CLINICAL REVIEW E136 Optimizing Reimbursement for Radioembolization: The Importance of Adequate Documentation C linical trials evaluating the use of Yttri- um-90 (Y90) transarterial radioemboliza- tion for hepatic tumors date back to the 1960s. 1 In recent years, Y90 has been increasingly utilized in treating hepatic metastases and hepatocel- lular carcinoma (HCC) with improved outcomes. 2 In 1999, the US Food and Drug Administration (FDA) approved the use of TheraSphere (BTG) particles for HCC via the humanitarian device exemption. Subsequently, in 2002, SIR-Spheres (Sirtex) par- ticles were approved for the treatment of hepatic colorectal cancer metastases with adjuvant intrahe- patic artery chemotherapy of FUDR (floxuridine). Since then, Y90 has been utilized for a variety of off-label indications, such as neuroendocrine tumor metastases, breast metastases, uveal melanoma metas- tases, cholangiocarcinoma, sarcoma, prostate cancer, ovarian metastases, melanoma, renal cell carcinoma, Rishi Chopra, MS 1 ; Jason C. Hoffmann, MD 1 ; Amanjit S. Baadh, MD 2 From 1 Winthrop University Hospital, Department of Radiology, Mineola, New York, and 2 Rush University Medical Center, Department of Interventional Radiology, Chicago, Illinois. ABSTRACT: Purpose: This article aims to review radioembolization-specific coding guidelines so that interventional radiologists can develop a better understanding of what documentation is essential in their reports, leading to appropriate authorization and reimbursement. Background: Over the past 10 years, interventional radiologists (IRs) have been performing increasing numbers of radioembolization procedures in treatment of hepatic malignancy. This article will review coding for radioembolization procedures, from initial interventional radiology clinic visit to postprocedure follow-up imaging. The article will highlight the importance of adequate documentation during clinic visits, image-guided interventions, and postprocedure cross-sectional imaging to ensure efficient insurance authorization and maximal reimbursement. Materials and Methods: The treatment of liver tumors with radioembolization merges key concepts well known to radiation oncology and interventional radiology practices. A typical radioembolization case includes the ini- tial patient consultation; a diagnostic angiogram to allow for treatment planning and possible pretreatment embolization of arteries such as the gastroduodenal artery, right gastric artery, and/or supraduodenal artery; and the actual yttrium-90 radioembolization treatment. SPECT nuclear medicine scans for tumor localiza- tion and contrast-enhanced multiphasic cross-sectional imaging for therapy planning and follow-up are also obtained. Thorough documentation of patient history, indications for treatment, appropriateness of therapy, and dosimetry calculations by interventional radiologists are critical to obtain procedural approval by insur- ance companies and appropriate reimbursement. This article will detail the current procedural terminology codes relevant to radioembolization and highlight the importance of adequate documentation throughout the treatment process. Conclusion: The emergence of radioembolization in the treatment of hepatic malignancy brings challenges for IRs that make clear, precise documentation critical. An understanding of radioembolization coding will allow IRs to provide improved documentation, leading to more efficient treat- ment authorization and reimbursement by insurance companies. Key words: yttrium-90, radioembolization, interventional oncology, reimbursement, billing, coding Copyright HMP Communications
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CLINICAL REVIEW
E136
Optimizing Reimbursement for Radioembolization: The Importance of Adequate Documentation
Clinical trials evaluating the use of Yttri-
um-90 (Y90) transarterial radioemboliza-
tion for hepatic tumors date back to the
1960s.1 In recent years, Y90 has been increasingly
utilized in treating hepatic metastases and hepatocel-
lular carcinoma (HCC) with improved outcomes.2 In
1999, the US Food and Drug Administration (FDA)
approved the use of TheraSphere (BTG) particles
for HCC via the humanitarian device exemption.
