Q & A with Dr. David Zielske

Question: TIPS and Variceal Sclerosis

I have a report for a TIPS with Variceal Sclerosis, for a patient with cirrhosis and GI bleeding. I know the TIPS is coded with 37182, and a coil embolization was done on the gastric varices so I would use 37204, 75894, 75898. Do I code the sclerosant solution that was injected into the varix also, or is that part of the embolization? If it is coded separately, would the unlisted codes be used like with the venous malformations of the head and neck? Or is it a different code?


Answer

Any treatment to get rid of the bleeding varix is part of the embolization and not coded separately. A sclerosing agent (gelfoam, coils, etc.) can be put into the vein to make it occlude. All of these methods would be coded as a single embolization…including the treatment of multiple varices. The CPT code for this treatment changes in 2014. Code 37241 would be used if the varix was NOT bleeding. Code 37244 will be used for treatment of GI bleeding (which is the case here).