoroscopic guidance 36597 76000
Thrombolytic declotting of vascular access 36593 N/A
CVA maintenance fibrin stripping (sep access) 36595* 75901
CVA maintenance through lumen (brushing) 36596 75902

OTHER IMAGING FOR CENTRAL/PERIPHERAL DEVICE S&I

Computed tomography, limited or localized follow-up study 76380
Fluoroscopy (separate procedure), up to 1 hour 76000
SVC gram 75827
IVC gram 75825
Venography, extremity, unilateral 75820
Venography, extremity, bilateral 75822
+ = Add-on code
* (For venous catheterization, see 36010-36012)
CPT Only Copyright 2018 American Medical Association. All Rights Reserved. Copyright 2019 Society of Interventional Radiology. All Rights Reserved
Patient Radiologist
Date Referring Physician
Diagnosis

EVALUATION & MANAGEMENT SERVICES

OFFICE/OUTPATIENT VISITS - NEW PATIENT

Required Components: 3/3
CPT History and Exam Medical Decision Making Presenting Problem Face-to-Face Time
99201 Problem-Focused Straightforward Self-Limited or Minor 10 minutes
99202 Expanded Problem-Focused Straightforward Low to Moderate 20 minutes
99203 Detailed Low Moderate 30 minutes
99204 Comprehensive Moderate Moderate to High 45 minutes
99205 Comprehensive High Moderate to High 60 minutes

OFFICE/OUTPATIENT VISITS - ESTABLISHED PATIENT

Required Components: 2/3
CPT History and Exam Medical Decision Making Presenting Problem Face-to-Face Time
99211 N/A N/A Minimal 5 minutes
99212 Problem-Focused Straightforward Self-Limited or Minor 10 minutes
99213 Expanded Problem-Focused Low Low to Moderate 15 minutes
99214 Detailed Moderate Moderate to High 25 minutes
99215 Comprehensive High Moderate to High 40 minutes

*OUTPATIENT CONSULT- NEW OR ESTABLISHED PATIENT

Required Components: 3/3
CPT History and Exam Medical Decision Making Presenting Problem Face-to-Face Time
99241 Problem-Focused Straightforward Self-Limited or Minor 15 minutes
99242 Expanded Problem-Focused Straightforward Low to Moderate 30 minutes
99243 Detailed Low Moderate 40 minutes
99244 Comprehensive Moderate Moderate to High 60 minutes
99245 Comprehensive High Moderate to High 80 minutes

INITIAL HOSPITAL CARE - NEW OR ESTABLISHED PATIENT

Required Components: 3/3
CPT History and Exam Medical Decision Making Presenting Problem Face-to-Face Time
99221 Detailed or Comprehensive Straightforward or Low Low 30 minutes
99222 Comprehensive Moderate Moderate 50 minutes
99223 Comprehensive High High 70 minutes

*INPATIENT CONSULT- NEW OR ESTABLISHED PATIENT

Required Components: 3/3
CPT History and Exam Medical Decision Making Presenting Problem Face-to-Face Time
99251 Problem-Focused Straightforward Self-Limited or Minor 20 minutes
99252 Expanded Problem-Focused Straightforward Low to Moderate 40 minutes
99253 Detailed Low Moderate 55 minutes
99254 Comprehensive Moderate Moderate to High 80 minutes
99255 Comprehensive High Moderate to High 110 minutes

POSTOPERATIVE FOLLOW-UP VISIT

99024 E/M was performed during a postop period for a reason(s) related to the original procedure

Modifier 25- To report a separate and distinct E/M service with a non-E/M service performed on the same date
*Local Medicare Part B carriers and/or A/B MACs will no longer recognize consultation codes (ranges 99241-99245, and 99251-99255) for
inpatient facility and office/outpatient settings.
CPT Only Copyright 2018 American Medical Association. All Rights Reserved. Copyright 2019 Society of Interventional Radiology. All Rights Reserved.
Patient Radiologist
Date Physician # 2
Referring Physician Technologist
Diagnosis Fluoroscopic Time
Moderate Sedation Time
Provided By Same Phy
Provided By Others
AAA-TA-IA ENDOVASCULAR REPAIR