Subsequently, in 2002, SIR-Spheres (Sirtex) par-
ticles were approved for the treatment of hepatic
colorectal cancer metastases with adjuvant intrahe-
patic artery chemotherapy of FUDR (floxuridine).
Since then, Y90 has been utilized for a variety of
off-label indications, such as neuroendocrine tumor
metastases, breast metastases, uveal melanoma metas-
Rishi Chopra, MS1; Jason C. Hoffmann, MD1; Amanjit S. Baadh, MD2 From 1Winthrop University Hospital, Department of Radiology, Mineola, New York, and 2Rush University Medical Center, Department of Interventional Radiology, Chicago, Illinois.
ABSTRACT: Purpose: This article aims to review radioembolization-specific coding guidelines so that interventional radiologists can develop a better understanding of what documentation is essential in their reports, leading to appropriate authorization and reimbursement. Background: Over the past 10 years, interventional radiologists (IRs) have been performing increasing numbers of radioembolization procedures in treatment of hepatic malignancy. This article will review coding for radioembolization procedures, from initial interventional radiology clinic visit to postprocedure follow-up imaging. The article will highlight the importance of adequate documentation during clinic visits, image-guided interventions, and postprocedure cross-sectional imaging to ensure efficient insurance authorization and maximal reimbursement. Materials and Methods: The treatment of liver tumors with radioembolization merges key concepts well known to radiation oncology and interventional radiology practices. A typical radioembolization case includes the ini-tial patient consultation; a diagnostic angiogram to allow for treatment planning and possible pretreatment embolization of arteries such as the gastroduodenal artery, right gastric artery, and/or supraduodenal artery; and the actual yttrium-90 radioembolization treatment. SPECT nuclear medicine scans for tumor localiza-tion and contrast-enhanced multiphasic cross-sectional imaging for therapy planning and follow-up are also obtained. Thorough documentation of patient history, indications for treatment, appropriateness of therapy, and dosimetry calculations by interventional radiologists are critical to obtain procedural approval by insur-ance companies and appropriate reimbursement. This article will detail the current procedural terminology codes relevant to radioembolization and highlight the importance of adequate documentation throughout the treatment process. Conclusion: The emergence of radioembolization in the treatment of hepatic malignancy brings challenges for IRs that make clear, precise documentation critical. An understanding of radioembolization coding will allow IRs to provide improved documentation, leading to more efficient treat-ment authorization and reimbursement by insurance companies.
4. Liu DM, Cade DN, Knight J, et al. Yttrium-90 radio-
embolization. Endovasc Today. 2008 June. Available at:
evtoday.com/pdfs/EVT0608_08.pdf
5. Kallini JR, Gabr A, Salem R, Lewandowski RJ. Tran-
sarterial radioembolization with yttrium-90 for the
treatment of hepatocellular carcinoma. Adv Ther.
2016;33(5):669-714.
6. Sirtex. Coding sheet January 2016: pre-treatment
mapping and microspheres administration: hospital
outpatient, ASC and physician services. Available at:
http://www.sirtex.com/media/70435/2016-sirtex-
coding-sheet-updated032116-final.pdf
7. Healthcare Administrative Partners. How to docu-
ment y-90 radioembolization cases to maximize reim-
bursement. Available at: http://info.hapusa.com/Blog/
bid/72834/How-to-Document-Y-90-Radioemboli-
zation-Cases-to-Maximize-Reimbursement
Editor’s note: The authors have completed and re-turned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no financial relationships or conflicts of interest regarding the content herein.
Manuscript received April 20, 2016; manuscript ac-cepted June 29, 2016.
Address for correspondence: Amanjit S. Baadh, MD, Rush University Department of Radiology, 1653 W Congress Pkwy, Chicago, IL 60612, United States. Email: [email protected].
Suggested citation: Chopra R, Hoffman JC, Baadh AS. Optimizing reimbursement for radioemboliza-tion: the importance of adequate documentation. Intervent Oncol 360. 2016;4(8):E136-E142.