Thrombolysis

prabha

Guru
Messages
160
Best answers
0
37620
35476
37201
36010
36010-59
75940-26
75825-2659
75825-2659
75820-26
75896-26
75978-26

Pls confirm the above set of codes for the below procedure.Can we use 37187 instead of 37201 & 75896?


IVC Gram/IVC Filter:
With the patient in the supine position, the right neck was
prepped and draped in a sterile fashion. Using real-time
ultrasound guidance, a 21-gauge needle was advanced into the right
internal jugular vein.

A 5-French sheath was placed. A guidewire was manipulated into
the infrarenal inferior vena cava. A 5-French sizing pigtail
catheter was placed in the peripheral IVC. Contrast was injected
and digital subtraction IVC examination was performed.

Catheter exchange for was performed for a deployment sheath for a
Gunther Tulip IVC filter. Infrarenal deployment of the Gunther
Tulip (potentially retrievable) IVC filter was performed.

Left Lower Extremity Venous Thrombolysis:
A sterile prep and drape of the left popliteal region and upper
left calf was performed. Using real time ultrasound guidance, a
21 gauge needle was advanced into a upper calf muscular vein. A
guide wire was passed in antegrade fashion. A 4 French
angiographic catheter was placed. Contrast injections of were
performed and digital subtraction venography of the left lower
extremity was obtained.

The catheter was exchanged for a six French vascular sheath. A
5-French angiographic catheter was manipulated into the left
external iliac vein. Contrast was injected and digital images
were obtained. A guidewire was manipulated across the external
iliac vein and into the left common iliac vein and then into the
infrarenal IVC. Contrast was injected and digital images were
obtained. The patient was given a systemic bolus of heparin.Using
a Possis mechanical thrombectomy system, Power pulse thrombolysis
of the left common iliac vein, external iliac, common femoral and
femoral vein was performed with the 6 Fr. DVX catheter. The Power
Pulse was performed using 20 mg tPA in 100 cc of normal saline.
The TPA was allowed to dwell within the treated segment for 90
minutes. The patient remain on the table during this interval
with continuous physiologic monitoring by anesthesia.

The Possis system was then used to perform mechanical lumpectomy
using both antegrade and retrograde passage over the treated
segment for a total of 200 cc normal saline.
Follow-up venography was performed.
The left calf sheath was exchanged for a 7-French vascular sheath.
A central left external iliac vein, left common iliac vein and
iliac vein bifurcation was dilated to 10 mm. Subsequently the
same venous segments were dilated to 12 mm and then to 14 mm.

The balloon catheter was exchanged for a 5-French 50-cm long
infusion catheter for continuous overnight infusion of TPA in the
ICU. The patient's infusion was started at 2mg tPA per hour with
the dose being split via the infusion catheter and the calf
sheath.

Specific instructions were discussed with the SICU physician team
regarding TPA infusion, intravenous heparin infusion and
monitoring of lab work.

FINDINGS:
Transjugular IVC Gram demonstrates nonocclusive thrombus along the
left lateral infrarenal IVC wall. The right and left renal veins
are patent. The right common iliac vein is patent. The
suprarenal IVC is patent without thrombus.

A potentially retrievable (Gunther Tulip IVC filter) was deployed
in the infrarenal IVC.

Left lower extremity venography demonstrates occlusion of the
length of the left femoral vein, common femoral vein, left
external iliac vein and left common iliac vein. Filling defects
are noted throughout the above veins consistent with acute and
subacute thrombosis. The findings are consistent with left iliac
vein compression syndrome (May Thurner syndrome).

Power pulse from the lysis of the above occluded venous segments
of the left lower extremity was performed using 20 mg TPA.
Following follicle mechanical thrombolyzes, there is significant
improvement in the appearance of the veins with some antegrade
flow. Percutaneous balloon angioplasty of the iliac veins was
performed using 10 mm, 12-mm and 14-mm balloons. Subsequently
continuous infusion of TPA was performed in order to lyse
residual, persistent thrombus in the femoral, common femoral,
external iliac and common iliac veins..

IMPRESSION:
Real-time ultrasound guided access of a patent right internal
jugular vein.

IVC contrast exam:
Patent suprarenal and juxtarenal inferior vena cava. Nonocclusive
thrombus along the left lateral wall of the infrarenal IVC.
Patent right common iliac vein.

Infrarenal deployment of Gunther Tulip IVC filter.

Real-time ultrasound guided access of a patent left upper calf
muscular vein.

Left Lower Extremity Angiogram:
Subacute to acute thrombus in the left femoral vein, common
femoral, external iliac and common iliac veins. The junction of
the left common iliac vein with the IVC is consistent with iliac
compression syndrome or May Thurner syndrome.

Pharmaco- mechanical thrombolysis was performed as described
above. Follow-up venography demonstrates improvement in
thrombosis following chemical mechanical thrombolysis using a
power pulse protocol.

Percutaneous left iliac venous balloon dilatation up to 14 mm as
described above.

Overnight continuous TPA infusion initiated as described above.
 

dhuston

Guest
Messages
110
Best answers
0
I think you can code both 37187 for the mechanical thrombectomy and 37201 for the infusion that was left overnight.

