CPT® Code 37182

Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation)

The CPT® Code 37182 refers to the procedure known as the insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS). This complex interventional radiology procedure is performed to create a pathway between the hepatic and portal veins, allowing for the diversion of blood flow. The primary goal of this procedure is to alleviate portal hypertension, which can lead to serious complications such as variceal bleeding and ascites. The process begins with venous access, typically achieved through the right internal jugular vein, where a needle is used to puncture the vein. A guidewire is then introduced under fluoroscopic guidance to facilitate the placement of a catheter into the hepatic veins. Once the catheter is in place, contrast material is injected to perform portography, which helps visualize the portal system and assess the optimal location for the shunt. The procedure involves creating a tract between the hepatic and portal veins, which is then dilated using a balloon-tipped catheter. Stents are placed within this tract to maintain patency and ensure proper blood flow. Throughout the procedure, hemodynamic evaluations are conducted by measuring pressure gradients to assess the effectiveness of the shunt. Post-procedure, imaging guidance is utilized to confirm the successful placement of the stents, and all instruments used during the procedure are removed, with direct pressure applied to the puncture site to prevent bleeding. This comprehensive approach ensures that the procedure is performed safely and effectively, addressing the underlying issues associated with portal hypertension.