Cardiology Coding Alert

Question: My cardiologist diagnosed the patient with acute saddle pulmonary embolism with acute cor pulmonale. They inserted EKOS catheters in bilateral pulmonary arteries for catheter-directed thrombolysis. After obtaining informed consent, the patient was prepped and draped in sterile fashion. My cardiologist inserted two 6-French glide sheaths in the right internal jugular artery under fluoroscopy and ultrasound guidance. They used a 5-French Swan-Ganz catheter for assessment of the pulmonary pressures. Using the 5-French Swan-Ganz catheter and 5-French FR 4 catheter and V 18 wires, my cardiologist successfully placed EKOS catheters into bilateral pulmonary artery branches. Moderate conscious sedation was provided under my cardiologist’s direct supervision with the sedation trained nurse using 0.5 mg of intravenous versed and 50 mcg of fentanyl to sedate the patient. Start time was 1356, and end time was 1556 for a total of 120 minutes. There were no complications. The pulmonary artery pressure was 58/26 mmHg. Which codes should I report on my claim?

AAPC Forum Subscriber

Answer: Report 37211 (Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day) with modifier 50 (Bilateral procedure) appended since your cardiologist placed two catheters.

For the ICD-10-CM code, report I26.02 (Saddle embolus of pulmonary artery with acute cor pulmonale).

Don’t miss: You should use code 37211 to report the initial day of transcatheter thrombolytic infusion(s) including follow-up arteriography/venography, and catheter position change or exchange, when your provider performs those services.

Code 37211 includes fluoroscopic guidance and associated radiological supervision and interpretation as well as ongoing evaluation and management (E/M) services related to thrombolysis on the day of the procedure. However, if the same physician provides a significant, separately identifiable E/M service on the same day of the procedure, you can report the appropriate level of E/M service and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).