Interventional radiology (IR), also known as vascular and interventional radiology (VIR) or surgical radiology, is a sub-specialty of radiology providing minimally invasive image-guided diagnosis and treatment of diseases in every organ system.
Five Vascular Systems for IVR
1.Arterial
2.Venous
3.Pulmonary
4.Portal
5.Lymphatic
Each system is coded separately.
Vascular Family
Primary Branch Vessels: Vessels that arise from a single branch from the aorta or vena cava
Vessels that arise from the access site ----vascular order
Vascular Order
First Order: Vessel that arises off the aorta or vena cava
Second Order: Vessel that branches off from a first order vessel
Third Order: Vessel branching off from a second order vessel
First order arising off the aorta
Left subclavian
Brachiocephalic
Left common carotid
Second order arising off first order vessel
Right subclavian
Right common carotid
Documentation required to correctly code
Site of the catheter entered the body
Movement of the catheter after entry
Final positioning of the catheter
Understand selective or non-selective
Non-Selective:
The catheter is inserted directly into a vessel (aorta, vena cava, portal vein, etc.); no additional movement of the catheter is made; no advancement of the catheter further.
Selective:
The catheter is inserted into a vessel (aorta, vena cava, portal vein, etc.) (the main branch-vascular family) then manipulated into a branched vessel (off the main branch-vascular family).
Once a catheterization is “selective” the non-selective catheterization is inclusive (so once the catheter is manipulated; drop the non-selective code)
Code each access—bilateral access or upper/lower extremity access
Diagnostic angiography performed at a separate setting from any interventional radiology procedure is separately reported.
Diagnostic angiography performed at the time of any interventional radiology procedure is not separately reportable if it is specifically included in the interventional code descriptor.
Modifiers may be appended when appropriate; watch edits!
Whenever catheters are placed and then a decision is made to do an intervention on the same vessels, the catheter placement (selective and non-selective) are not coded separately, as they are bundled with the intervention CPT code(s).
Example 1
The left common femoral artery was accessed percutaneously, and a catheter placed in the aorta.
Aortogram was obtained with injection of contrast.
The catheter was then cannulated in the left common iliac and a left lower extremity angiogram was performed.
The angiogram showed a 60% stenosis in the superficial femoral artery (SFA).
The catheter was then changed and parked in the SFA contrast was injected; angiogram performed; showing 85% stenosis in the anterior tibial artery.
The decision was made at this time to perform stent placement/angioplasty in the SFA and athrectomy/stent/angioplasty in the anterior tibial artery.
Answer: 37231-LT, 37226-LT
Example 2
Endovascular laser ablation of three incompetent perforator vein(s), RT and LT LE
The patient was placed in reverse-Trendelenburg position and local anesthesia was instilled in the skin overlying the access site. The vein was accessed using ultrasound guidance. The laser catheter was prepped according to the IFU. The 21 g access needle was placed into the vein and positioned at a point at the layer of fascia and at least 1 cm from the deep venous system confirmed utilizing ultrasound guidance.
After the laser catheter position was verified by ultrasound, local anesthesia was infiltrated into the tissue surrounding the treatment site. Laser energy was applied at 7W. Repeat ultrasound of the perforator vein was performed, confirming successful closure of the perforator vein with no extension of the thrombus into the deep venous system. The laser and needle were withdrawn, and hemostasis established with direct pressure.
Answer: 36478-50 , 36479
Therapeutic Interventions Include
Angioplasty
Angioplasty is a minimally invasive procedure used in interventional radiology to widen narrowed or obstructed blood vessels, typically arteries. It involves the insertion of a balloon-tipped catheter into the affected vessel, which is then inflated to expand the vessel and improve blood flow. This technique is commonly used to treat conditions such as atherosclerosis, where plaque buildup restricts blood flow. Angioplasty can be performed alone or in conjunction with stent placement to maintain vessel patency.
Stents
Stents in interventional radiology are small, expandable tubes used to keep blood vessels or other tubular structures open. They are often deployed to treat conditions like arterial blockages or obstructions in the bile ducts. Stents can be made of metal or plastic and may be coated with medication to prevent re-narrowing. Their placement is minimally invasive, guided by imaging techniques such as X-rays or ultrasound.
Atherectomy
Atherectomy is a minimally invasive procedure used in interventional radiology to remove atherosclerotic plaque from blood vessels. It employs specialized catheters equipped with cutting blades or lasers to clear blockages and restore blood flow. This technique is often used in peripheral artery disease (PAD) to treat narrowed or obstructed arteries. Atherectomy helps improve symptoms and reduce the risk of complications such as limb amputation.
Embolization
Embolization in Interventional Radiology is a minimally invasive procedure used to block abnormal blood flow within blood vessels. By introducing embolic agents through a catheter, doctors can treat conditions like aneurysms, tumors, and uterine fibroids. This technique reduces bleeding, shrinks tumors, and alleviates symptoms without the need for open surgery. It offers a targeted, effective treatment with reduced recovery time.
Thrombolysis
Thrombolysis in interventional radiology involves the use of catheter-directed techniques to dissolve blood clots within blood vessels. This minimally invasive procedure administers clot-dissolving medications directly to the site of the clot, enhancing treatment efficacy. It is commonly used for conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE). Thrombolysis can quickly restore blood flow, reduce symptoms, and prevent long-term complications.
Thrombectomy
Thrombectomy in interventional radiology is a minimally invasive procedure used to remove blood clots from blood vessels. This technique involves the use of catheters and imaging guidance to navigate and extract the clot, restoring normal blood flow. It is commonly performed to treat conditions like deep vein thrombosis and acute ischemic stroke. Thrombectomy can significantly reduce the risk of complications and improve patient outcomes.
Dialysis Graft Declotting
Dialysis graft declotting in Interventional Radiology is a minimally invasive procedure used to clear blood clots from dialysis access grafts. This technique involves the use of specialized catheters and imaging guidance to restore blood flow and maintain the functionality of the graft. It helps prevent complications and ensures the continued effectiveness of dialysis treatment. Typically, the procedure is performed on an outpatient basis, offering a quick recovery time for patients.
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