by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Catheter Placement for MAA Administration
Question:
Procedure was “Hepatic radioembolization preparatory angiogram and Tc99m-MAA administration.” Can we code 36247 catheter placement for MAA administration? CPT Assistant, February 2012 says, “The administration of a radiopharmaceutical is inherent to nuclear medicine studies.” Is catheter placement included in nuclear medicine studies? Selective angiography was done with catheterization at left hepatic artery trunk. Radioisotope: Technetium-99m MAA administration was done from catheter position: Segment 4 branch off the left hepatic artery trunk. Contrast was also used, but it was not mentioned when or how it was given. 78202 and 78830 were done.
Can we code 36247 with 78202 and 78830 without 75726? Or should this be 75726, 36247, 78830, and 78202?
Answer:
MAA is given to simulate what it will be like to perform embolization with Y-90 SirSphere or TheraSphere. It is given during the work-up phase pre Y-90 and usually involves diagnostic visceral angiography (75726s and 75774s with multiple catheter placement codes). The actual injection of MAA is not reported, just the imaging to follow (nuclear imaging of liver/lung) OR a simulation code is submitted, but not both.
So, the catheter placement to administer the MAA in this case is billed with 36247, and, my guess is that the MD may need some education regarding documentation requirements for S&I codes such as 75726. And, never report an MAA injection as an embolization….it isn’t.
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