Q & A with Dr. David Zielske

Question: Sclerotherapy for Lymphatic Malformations

In the past, the coding recommendation for direct sclerotherapy/embolization of lymphatic malformations was to use unlisted codes. With the new embolization codes for 2014, would 37241 be a possibility for these procedures? I looked at 37244 but since that is referring to extravasation, it doesn't appear to match the intent of the sclerotherapy/embolization. Although 37241 doesn't use the term lymphatics, both the CPT book and CPT Insiders refer to these embolization codes to be used when "arteries, veins, and lymphatics may all be the target of embolization". Would you recommend continuing to use the unlisted codes or using one of the 2014 codes?


Answer

Do not use an unlisted code for this type of embolization in 2014. We would use code 37241 for treatment of a lymphatic malformation and 37244 for a transected, leaking, thoracic duct in the chest cavity, to treat the extravasation of the lymph from the duct. The code to report depends on the indication.