Wiki TIPS revision with mechanical thrombectomy

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The radiologist accessed an existing TIPS and performed portography and hemodymanic evaluation. The TIPS was found to be occluded. Mechanical thrombectomy was performed and an additional stent was placed. Can you tell me if the thrombectomy is included in the work of the TIPS revision 37183, or if 37187 may be reported as well?

Per the CPT information, 37183 doesn't appear to include the work of a thrombectomy, nor are there any NCCI edits. But, the 2003 AMA vignette for CPT 37183 includes this statement in the Intra-Service work section: "If thrombus in the TIPS tract or portal vein clot is present, either pharmacological and/or mechanical removal of the thrombus is performed and the tract and portal vein restudied. If TIPS tract stenosis is present, angioplasty and/or repeat stenting of the tract is performed to re-establish a widely patent tract and normalize pressure." The thrombectomy appears to be included in the revision charge per this information.

Any help is appreciated!
 
It looks like the TIPS stent is occluded, so I would code 37183 which includes intrahepatic tract recanalization/dilatation, stent placement. 37187 is coded when thrombectomy is performed outside of the TIPS zone,i.e splenic, mesenteric or non-portal venous branches.
HTH,
Jim Pawloski, CIRCC
 
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