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Q: Physician reimbursement ( Answered 5 out of 5 stars,   1 Comment )
Question  
Subject: Physician reimbursement
Category: Health > Medicine
Asked by: raddoctr-ga
List Price: $50.00
Posted: 07 Jun 2003 09:16 PDT
Expires: 07 Jul 2003 09:16 PDT
Question ID: 214365
What is the physician (i.e Interventional radiologist) reimbursement
for uterine artery embolization and hepatic artery chemoembolization?

Request for Question Clarification by voila-ga on 07 Jun 2003 12:09 PDT
Hi raddoc,

If Google Answers doesn't have a coding expert, we could certainly use
one with your question!  I guess I have to ask you a couple questions
before proceeding further.

Since private sector fees may vary, could you give us your geographic
location?

Are you currently billing these procedures as a bundled or unbundled
charge
(placement vs placement/interpretation)?

Are you currently using J-codes for administration of chemo agents?
Answer  
Subject: Re: Physician reimbursement
Answered By: voila-ga on 08 Jun 2003 08:02 PDT
Rated:5 out of 5 stars
 
Greetings,

To locate the CPT code for a UAE/UFE, I searched under "uterine artery
embolization" on Google and located this article from Blue Cross/Blue
Shield:
http://mt1-bcbs.bcbsmt.com/bsd/MedicalPolicy.nsf/0/d36bff3b5c7e19fc87256be600678939?OpenDocument


36247
Selective catheter placement, arterial system; initial third order or
more selective abdominal, pelvic, or lower extremity artery branch, 
within a vascular 

36248
Additional second order, third order, and beyond, abdominal, pelvic, 
or lower extremity artery branch, within a vascular family (list in 
addition to code for initial second or third order vessel as 
appropriate)

37204
Transcatheter occlusion or embolization (eg, for tumor destruction, to
achieve hemostasis, to occlude a vascular malformation), percutaneous,
any method, non-central nervous system, non-head or 

75736
Angiography, pelvic, selective or supraselective, radiological 
supervision and 

75894
Transcatheter therapy, embolization, any method, radiological 
supervision and 

ICD-9 Diagnosis Codes

218.0 submucous leiomyoma of uterus
218.1 intramural leiomyoma of uterus
218.2 subserous leiomyoma of uterus
218.9 leiomyoma of uterus, unspecified

This document suggests using unbundled codes of 37204 and 75984:
http://www.wellmark.com/e_business/provider/medical_policies/policies/Transcatheter_Uterine.htm

"To bill for physician services, use appropriate CPT codes, alpha 
numeric (HCPCS level 2) codes, revenue codes, and/or ICD-9 diagnostic
codes.

The HCPCS code S2250 is specific for this procedure and we recommend 
providers use this procedure.  Providers may use CPT codes 37204 and
75894 with the ICD-9 diagnosis code of uterine fibroid (218.0-218.90).

*********************

Next, I went to the AMA site:
http://www.ama-assn.org/ama/pub/category/3113.html

and clicked on the fourth choice (CPT/RVU Search)

and clicked "agree" in license agreement area:

From there you'll see an entry screen to plug in specific information.

Steps:

1.  In the #1 drop-down menu, I chose New York.
2.  "Manhattan" popped in as the default but alternative choices are
available.
3.  At "search type," click "CPT code."
4.  Enter 5-digit CPT code (37204).
5.  Click "search."
5.  Payment is $1098.25.

Use your back key to input the second CPT code.

1.  Type in second CPT code (75894).
2.  Payment is $1,283.36.

**********************

For the transhepatic artery embolization (TACE), I checked a Q&A "Ask
the Experts" coding site and found some guidance with this question:
http://www.advanceforhim.com/common/Editorial/Editorial.aspx?CC=5058&CP=8

Q: Our interventional radiologist performs chemoembolization for 
patients with hepatocellular cancinoma. The hepatic arteries are 
selectively catheterized to view the areas of tumor blush. The vessels
are sequentially embolized using doxorubicin, cisplatin, mitomycin C 
and Lipiodol. What CPT/HCPCS codes would be used for Medicare vs. 
non-Medicare patients?

A: While interventional radiology is not my expertise, I am confident
these are the correct codes. For the embolization of the hepatic 
vessels, I would use 36246 if the embolization was done in the common
hepatic or 36247 if the embolization was performed in the left/right 
hepatic artery. Also, you would need to code the S & I of 75726. Also
the HCPCS drugs are additionally assigned as follows- J9000 or J9001 
for the doxorubicin (J9001 is sep reimbursable under APC but J9000 is
packaged), J9060 or J9062 for the cisplatin (1st has SI of K and the 
2nd has SI E meaning there is likely another code to report for 
Medicare), J9280-J9291 for mitomycin (J9290 & J9291 have SI of E 
meaning there is likely another code to report for Medicare).

