Ask Dr. Z

Our IR coded prostate artery embolization using CPT code 37243 and ICD-10 codes N40.1 and R31.0. The payer, Humana Medicare, paid the claim initially and then recouped the money. They forwarded a LEVEL 2 MEDICAL RECORD REVIEW DISPUTE DETERMINATION letter stating INTERNAL CODER TEAM found that CPT 37243 was not supported because "the records did not contain documentation of a prostatic or other pelvic tumor, any organ ischemia, or infarction". The letter further stated that the PAE procedure "is better represented by a different CPT code, and 37242 is suggested". Please advise as to your opinion regarding this determination.