May 2014 Q & A

Question: Yttrium-90 intrahepatic embolization, catheter placements bundled by NCCI

Under ultrasound guidance for right common femoral artery access, a catheter was advanced to abdominal aorta and on to superior mesenteric artery where an arteriogram was performed (36245-59 for catheter placement). The catheter was redirected into the celiac artery and the proper hepatic artery was selected (36247-59) where an angiogram was performed.

The catheter was then advanced into the right hepatic artery (36248) proximal to its bifurcation. Angiogram confirmed position of the catheter in same location as on planning procedure. Catheter secured in position and attached to heparinized flush. Y90 SIR-Sphere delivery apparatus was set up, dose deposited into a closed delivery system, connected to 2 inlet tubings of sterile H20 & contrast & single outlet tubing for Y90 delivery. Multiple small aliquots of Y90 were injected into the artery followed by D5W & contrast flushes. Angiography was intermittently performed confirming antegrade flow & access degree of embolization. When the total volume of Y-90 was administered, the catheter was removed (37243).

Is there an NCCI error bundling the catheter placements? Are we correct in adding -59 to the catheter placement codes?

Answer:

The edits have been removed retroactively with the release of the 4/1/2014 edits. You should no longer need the -59 modifier with catheter placement codes and 37243. Also, 36248 is NOT additionally coded for moving the catheter from the proper hepatic to the right hepatic.