Cardiology Coding Alert

You Be the Coder:

Solve Mechanical Thrombectomy Situation

Question: After prepping and anesthetizing the patient, my cardiologist accessed the site of the artery and placed vascular clamps across the affected initial artery. My cardiologist then performed an arterial puncture inside the first blocked vessel. They also performed an arterial irrigation by injecting heparin saline through the access site. The provider used a fiberoptic angioscope to identify the exact location of the arterial thrombosis. Using fluoroscopic guidance, they inserted a guidewire into the artery and advanced the catheter over the guidewire to the occlusion site. My cardiologist then manipulated the tip of the catheter system to the occlusion site inside the diseased artery and injected a thrombolytic agent to achieve complete fragmentation of the clot. They suctioned out the clot fragments from the affected artery to restore its blood supply. Lastly, the physician removed the catheter system and stopped all bleeding by applying pressure at the entry site. How should I report this procedure?

Minnesota Subscriber

Answer: You should report 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) on your claim.

Coding tip: Never report 37184 in conjunction with codes 61645, 76000, or 96374, per CPT®.

Don’t miss: You can also report add-on code +37185 (… second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure) along with primary code 37184 when your provider treats an occlusion in a second and all subsequent arteries or arterial bypass grafts by using a combined technique of mechanical thrombectomy and pharmacological thrombolytic injection.

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