CATHETERIZATION: SELECTIVE 1st 2nd 3rd Add'l 2nd & CATHETERIZATION: NON-SELECTIVE
Arterial Vascular Family ORDER ORDER ORDER 3rd Order Report cath codes in addition to exposure CPT
IIiac, Ipsilateral 36245 36246 36247 +36248 X_ Introduction of catheter, aorta (Femoral, Brachial, Axillary) 36200*
Common IIiac, Contralateral 36245 36246 36247 +36248 X_ Introduction of needle or intracatheter; extremity artery 36140*
Common Femoral, Ipsilateral 36245 36246 36247 +36248 X_ EXPOSURE FOR ENDOPROSTHESIS CPT
Common Femoral, Contralateral 36245 36246 36247 +36248 X_ Open femoral artery exposure 34812***
Common Iliac or Femoral, Axillary or Brachial Approach 36245 36246 36247 +36248 X_ Placement of femoral-femoral prosthetic graft +34813**
Other Abdominal Aorta Vascular Family 36245 36246 36247 +36248 X_ Open iliac artery exposure 34820***

ENDOVASCULAR REPAIR OF THE INTRARENAL AORTA CPT S&I FENESTRATED ENDOVAS REPAIR VISCERAL/INFRARENAL AORTA CPT
EVAR infrarenal aorta w/ aorto-aortic tube endograft, other than rupture 34701 Included Endo repair of visceral aorta; incl. one visceral artery endoprosth. 34841
EVAR infrarenal aorta w/ aorto-aortic tube endograft, rupture 34702 Included Endo repair of visceral aorta; incl. two visceral artery endoprosth. 34842
EVAR infrarenal aorta w/ aorto-uni-iliac endograft, other than rupture 34703 Included Endo repair of visceral aorta; incl. three visceral artery endoprosth. 34843
EVAR infrarenal aorta w/ aorto-uni-iliac endograft, rupture 34704 Included Endo repair of visceral aorta; incl. four or more visceral artery endoprosth. 34844
EVAR infrarenal aorta w/ aorto-bi-iliac endograft, other than rupture 34705 Included Endo repair viscl aorta/infrarenal abd aorta; one viscl artery endoprosth. 34845
EVAR infrarenal aorta w/ aorto-bi-iliac endograft, rupture 34706 Included Endo repair viscl aorta/infrarenal abd aorta; two viscl artery endoprosth. 34846
EVAR iliac artery at the time of aortoiliac artery endograft plcmnt, unilateral +34717 Included Endo repair viscl aorta/infrarenal abd aorta; three viscl artery endoprosth. 34847
EVAR iliac artery, not associated with plcmnt of an aorto-iliac artery endograft, unilateral 34718 Included Endo repair viscl aorta/infrarenal abd aorta; four + viscl artery endoprosth. 34848
EVAR iliac artery w/ ilio-iliac tube endograft, other than rupture 34707 Included Phys. plan patient-specific fen viscl aortic endograft- min. 90mins. phys. time 34839
EVAR iliac artery w/ ilio-iliac tube endograft, rupture 34708 Included
Plcmt of ext endograft dist common iliac/ prox renal artery(ies) same set as init plcmt +34709 Included OCCLUSION DEVICE CPT
Delayed plcmt of extension(s) in a different setting 34710 Included Endovascular placement iliac occlusion device +34808
Delayed plcmt of extension(s) in a different setting; each add'l vessel treated +34711 Included
Placement of endoanchors 34712 Included OPEN CONVERSION CPT
Percutaneous closure of femoral artery from large (12 French or greater) sheath +34713 Included Open repair infrarenal aortic aneurysm endo repair; tube prosthesis 34830**
Endo repair of iliac art bifurc using endoprosthesis into external/internal iliac artery; unil 0254T Open repair infrarenal aortic aneurysm endo repair; aorto-bi-iliac prosthesis 34831**
Open repair infrarenal aortic aneurysm endo repair; aorto-bifem prosthesis 34832**
TA ENDOPROTHESIS DEPLOYMENT CPT S&I
TA endo repair w/ coverage of subclavian origin 33880** 75956 BYPASS CPT
TA endo repair w/o coverage of subclavian origin 33881** 75957 Bypass graft, with vein; femoral-popliteal 35556***
Open subcl. to carotid transpositio in conj w/ TA endo repair, neck incision 33889*** N/A Bypass graft, with other than vein; femoral-popliteal 35656***
Graft other than vein, transcervical retropharyngeal carotid-carotid with TA 33891*** N/A
THROMBOENDARTERECTOMY CPT
TA EXTENSIONS/CUFFS DEPLOYMENT CPT S&I Thromboendarterectomy, incl. patch graft; iliofemoral 35355***
Placement of proximal extension prosthesis; initial extension 33883** 75958 Thromboendarterectomy, incl. patch graft; common femoral 35371***
Placement of proximal extension prosthesis; each add'l proximal extension +33884** X_ 75958 Thromboendarterectomy, incl. patch graft; deep femoral (profunda) 35372***
Placement of distal extension prosthesis delayed after desc TA endo repair 33886** 75959
EMBOLECTOMY THROMBECTOMY CPT
Embolectomy/thrombectomy, w/ w/o catheter; fem-pop, aortoiliac artery, leg incision 34201***
TRANSLUMINAL BALLOON ANGIOPLASTY CPT S&I Embolectomy/thrombectomy, w/ w/o catheter; pop-tibio-peroneal artery, leg incision 34203***
PTA, initial artery 37246 Included
PTA, each additional artery +37247 Included ARTERIAL REPAIR CPT
PTA, initial vein 37248 Included Repair blood vessel, direct; lower extremity 35226***
PTA, each additional vein +37249 Included Repair blood vessel with vein graft; lower extremity 35256***
Repair blood vessel with graft other than vein; lower extremity 35286***
INTRAVASCULAR ULTRASOUND CPT S&I
Intravascular ultrasound; initial (non coronary) vessel +37252 N/A
Intravascular ultrasound; each add'l (non coronary) vessel +37253 N/A Inpatient Only Procedures