Diane Huston, CPC,RCC
 

Jim Pawloski

True Blue
Messages
1,270
Location
Ann Arbor
Best answers
0
37620
35476
37201
36010
36010-59
75940-26
75825-2659
75825-2659
75820-26
75896-26
75978-26

Pls confirm the above set of codes for the below procedure.Can we use 37187 instead of 37201 & 75896?


IVC Gram/IVC Filter:
With the patient in the supine position, the right neck was
prepped and draped in a sterile fashion. Using real-time
ultrasound guidance, a 21-gauge needle was advanced into the right
internal jugular vein.

A 5-French sheath was placed. A guidewire was manipulated into
the infrarenal inferior vena cava. A 5-French sizing pigtail
catheter was placed in the peripheral IVC. Contrast was injected
and digital subtraction IVC examination was performed.

Catheter exchange for was performed for a deployment sheath for a
Gunther Tulip IVC filter. Infrarenal deployment of the Gunther
Tulip (potentially retrievable) IVC filter was performed.

Left Lower Extremity Venous Thrombolysis:
A sterile prep and drape of the left popliteal region and upper
left calf was performed. Using real time ultrasound guidance, a
21 gauge needle was advanced into a upper calf muscular vein. A
guide wire was passed in antegrade fashion. A 4 French
angiographic catheter was placed. Contrast injections of were
performed and digital subtraction venography of the left lower
extremity was obtained.

The catheter was exchanged for a six French vascular sheath. A
5-French angiographic catheter was manipulated into the left
external iliac vein. Contrast was injected and digital images
were obtained. A guidewire was manipulated across the external
iliac vein and into the left common iliac vein and then into the
infrarenal IVC. Contrast was injected and digital images were
obtained. The patient was given a systemic bolus of heparin.Using
a Possis mechanical thrombectomy system, Power pulse thrombolysis
of the left common iliac vein, external iliac, common femoral and
femoral vein was performed with the 6 Fr. DVX catheter. The Power
Pulse was performed using 20 mg tPA in 100 cc of normal saline.
The TPA was allowed to dwell within the treated segment for 90
minutes. The patient remain on the table during this interval
with continuous physiologic monitoring by anesthesia.

The Possis system was then used to perform mechanical lumpectomy
using both antegrade and retrograde passage over the treated
segment for a total of 200 cc normal saline.
Follow-up venography was performed.
The left calf sheath was exchanged for a 7-French vascular sheath.
A central left external iliac vein, left common iliac vein and
iliac vein bifurcation was dilated to 10 mm. Subsequently the
same venous segments were dilated to 12 mm and then to 14 mm.

The balloon catheter was exchanged for a 5-French 50-cm long
infusion catheter for continuous overnight infusion of TPA in the
ICU. The patient's infusion was started at 2mg tPA per hour with
the dose being split via the infusion catheter and the calf
sheath.

Specific instructions were discussed with the SICU physician team
regarding TPA infusion, intravenous heparin infusion and
monitoring of lab work.

FINDINGS:
Transjugular IVC Gram demonstrates nonocclusive thrombus along the
left lateral infrarenal IVC wall. The right and left renal veins
are patent. The right common iliac vein is patent. The
suprarenal IVC is patent without thrombus.

A potentially retrievable (Gunther Tulip IVC filter) was deployed
in the infrarenal IVC.

Left lower extremity venography demonstrates occlusion of the
length of the left femoral vein, common femoral vein, left
external iliac vein and left common iliac vein. Filling defects
are noted throughout the above veins consistent with acute and
subacute thrombosis. The findings are consistent with left iliac
vein compression syndrome (May Thurner syndrome).

Power pulse from the lysis of the above occluded venous segments
of the left lower extremity was performed using 20 mg TPA.
Following follicle mechanical thrombolyzes, there is significant
improvement in the appearance of the veins with some antegrade
flow. Percutaneous balloon angioplasty of the iliac veins was
performed using 10 mm, 12-mm and 14-mm balloons. Subsequently
continuous infusion of TPA was performed in order to lyse
residual, persistent thrombus in the femoral, common femoral,
external iliac and common iliac veins..

IMPRESSION:
Real-time ultrasound guided access of a patent right internal
jugular vein.

IVC contrast exam:
Patent suprarenal and juxtarenal inferior vena cava. Nonocclusive
thrombus along the left lateral wall of the infrarenal IVC.
Patent right common iliac vein.

Infrarenal deployment of Gunther Tulip IVC filter.

Real-time ultrasound guided access of a patent left upper calf
muscular vein.

Left Lower Extremity Angiogram:
Subacute to acute thrombus in the left femoral vein, common
femoral, external iliac and common iliac veins. The junction of
the left common iliac vein with the IVC is consistent with iliac
compression syndrome or May Thurner syndrome.

Pharmaco- mechanical thrombolysis was performed as described
above. Follow-up venography demonstrates improvement in
thrombosis following chemical mechanical thrombolysis using a
power pulse protocol.

Percutaneous left iliac venous balloon dilatation up to 14 mm as
described above.

Overnight continuous TPA infusion initiated as described above.
I think you may have missed the S&I code for the filter 75940
 

dpeoples

True Blue
Messages
889
Location
Birmingham, Alabama
Best answers
0
I think you can code both 37187 for the mechanical thrombectomy and 37201 for the infusion that was left overnight.

Diane Huston, CPC,RCC
I agree with Diane, you can bill both. You might need to modify 37201/75896 (59) depending on your payor. It is clearly a separate service.

HTH:)
 
Top