August 2016 Q & A

Question: Embolization - 37241 for lymphatic malformation treatment


How do I code the following?


PROCEDURE: The left axillary lymphatic malformation was examined with ultrasound and a suitable access site for needle placement was identified and the skin marked. The left axilla was prepared and draped in the usual sterile fashion. Using ultrasound guidance the first site (site #1) in the deep aspect of the axillary region was accessed with a trocar 6.3 French Dawson-Mueller pigtail drain. Next, using ultrasound guidance, the second, more superficial site (segment #2) was accessed with a trocar 6.3 French Dawson-Mueller pigtail drain. Finally, a superficial collection (site #3) was accessed with a 21-gauge micropuncture needle through which direct injection of 2 mL of doxycycline was performed. The predominant injection solution composed of a 4:1 dilution of doxycycline (10 mg/mL): Omnipaque 300 was injected under ultrasound and fluoroscopic guidance, according to the following outline: A total of 160 mg doxycycline in 16 mL saline was injected.

Non-selective catheter placements cannot be submitted with embolization procedures (See the National Correct Coding Initiative Manual for Medicare Services). The procedure performed is an embolization; a venous embolization code is used for lymphatic malformation treatments as described in your example. This is one surgical site for coding purposes (one extremity). Code 37241 describes this procedure.

It was brought to our attention that some coders believe this should be reported with codes 10030 and 49185. If this is a lymphocele, and NOT a true lymphatic malformation, then we would code: using 10030 x 2 if the catheter is indwelling (or 10160 x 2 if the catheter is removed at the end of the procedure), along with 49185 x 2 for treatment of two separate lymphoceles with alcohol. A lymphocele is a fluid collection, usually from a disrupted lymph duct (post-surgical is not uncommon with renal transplants, groin or axillary surgery, etc.). A lymphatic malformation is a totally different problem, and it is congenital in nature. There are microcystic and macrocystic lymphatic malformations, with the macrocystic being the one that is drained with catheters and treated the way described in this report. It is up to the MD to accurately describe the abnormality treated in his dictation. In this case, he stated it was a malformation, so I believed him. A lymphatic malformation and a lymphocele can basically be treated the same way; however, they have much different coding based on the physician defined etiology of the pathology. Hope this clears up this case.