******************
Followup question:

Q: Yes...I agree with the selective cath codes but what about the 
chemo administration? The dispute is between 37204 and the chemo 
96400-96549 codes. If the chemo (96400-96549) codes are correct, then
we must use the Q code for Medicare but if the 37204 is correct...

A: I did some research on the actual chemoembolization procedure and 
here is what I found. The hepatic chemoembolization procedure combines
peripheral occlusion and local deposition of chemotherapeutic agent or
agents.  Is the chemoembolization performed percutaneously or is it 
done through the selective catheterization? Based on what you have 
described thus far the chemoembolization is performed through 
selective catheterization. With this in mind, I would suggest coding 
the 36246 or 36247, whichever is appropriate, and the S&I code. This 
takes care of the matter used for embolization. For the chemo 
administered, I suggest coding the Q0084 if the chemo is infused over
an extended period of time. However, if the chemo is administered in 
conjunction with the administration of the embolization under one 
injection procedure, I would not code the Q0084 but would just code 
the 36246 or 36247 plus S & I, and of course you would need to bill 
the HCPCSs injected. If the chemo was infused and the patient happens
to be non-Medicare, then you would need the CPT codes 96400-96459 and
not the Q0084 code.

*******************

As you can see from the exchange above, this is a difficult coding
question even for the experts since IR is a very specialized field. 
Based on the above information, here are the reimbursement rates:

36246 =  $274.05

  (OR)

36247 =  $384.99

75726 =  $696.34

96400-96459  =  amount to vary depending on infusion time


You may wish to attach support documents when filing a claim on this 
procedure as it is indeed quite new as far as claims handling.  This 
may save a step should it fall into the hands of a less than 
knowledgeable claims examiner.

Additional links:

Supporting document for UAE
http://www.radweb.mc.duke.edu/ufe/ufearticle.pdf

Aunt Minnie Archives:
http://www.auntminnie.com/archive/59_1.htm

Effective for dates of service on or after May 31 2001, UAE is a 
covered procedure and does not require preauthorization.

Society of Interventional Radiology:
http://www.sirweb.org/patPub/uterine.shtml

BCBS Policy criteria
http://www.regence.com/trgmedpol/surgery/sur97.html

Hopefully the claims process is a bit more streamlined since this
woman's fight with her HMO:
http://www.public.asu.edu/%7Enancylee/UAE/UAEHMO.html
http://www.uterinefibroids.com/c_uae.htm


********************

I trust this is the information you require.  If you are a member of 
SIR, it may be prudent to contact them for additional coding 
refinement.  However, if I can assist you further, please click on the
clarification button before rating my answer.  Thank you for using our
service and best of luck in the latest round of the reimbursement 
battle.

Society of Interventional Radiology
10201 Lee Highway
Suite 500
Fairfax, Virginia  22030
(800) 488-7284  (703) 691-1805  Fax (703) 691-1855
E-mail us at info@sirweb.org

Regards,
V

Request for Answer Clarification by raddoctr-ga on 10 Jun 2003 10:34 PDT
Voila,

Thank you for your extensive research, I can see you've put a
significant amount of thought and effort into this answer.  However,
as I am just finishing my fellowship CPT coding and charges are new to
me - thus, I chose to ask 'google answers'.

The basic question I need answered is:  How much (in total) will I be
reimbursed for a UFE or TACE (in Wisconsin, btw)?  For example, for a
UFE do I just add up the payments for all those CPT codes (i.e 36247,
36248, 37204, 75736 and 75894)? Some of them, for example 37204 and
75894, seem redunant - do I get reimbursed for both with each
procedure?

Regarding your clarifications:
- I will be preforming these procedures in Wisconsin.
- yes I would be billing for everything - including embolization and
interpretation of images.
- I'm not sure what J-codes are.

With regard to TACE. Infusion time is not applicable. You simply
infuse until you get arterial stasis or the whole dose of chemotherapy
(i.e at my institution that would be cisplatinum 100 mg, doxorubicin
50 mg, mitomycin 15 mg - mixed with lipiodol) has been given.

Thank you for all your help thus far,

~Noam

Request for Answer Clarification by raddoctr-ga on 10 Jun 2003 12:14 PDT
Also... I work with a group of radiologists who have a service
contract with the hospital. Do those dollar amounts go directly to me
or does the hospital get some 'technical fee'?

Clarification of Answer by voila-ga on 11 Jun 2003 05:58 PDT
Hello doc,

Not a problem and glad to help.  I assumed we'd have to do a few back
and forth messages on this to get these codes fine tuned.  I have read
your questions and if you'll give me a till the weekend to sort
through the information, I'll get back to you with these answers. 
Thank you for your patience.

