Radiology Coding Alert

Question: I have been told that CPT 36870 is the appropriate code for lyse-and-wait of a dialysis graft, TPA (tissue plasminogen activator) injected. I disagree, however, and believe 37201 is a better code. CPT 36870 has a 90-day global period, which seems excessive for TPA. Am I correct?

Kentucky Subscriber
 
Answer: The declotting of the dialysis graft is reported with 36870. This code, introduced in CPT 2001, describes all percutaneous methods of opening thrombosed dialysis shunts. These techniques may include mechanical thrombectomy -- which is a procedure that physically removes the clot -- as well as lyse-and-wait, and short infusions of thrombolytic agents. The 90-day global reflects the comprehensive work performed by the physician.
 
On the other hand, 37201 (transcatheter therapy, infusion for thrombolysis other than coronary) is an infusion code, which is not an accurate description of the lyse-and-wait technique.
 
Earlier this year, 36870 did not include infusions of thrombolytic agents lasting longer than one hour, which should have been reported separately. This has been changed, and there is now no time limit on the thrombolysis.