Cardiology Coding Alert

Hint: There are 3 main types of thrombolytic therapy procedures.

Thrombolytic therapy, or thrombolysis treatment, dissolves blood clots and can restore normal blood flow in the body. It can be used for conditions such as heart attack, stroke, deep vein thrombosis (DVT), and with blood clots aka pulmonary embolisms (PE) in both the lungs and legs. In other cases, it can also be used in patients with peripheral vascular disease (PVD) and peripheral artery disease (PAD).

Thrombolysis is administered via intravenous (IV) route or in the blot clot itself through a catheter approach. This process can break the clot down and help prevent further damage to the tissue or organs. In more critical cases, surgery is also necessary to treat the underlying disease or cause.

Understand the Therapy Types

There are three main types of thrombolytic therapy:

• Systemic thrombolysis involves direct IV administration to break down and dissolve the clot(s) throughout the body. It is used in patients with heart attack, PE, and stroke.
• Catheter-directed thrombolysis relies on a catheter to target the clot and deliver the medicine directly to the clot. This is typically used in patients with DVT and PAD.
• Mechanical thrombectomy involves a specialized catheter with either a rotating device or with a suction cup or fluid jet at the end and ultrasound. This breaks the clot up or suctions out the clot. This type can also be combined with thrombolysis medication for faster results. This is used in patients with clots or embolism in the veins or arteries throughout the body.

Rely On These CPT^® Codes for Procedures

When coding percutaneous arterial mechanical thrombectomy, you’d use 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial, or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel) for the initial vessel. For a secondary and/or subsequent vessel and secondary mechanical thrombectomy, respectively, look to these codes:

• +37185 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial, or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure))
• +37186 (Secondary percutaneous transluminal thrombectomy (e.g., nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial, or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure))

Coders should look to codes for 37187 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance) and 37188 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy) for venous mechanical thrombectomy procedures.

When coders report arterial and venous thrombolysis, they can look to 37211 (Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day) and 37212 (Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day) for the initial treatment day. Codes 37213 (Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed) and 37214 (Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed, cessation of thrombolysis including removal of catheter and vessel closure by any method) cover some subsequent treatment situations.

Keep These ICD-10-CM Codes Handy

When reporting thrombolytic therapy, certain diagnoses may pop up. Here are some of the more common diagnoses you may see when reporting thrombolytic therapy:

• Hemorrhage
  • I60.- (Nontraumatic subarachnoid hemorrhage) to I62.- (Other and unspecified nontraumatic intracranial hemorrhage)
• Cerebral thrombosis/embolus
  • I63.0 (Cerebral infarction due to thrombosis of precerebral arteries) to I63.6 (Cerebral infarction due to cerebral venous thrombosis, nonpyogenic)
• Cerebral infarction
  • I63.8 (Other cerebral infarction)
  • I63.9 (Cerebral infarction, unspecified)
• Transient ischemic attack (TIA)
  • G45.9 (Transient cerebral ischemic attack, unspecified)
• Peripheral vascular disease
  • I73.9 (Peripheral vascular disease, unspecified)
• Peripheral artery disease
  • I70.2- (Atherosclerosis of native arteries of the extremities) to I70.299 (Other atherosclerosis of native arteries of extremities, unspecified extremity)
• Acute embolism and thrombosis of deep veins of the lower extremity
  • I82.4- (Acute embolism and thrombosis of deep veins of lower extremity) to I82.499 (Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity)

Examine These Scenarios

Scenario 1: DVT

A 54-year-old patient arrives to the hospital with a documented history of PAD and lower leg swelling. Patient is being worked up for a blood clot in the lower right leg. Diagnostic testing is performed, and the patient is found to have a DVT. Patient is taken to the OR for treatment. Ultrasound guidance is performed to see the needle puncture, to measure vessel patency and images were taken and saved in the record. Diagnostic venography was performed and reveals significant clot. Initial percutaneous venous thrombectomy is performed. An infusion catheter is inserted, then thrombolytic infusion is started. Infusion is performed for 24 hours and after which no significant clot remains.

For this encounter, report these codes:

• 37187 with modifier RT (Right side (used to identify procedures performed on the right side of the body))
• 37212 with modifiers 59 (Distinct Procedural Service) and 51 (Multiple Procedures)
• 36010 (Introduction of catheter, superior or inferior vena cava) with modifier 51
• 75822 (Venography, extremity, bilateral, radiological supervision and interpretation) with modifiers 26 (Professional component) and 59
• 76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)) with modifier 26

Scenario 2: Embolus of the lower extremity

A 42-year-old patient presents with left leg pains with exam; faint pulses are found. Diagnostic angiogram by contralateral puncture and insertion of catheter in the left iliac artery was performed and found to have an embolus in the left superior femoral artery. Insertion of infusion catheter is placed, and thrombolytic agent is initiated. Infusion was completed at 6 hours and confirmed clot has dissolved.

Report these codes:

• 37211
• 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) with modifier 51
• 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation), with modifiers 26 and 59.

Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee