December 2014 Q & A

Question: Preoperative Tumor Embolization

The preoperative embolizations are sometimes confusing because they are done for varying reasons. When embolization is arteries supplying tumor, would this be considered Tumor Embolization? Patient has metastatic renal cell carcinoma to femur.

Title of Procedure: "Transarterial particle embolization of left femoral metastasis”. Indication: "Preoperative Embolization”. Impression: Large hypervascular lesion in distal left femur, receiving blood supply from multiple branches of superficial femoral artery. Successful embolization of 3 branches of left SFA with approximately 90% of tumor vascularity embolized using 500 um & 700 um particles. I would appreciate your input.

Answer:

Yes, your physician is embolizing a tumor here, so 37243 would apply along with any diagnostic angiography and catheter placement codes. The “pre-operative” aspect is to decrease blood loss at the time of surgery (renal cell carcinoma metastases are usually very vascular). You are still embolizing a tumor. You should discuss with your physician whether imaging is for localization purposes (not billable), or for truly diagnostic imaging that will determine if embolization is to be performed (potentially billable).