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by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Question: Embolization 37244 vs 37242
How should the following be coded, since there is no active bleeding seen on the current angiogram?
Technically successful selective superior mesenteric, celiac and superselective GDA angiography with demonstration of hyperemic flow to the antrum and duodenum via the pancreaticoduodenal arcade, without identifiable active extravasation. Technically successful particle and Gelfoam embolization of the gastroduodenal artery is then performed.
If the primary indication for embolization is current GI bleeding or a history of recent GI bleeding, and it is the active reason for the embolization, then report CPT code 37244. GI bleeds are often not “caught” in the act of active extravasation on the angiogram, rather they present with bloody stools, a positive nuclear scan and questionable findings on the angiogram (often seen as vasospasm, vessel cut-off, or hyperemia).
If the embolization is for remote history of bleeding and NOT for recent/active bleeding, then CPT code 37242 would describe the embolization procedure.
The diagnostic angiography codes are 75726-XU x 2 for superior mesenteric and celiac artery imaging (visceral angiography) and 75774 for gastroduodenal artery imaging (each additional selective angiogram beyond basic as it is in the celiac artery vascular family).
The catheter placements are 36247 for the GDA and 36245-XS for the SMA.
If other vessels than stated were selected and imaged, they would be reported also.
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