Wiki 37187?

EikaMTGQueen

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I need help - my coding department says this TPA (37187) is not code-able and in my eyes I think it is. This doctor then removes the IVC filter as below. Can you please give me your opinion on this?

Thanks
Erica Ross CIRCC, RCC


Kumpe catheter was then placed over exchange length stiff Glidewire into the
left lower extremity. Left lower extremity venogram was performed with
hand-injection DSA images confirming some collaterals with minimal filling
defect in the distal superficial femoral vein and popliteal vein. This was
followed by placement of 4 mg of TPA within mechanical infusion device for 30
minutes. Post TPA thrombolysis left lower extremity no residual acute defect
seen. Patent collaterals are noted. The catheter was removed over wire.


Through the sheath a snare was placed. This was followed by placement of a
snare, and the snare was used to gain access into the existing IVC filter
hook. IVC filter was tilted by approximately 40 degrees to the left. Multiple
attempts were made using clover stent as well as the gooseneck stent without
success. This was followed by placement of a dilator over wire. 12 French as
well as 14 French dilator followed by placement of a 16 French sheath.
Through 16 French sheath a SOS Omni catheter was advanced over a wire
surrounding the medial aspect of the left IVC filter. A Glidewire was then
advanced through the catheter. The wire was then snared into the sheath. The
same was repeated in a cross-sectional matter within the IVC filter.
Additional wire was also advanced and snared into the sheath. This was
followed by placement of a sheath over the IVC collapsing the struts. The
filter was removed successfully with fluoroscopic guidance. IVC filter
removal venogram demonstrates no thrombus. The sheath was then removed and
pressure was applied for hemostasis. The patient tolerated the procedure
well. There were no complications.
 
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