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General Surgery Coding Alert

You Be the Coder:

Know When Vascular Procedure Includes Radiology

Published on Tue Jun 17, 2014

Question: Our vascular surgeon carried out an angiojet thrombectomy with multiple passes in the main pulmonary artery, and also placed an IVC filter. Imaging was involved as follows:

diagnostic angiography on the main pulmonary artery 

TPA injection 

IVC venogram to identify renal veins.

How should I code this, and which imaging services can I separately report? 

Codify Subscriber

Answer: Report the vascular surgeon’s work using 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection[s]; initial vessel) for the thrombectomy. 
 
The thrombectomy code includes intraprocedural thrombolytic injections, so you should not report the TPA injections separately.
 
The code for the radiological portion of main pulmonary artery angiography is 75746-26 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation; Professional component). Code 75746 is bundled into 37184, so you should report 75746 only if it’s for a truly diagnostic angiogram, meaning no previous angiogram is available and the decision to perform the thrombectomy was based on this angiogram. To report a true diagnostic angiogram, append modifier 59 (Distinct procedural service) to 75746.
 
For your surgeon’s IVC filter placement, use 37191 (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance [ultrasound and fluoroscopy], when performed). No additional radiology code is appropriate. 

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