CPT 37183 TIPS Revision Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 37183: TIPS Shunt Revision with Stent Placement

CPT code 37183 represents endovascular revision of a transjugular intrahepatic portosystemic shunt (TIPS) involving removal of a previously placed shunt and insertion of a new stent into the artificial channel between the portal vein and a hepatic vein. This service is clinically significant for patients with portal hypertension who develop shunt occlusion, thrombosis, or stenosis and often requires advanced interventional radiology resources in hospital settings. Nationally, the procedure matters because it affects access to specialty care, resource utilization in inpatient and outpatient hospital environments, and payer coverage policies for complex vascular interventions.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for TIPS revision, typical sites of service, and the common billing and coding considerations associated with CPT code 37183. The publication summarizes payer coverage tendencies, common modifiers used with this service (data not available in the input for specific payer rules), and the policy and billing implications that organizations should consider when submitting claims for shunt revision with stent placement. The piece also highlights where data are not available in the input, and points to the clinical indications prompting the procedure to help align documentation with coding.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare37183CPTTransjugular intrahepatic portosystemic shuntTIPS revisionInterventional radiologyEndovascularStent placementHospital outpatientHospital inpatient

Billing Code Overview

CPT code 37183 describes the removal of a previously placed shunt and insertion of a new stent into the artificial channel or tunnel created between the portal vein and a hepatic vein (transjugular intrahepatic portosystemic shunt revision with stent placement). This procedure is performed when the existing shunt requires replacement because of occlusion, thrombosis, or stenosis.

Service type: Endovascular revision and stent placement of a transjugular intrahepatic portosystemic shunt (TIPS revision)
Typical site of service: Hospital inpatient or hospital outpatient interventional radiology suite

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old with cirrhosis and portal hypertension who previously underwent transjugular intrahepatic portosystemic shunt (TIPS) placement. Over weeks to months the patient develops recurrent ascites and signs of portal hypertension or acute decompensation due to TIPS dysfunction from stenosis or thrombosis. The clinical workflow begins with cross-sectional imaging (Doppler ultrasound, CT or MR venography) demonstrating reduced or absent flow through the TIPS or imaging evidence of stenosis or occlusion. The interventional radiology team evaluates the patient, reviews coagulation status and anticoagulation management, and obtains informed consent for TIPS revision. In the angiography suite under moderate sedation or general anesthesia, venous access is obtained (commonly via the right internal jugular vein), hepatic venography and portal pressure measurements are performed, the failed shunt is recanalized or the old stent removed as indicated, and a new stent is placed to re-establish flow between the portal vein and a hepatic vein. Hemostasis is secured and the patient is observed post-procedure for access-site complications, bleeding, encephalopathy, or hemodynamic changes. Typical sites of service are the hospital-based interventional radiology suite, an ambulatory surgery center (if available and appropriate), or an inpatient angiography suite when performed for urgent complications. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

CPT 37181: Splenorenal Shunt, Open Surgical Venous Bypass

CPT-37160-CAVAL-MESENTERIC-VENOUS-ANASTOMOSIS-PORTAL-HYPERTENSION

CPT 37160: Caval–Mesenteric Venous Anastomosis for Portal Hypertension

CPT-37182-TIPS-SHUNT-CREATION-STENT-PLACEMENT-PORTAL-HYPERTENSION

CPT 37182: TIPS Creation with Stent for Portal Hypertension

CPT-37140-PORTOCAVAL-SHUNT-PORTAL-HYPERTENSION-SURGERY

CPT 37140: Portocaval Shunt for Portal Hypertension

CPT-37180-PROXIMAL-SPLENORENAL-VENOUS-ANASTOMOSIS

CPT 37180: Proximal Splenorenal Venous Anastomosis

CPT-37145-RENOPORTAL-VENOUS-ANASTOMOSIS-RENAL-TO-PORTAL-VEIN

CPT 37145: Renoportal Venous Anastomosis, Renal-to-Portal Vein

Taxonomy Code	Specialty	Notes
207RX0500X	Interventional Radiology	Most common specialty performing TIPS revision and stent exchange.
2082S0112X	Vascular and Interventional Radiology	Alternate taxonomy for physicians focusing on vascular interventions and stent work.
207RH0002X	Diagnostic Radiology	Radiologists with procedural privileges who perform interventional procedures in hospital settings.
333612000X	Hepatology	Provides pre- and post-procedural management for patients with portal hypertension and liver disease.
207L00000X	Surgery - Vascular	Vascular surgeons may be involved in complex reinterventions or multidisciplinary cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I85.01`	Esophageal varices with bleeding	Portal hypertension with variceal bleeding reflects severity of portal hypertension often managed in context of TIPS.
`I85.00`	Esophageal varices without bleeding	Indicates portal hypertension and recurrent varices that may prompt TIPS revision if uncontrolled.
`K76.6`	Portal hypertension	Primary indication for TIPS creation and for revision when shunt dysfunction causes recurrent portal hypertensive complications.
`I82.409`	Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity	Thrombosis of the TIPS stent or portal vein thrombosis can necessitate stent removal and replacement.
`I82.890`	Embolism and thrombosis of other specified veins	Reflects thrombotic complications affecting hepatic or portal venous inflow requiring intervention.
`R17`	Unspecified jaundice	Liver dysfunction and biliary issues may coexist in patients needing TIPS revision; used when jaundice is clinically present.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37184`	Transcatheter placement of intravascular stent(s), central venous system (e.g., superior vena cava, inferior vena cava, innominate vein); each additional stent (List separately in addition to code for primary procedure)	May be used when additional stents are required during the TIPS revision procedure as adjunctive devices.
`75894`	Transcatheter therapy, embolization, any method, radiologic supervision and interpretation	Performed when concomitant embolization of varices or collateral vessels is required during the same session.
`36245`	Selective catheter placement, venous system, superior or inferior vena cava including all associated radiological supervision and interpretation	May be performed for venous access or diagnostic venography as part of the TIPS revision workflow.
`43286`	Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement, biliary or pancreatic	Data not specific to TIPS but occasionally part of multidisciplinary care for hepatobiliary disease; used when combined endoscopic procedures are clinically necessary.
`36415`	Collection of venous blood by venipuncture	Performed pre- and post-procedure for laboratory monitoring including coagulation testing and liver panels.

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