INTRAVASCULAR STENTS CPT S&I *For bilateral procedure, use modifier 50

Other than lower ext., for occlusive disease, cervical carotid, extra/intracranial or coronary **For two Surgeons (Co-Surgeons), use modifier 62
Transcath placement of intravascular stent, open or percutaneous; initial artery 37236* N/A ***For bilateral procedure and two surgeons, use modifiers 50 and 62
Transcath placement of intravascular stent, open or percutaneous; each add'l artery +37237* X_ N/A
Transcath placement of intravascular stent, open or percutaneous; initial vein 37238* N/A -Stents placed inside the endoprosthesis treatment zone are
Transcath placement of intravascular stent, open or percutaneous; each add'l vein +37239* X_ N/A not separately billable.
Transcath placement of intravascular stent, open ipsilateral cervical carotid artery exposure 37217* N/A -Balloon dilatation of endoprosthesis is not separately billable.
-Multiple cuffs in the same vessel are not reportable beyond the first.
OTHER CPT S&I -Code caths of different vascular families separately per
US guidance for vascular access +76937 standard catheter coding conventions.
CT, limited or localized follow-up 76380 -Code Multiple Caths in the Same Vascular Family to the Highest Order.
-Use the "Each Additional" Code for Each Add/l 2nd or 3rd Order Vessel.

