Wiki atherectomy with infusion of nitroglycerin


East Berlin, PA
Best answers
Needing some help clearing up a coding question in our office, we have several different opinions on coding the following case.

Our physician is performing a peripheral arteriogram and intervention. He placed the sheath in contralateral fashion into the right common femoral. Now we were able to navigate through the total occlusion of the right anterior tibial. The wire went very easily through this occlusion, it was felt that this was a thrombotic occlusion hence a Clearway therapeutic infusion catheter was placed inside the right anterior tibial and intrarterial of nitroglycerin infusion was performed to reduce thrombus burden. Now laser atherectomy of the right anterior tibial was performed using a 0.9mm laser catheter.

Would you just code for the atherectomy of the right anterior tibial or would the infusion of nitroglycerin be coded seperately with 37201 and a 59 modifier?

Thanks for any help.
If the nitro infusion was truly set up with an infusion catheter as a therapeutic measure and left to lyse your thrombus over an extened period of time (the CIRCC study guide page 29 states the infusion catheter is in place for 60 min or more), then you could bill 37201 and 75896 (fluoro) for this service. The intent of the infusion should be to lyse/dissolve the clot with the nitro.

But alot of times a quick bolus or short infusion of nitroglycerin in a vessel is done prior to a thrombectomy or atherectomy in order to get the vessel to completely dialate prior to the atherectomy or thrombectomy procedure. They do this alot prior to coronary thrombectomies. Sometimes the infusion of nitro can also be to just help break up the clot a small bit in order to increase the chances that the thrombectomy/atherectomy will be more successful, but is not considered a therapeutic measure. In these cases, I wouldn't bill for 37201/75896 additionally.

Also take this into consideration for your decision--I would ask your physician to explain to you what the primary procedural plan/intent was -- if the intent was to try a therapeutic infusion of nitro in hopes to lyse the clot, but ultimately wasn't fully successful, I would bill additionally for the 37201/75896 along with you atherectomy/thrombectomy procedure. If the primary procedural plan/intent was to just perform the atherectomy/thrombectomy, then I wouldn't bill for 37201/75896 additionally.