Wiki Thrombectomy confusion

coders_rock!

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Can someone please confirm my coding for the below scenerio? 37187, 35476, 36010, 37211, 75978, 75896, 75820, 75827.

Operations: LT arm subclavian vein, SVC venogram, extensive brachial axillary subclavian SVC, traverse mechanical thrombectomy with TPA, as well as extensive brachial axillary subclavian recanalization & balloon angioplasty.

Procedure: A French sheath was inserted into the brachial vein and an extensive venography showed complete occlusion. Recanalization was performed. A segment of the axilla was ballooned out. A traverse device was engaged. Ten (10) mg of TPA was given and sequential TPA was injected. Both balloons were inflated from the SVC & pulled back into subclavian. TPA was given over the course of 10 minutes. Aspiration was performed in a standard fashion and saline was injected. Balloon angioplasty was done with excellent results.
 
Can someone please confirm my coding for the below scenerio? 37187, 35476, 36010, 37211, 75978, 75896, 75820, 75827.

Operations: LT arm subclavian vein, SVC venogram, extensive brachial axillary subclavian SVC, traverse mechanical thrombectomy with TPA, as well as extensive brachial axillary subclavian recanalization & balloon angioplasty.

Procedure: A French sheath was inserted into the brachial vein and an extensive venography showed complete occlusion. Recanalization was performed. A segment of the axilla was ballooned out. A traverse device was engaged. Ten (10) mg of TPA was given and sequential TPA was injected. Both balloons were inflated from the SVC & pulled back into subclavian. TPA was given over the course of 10 minutes. Aspiration was performed in a standard fashion and saline was injected. Balloon angioplasty was done with excellent results.


I see 37187 ( includes TPA so no 37211/37212)
35476/75978
36010/75820

As documented, complete occlusion from a brachial injection would preclude an image and interpretation of the SVC, so I would not code for that (75827) based only on this report. Perhaps some clarification from the provider would help?

Lastly, 75896 does not apply to 37211/37212, which is not applicable in this case anyway.

HTH :)
 
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