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Thrombolysis

  1. Default Thrombolysis
    Medical Coding Books
    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.
    Prabha CPC

  2. Default
    I think you can code both 37187 for the mechanical thrombectomy and 37201 for the infusion that was left overnight.

    Diane Huston, CPC,RCC

  3. #3
    Default
    Quote Originally Posted by prabha View Post
    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

  4. #4
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by dhuston View Post
    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
    Danny L. Peoples
    CIRCC,CPC

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