General Surgery Coding Alert

Question: Our vascular surgeon performed a vacuum thrombectomy with angioplasty of the inferior vena cava. Can we bill multiple procedure codes?

Tennessee Subscriber

Answer: Yes, you’ll require multiple CPT® codes to adequately capture your surgeon’s work in this case. 

You should report the inferior vena cava mechanical vacuum thrombectomy using 37187 (Percutaneous transluminal mechanical thrombectomy, vein[s], including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance).

The code explicitly includes thrombolytic injections performed during the procedure and fluoroscopic guidance, but CPT® guidelines state, “Code(s) for catheter placement(s), diagnostic studies, and other percutaneous interventions (e.g., transluminal balloon angioplasty, stent placement) provided are separately reportable.”

For catheter insertion in the inferior vena cava, report 36010 (Introduction of catheter, superior or inferior vena cava). 

Report the angioplasty using 35476 (Transluminal balloon angioplasty, percutaneous; venous) and 75978 (Transluminal balloon angioplasty, venous [e.g., subclavian stenosis], radiological supervision and interpretation). If you’re reporting only the surgeon’s services, add modifier 26 (Professional component) to 75978.