Infusion for thrombolysis-How to code

Shirleybala

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Hello:
How to code for abdominal drainage cathater thrombolysis.

Clinical History: 71-year-old female status post remote rectopexy
with recent attempted Hartman pouch reversal now status post
exploratory laparotomy with small bowel in carotid and closure.
Patient with multiple collection status post right upper quadrant
and left lower quadrant percutaneous drainage. Patient with poor
drainage from the percutaneous drain within the right upper
quadrant perihepatic collection. Patient referred for infusion of
TPA within the right upper quadrant drainage catheter.

Findings:

The patient currently has no complaints and denies pain.

PE:

RUQ Percutaneous Drainage Catheter Site: C/D/I with no erythema.

LLQ Percutaneous Drainage Catheter Site: C/D/I with no erythema.

Procedure:

The right lower quadrant drainage catheter was sterilely prepped.

The catheter was infused with 5 mg of tPA in 20 cc of normal
saline and capped.

A dressing was reapplied over the right upper quadrant skin entry
site.

The patient tolerated the procedure well and was transferred to
the floor in stable condition. There were no immediate
complications.

Impression:

Successful infusion of 5 mg of tPA in 20 cc of normal saline in
the right upper quadrant drainage catheter draining the
perihepatic fluid collection as described above.

Plan:

The tPA solution will be allowed to dwell within the RUQ
collection for approximately 3-4 hours after which the right upper
quadrant drain will be placed back to gravity drainage by the
interventional radiology team.
 

dhuston

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I just received an answer directly from SIR today on a similar question. My question was about injection of tpa into an existing pleural catheter but I believe their answer would apply to this also. They said it would be an E&M code. This didn't make my docs happy since there's a lot more work than just a hospital visit but this is not the same as a 37201 or 37202 procedure so you can't use those codes.

Diane Huston, CPC,RCC
 

Shirleybala

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Can I use 49424- Contrast injection in cath(But i know its a thrombolysis agent not a contrast)
 

sneekersia

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tPa for Thrombolysis 37195

I am trying to bill this for a neurology practice when the patient has an inpt status, for stroke prevention. I keep getting denials for place of service. I assume this means that the code 37195 is included in the DRG for that stay. Is there maybe a supervision and interpretation code that would be appropriate. Can anyone help me code this I have looked thru the Federal Registry and CMS and cannot find any specifics on this.
Thanks
 
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