Cardiology Coding Alert

Question: After the patient was appropriately prepped and anesthetized, my cardiologist accessed the affected vein through a tiny incision at the groin. They first performed a separately reportable venography by injecting contrast material through the incision into the vein to localize the exact site of the clot in the vein. Under fluoroscopic guidance, they inserted a guidewire to the site of occlusion and threaded a catheter, with a sharp mechanical device at its tip to break the clot, over the guidewire. My cardiologist further dissolved the clot with multiple injections of a thrombolytic agent. Finally, they removed all instruments and stopped any bleeding by applying pressure at the site of entry. How should I report this?

AAPC Forum Participant

Answer: You should report 37187 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance) for the initial application. This is an example of venous mechanical thrombectomy. If you need to report bilateral venous mechanical thrombectomy performed through a separate site, append modifier 50 (Bilateral procedure) to code 37187.

Repeat: Report 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 repeat treatment on a subsequent day during a course of thrombolytic therapy.

Don’t miss: Venous thrombectomy codes can be used for peripheral or intracranial veins, and there is no separate code for secondary thrombectomy in this code set. The procedure is for one or more veins in the same extremity and may be the only procedure the provider performs, or it may be performed with infusion therapy.