How To Use CPT Code 37183

CPT 37183 describes a procedure known as the revision of transvenous intrahepatic portosystemic shunt(s) (TIPS). This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 37183?

CPT 37183 is used to describe a specific procedure performed by a healthcare provider. This procedure involves the revision of a transvenous intrahepatic portosystemic shunt(s) (TIPS). The provider removes a shunt that was previously placed and inserts a new stent in the artificial channel or tunnel between the portal vein and one of the hepatic veins. This procedure is typically performed to address issues such as blood clots or narrowing of the artery.

2. Official Description

The official description of CPT code 37183 is: ‘Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recannulization/dilatation, stent placement and all associated imaging guidance and documentation).’ It is important to note that CPT codes 75885 and 75887 should not be reported in conjunction with 37183, and for the repair of arteriovenous aneurysm, code 36832 should be used.

3. Procedure

1. When performing the revision of a TIPS, the healthcare provider begins by making an incision over the right internal jugular vein.
2. They then insert a guidewire into the vein and advance a catheter to the hepatic vein of the liver.
3. The provider removes the existing shunt through the catheter and inserts a new transjugular intrahepatic portosystemic shunt (TIPS).
4. To confirm the correct placement of the stent, the provider may perform a venography or portography.
5. If a blood clot is present, the provider may inject an anticoagulant to mechanically remove the clot.
6. If there is a narrowing in the artery, the provider may perform angioplasty before placing another stent.
7. The provider checks for proper blood flow and ensures there is no blood leakage in the anastomosis.
8. To stop any bleeding, the provider applies pressure at the site of entry into the internal jugular vein and may suture as necessary.
9. This procedure includes all associated imaging guidance and documentation performed by the provider.

4. Qualifying circumstances

The revision of a TIPS is typically performed on patients who have previously undergone a TIPS procedure and require further intervention due to issues such as blood clots or narrowing of the artery. The procedure is performed by a healthcare provider who has the necessary expertise and qualifications. It is important to note that CPT codes 75885 and 75887 should not be reported in conjunction with 37183, and for the repair of arteriovenous aneurysm, code 36832 should be used.

5. When to use CPT code 37183

CPT code 37183 should be used when a healthcare provider performs the revision of a transvenous intrahepatic portosystemic shunt(s) (TIPS). This code is appropriate when the provider removes a previously placed shunt and inserts a new stent in the artificial channel or tunnel between the portal vein and one of the hepatic veins. It is important to follow the documentation and billing guidelines to ensure accurate reporting of this procedure.

6. Documentation requirements

When reporting CPT code 37183, the healthcare provider must ensure that the following documentation is included:

• Patient’s medical history and indication for the revision of the TIPS
• Details of the procedure performed, including venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recannulization/dilatation, stent placement, and any associated imaging guidance
• Date of the procedure and the time spent performing each component
• Any additional procedures or interventions performed during the same session
• Documentation of any complications or adverse events
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 37183, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The healthcare provider should report this code when performing the revision of a TIPS and should not report codes 75885 or 75887 in conjunction with 37183. Additionally, for the repair of arteriovenous aneurysm, code 36832 should be used. It is important to follow the specific guidelines provided by the payer and to accurately document the procedure to support the billing claim.

8. Historical information

CPT code 37183 was added to the Current Procedural Terminology system on January 1, 2003. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs the revision of a TIPS for a patient who developed a blood clot in the shunt.
2. A patient who previously underwent a TIPS procedure requires a revision due to narrowing of the artery.
3. A healthcare provider performs the revision of a TIPS for a patient who experienced complications with the previously placed shunt.
4. A patient with a history of TIPS procedure presents with symptoms indicating the need for a revision, and the healthcare provider performs the necessary intervention.
5. A healthcare provider performs the revision of a TIPS for a patient who developed an infection at the site of the previously placed shunt.