Regards,
V

Clarification of Answer by voila-ga on 15 Jun 2003 12:12 PDT
Sorry for the delay, Noam.  I'll address your questions one-by-one and
I may have to pose a few myself just to be clear on the procedure. 
Google Answers is a bit cumbersome in the dialog area on complex
questions, but I'm here until there's a mutually satisfied answer.

************************

Q:  
Do those dollar amounts go directly to me or does the hospital get
some 'technical fee'?

A:
These are professional fees.  There are mirrored charges from the
hospital but these indeed are separate technical charges for supplies,
room set-up, personnel, etc.

From this website:
http://tinyurl.com/ebik (redirect from cached document)

"For services provided in institutional settings, such as hospitals
(inpatient or outpatient), the institution bills and gets paid for the
technical component (TC) of the service.  The physician providing the
professional service gets paid for the professional component (PC).
The same code (CPT or HCPCS code) is used by the hospital and
physician charge.  Modifiers are added to the code to describe the TC
or PC component.  The technical component modifier is TC and the
professional component modifier is 26."

**************************

Q:    
For a UFE do I just add up the payments for all those CPT codes (i.e
36247, 36248, 37204, 75736 and 75894)?   Some of them, for example
37204 and 75894, seem redundant - do I get reimbursed for both with
each procedure?

A:   
No, the codes I gave you allowed for a variety of coding situations. 
Checking with the Society for Interventional Radiologists, it was
suggested that we use 36247 x 2 for placement of the catheters, along
with 75736 x 2 for S&I (supervision and interpretation).  However,
embolizing the right and left uterine artery is considered a single
operative field and should only be reported as a single embolization
or 37204 x 1 + 75894.   After that is a followup completion angiogram
or CPT code 75898.

Therefore, the codes we'll be using are 36247, 75736, 37204, 75894,
and 75898.

Also, you should know if there is any other professional
(gynecologist?) in attendance who might bill for the supervision
component of the S&I portion of this procedure, your reimbursement
will be effected and a modifier -52 would be required.

***************************

TACE:
Q:  With regard to TACE. Infusion time is not applicable. You simply
infuse until you get arterial stasis or the whole dose of chemotherapy
(i.e at my institution that would be cisplatinum 100 mg, doxorubicin
50 mg, mitomycin 15 mg - mixed with lipiodol) has been given.

COMMENT:
The appropriate selective catheterization code would be used (usually
36247), and 75726 would be used for the diagnostic arteriogram done
before the embo.  If multiple third order branches are selected and
studied, 36248 and 75774 would also be used according to component
coding guidelines.  37204 + 75894 would describe the embolization
procedure.  96420,  chemotherapy administration, intra-arterial, push
technique, is used by some people to document the additional work of
giving the chemotherapeutic agent with the embolic agent.  75898 would
be coded for the follow-up completion angiogram.

I think we're in agreement that the 96420 chemo admin code should be
omitted.  Insurance companies are no doubt going to be looking at
these charges under a microscope.
 
Therefore, we're looking at using codes 36247, 75726 (36248 + 75774
for multiple branches), 37204, 75894, and 75898.

****************************

I've been stymied on looking up these CPT codes as there's trouble on
the AMA site.  This message has popped up since Friday night:

"CPT Online catalog is temporarily unavailable. Please try again in a
short while. We appoligize {sic} for any inconvienience {sic} this my
{sic} cause you."

I will keep checking the site for progress but this is the only free
site I've located that can give us this information.  Will be in touch
with these CPT code Wisconsin reimbursement rates as soon as access is
available.


Regards,
V
raddoctr-ga rated this answer:5 out of 5 stars
Great job. Good, solid research.  If I were making those dollars I'd
give her a tip to match her obvious commitment to this question.
Perhaps next time...

Comments  
Subject: Re: Physician reimbursement
From: voila-ga on 16 Jun 2003 11:36 PDT
 
Hello again, Noam

I was able to look up these codes for you this morning; the AMA site
had a miraculous recovery.

UFE:

36247 x 2 @ $315.29 = $630.58
75736 x 2 @ $484.25 = $968.50
37204 + 75894       = $884.94
75898               = $118.37

TOTAL                $2,602.39

******************************
TACE:

36247                  $315.29
75726                  $484.25
37204 + 75894          $884.94
75898                  $118.37

TOTAL                 $1,802.85

*******************************

Additional branches studies (CPT/reimbursement rate):
36248 + 75774           $445.50

Chemotherapy (CPT/reimbursement rate):
96420                   $ 42.74

********************************

I trust this is the information you require, but I'll be standing by
should you need further clarification.

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