Ask Dr. Z

Initial Question:

We have a physician who does embolizations on the gastroduodenal artery, left gastric artery, and thoracic arteries (normal anatomy), and I was wondering if we could not charge two embolizations since one is above the diaphragm and one is below the diaphragm and in two different coding family sets? I know it is once per surgical field and have heard if you make one puncture it is considered one surgical site, but if you do two different abdominal areas (e.g., liver, pancreas, spleen) it is considered two different surgical sites even though you go through one puncture site. Could you please clarify when charging two would be acceptable billing?

Additional Info Provided Following Inquiry from Dr. Z:

Most of the dx are a primary cancer (rectal, colon, etc.) metastatic to the liver and he says intercostal on the thoracic arteries. It looks like most of them are evualating suitability for Sirtex radioembolization. Please let me know if there is additional information I need to supply; I know nothing is ever black and white in coding.