+ = Add-on code
Patient Radiologist
Date Technologist
Referring Physician Moderate Sedation Time
Diagnosis Provided By Same Phy
Provided By Others
BREAST CORE NEEDLE BIOPSY CPT S&I
Stereotactic guidance, 1st lesion 19081 Included
Stereotactic guidance, each additional lesion +19082 X_ Included
Ultrasound guidance, 1st lesion 19083 Included
Ultrasound guidance, each additional lesion +19084 X_ Included
Magnetic resonance guidance, 1st lesion 19085 Included
Magnetic resonance guidance, each additional lesion +19086 X_ Included
Tomosynthesis guidance without stereotactic 19499
Breast Biopsy includes imaging, localization device, and imaging of biopsy specimen, when performed

BREAST LOCALIZATION DEVICE W/O BREAST BIOPSY CPT S&I

Mammographic guidance, 1st lesion 19281 Included
Mammographic guidance, each additional lesion +19282 X_ Included
Stereotactic guidance, 1st lesion 19283 Included
Stereotactic guidance, each additional lesion +19284 X_ Included
Ultrasound guidance, 1st lesion 19285 Included
Ultrasound guidance, each additional lesion +19286 X_ Included
Magnetic resonance guidance, 1st lesion 19287 Included
Magnetic resonance guidance, each additional lesion +19288 X_ Included
Surgical specimen radiography 76098
A diagnostic post-procedure mammogram may not be coded in addition to mammographic guided biopsies nor device localizations.

OTHER BREAST PROCEDURES CPT S&I

Ultrasound Guidance 76942
Computed Tomography Guidance 77012
Magnetic Resonance Guidance 77021
Puncture aspiration of cyst of breast 19000 By modality
Puncture aspiration of cyst of breast; each additional cyst +19001 X_ By modality
FNA Bx w/o Imaging, first lesion 10021 No image
FNA Bx w/o Imaging, ea addt'l +10004 No image
FNA Bx w/ Ultrasound, first lesion 10005 Included
FNA Bx w/ Ultrasound, ea addt'l +10006 Included
FNA Bx w/Fluoro, first lesion 10007 Included
FNA Bx w/Fluoro, ea addt'l +10008 Included
FNA Bx w/CT, first lesion 10009 Included
FNA Bx w/CT, ea addt'l +10010 Included
FNA Bx w/MR 10011 Included
FNA Bx w/MR, ea addt'l +10012 Included
Injection for Galactogram or Ductogram, Single Duct 19030 77053
Injection for Galactogram or Ductogram, Multiple Ducts 19030 X_ 77054
Sentinel Node Injection 38792
Lymphatics and Lymph Nodes Imaging (includes code 38792, if performed) 78195
Code 10022 has been deleted. To report, see 10005, 10006, 10007, 10008, 10009, 10010, 10011, 10012). Do not report 10004,
10021 in conjunction with 10005, 10006, 10007, 10008, 10009, 10010, 10011, 10012 for the same lesion).

SOFT TISSUE-MARKER PLACEMENT OTHER THAN BREAST TISSUE

CPT S&I
Placement of soft tissue localization device(s), perc, first lesion 10035 Included
Placement of soft tissue localization device(s), perc, ea. addt'l lesion +10036X_ Included
Use 10035 and 10036 for soft tissue localization other than breast(s). See codes 19081 - 19088 and 19281 - 19288 for
breast tissue device localization with or without biopsy.

MAMMOGRAM and TOMOSYNTHESIS CPT CAD

Diagnostic Unilateral 77065 Included
Diagnostic Bilateral 77066 Included
Screening 77067 Included
Digital breast tomosynthesis; unilateral 77061 N/A
Digital breast tomosynthesis; bilateral 77062 N/A
Screening digital breast tomosynthesis, bilateral +77063 N/A
For Medicare, use G0279 to report diagnostic digital breast tomosynthesis.
Mammogram codes 77065-77067 include computer-aided detection (CAD), when performed

+ = Add-on code
CPT Only Copyright 2018 American Medical Association. All Rights Reserved. Copyright 2019 Society of Interventional Radiology. All Rights Reserved