# thrombectomy coding



## theresa.dix@tennova.com

Needing some input. 92973 is only to be used for mechanical thrombectomy. If an aspiration thrombectomy is done according to Z health they recommend the unlisted code. Last I knew Z health was waiting for clarification from AMA and ACC  on this. Has anyone heard if the clarification came? Some of our physicians are asking and I cannot fine the answer.

Thank you,


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## Jim Pawloski

theresa.dix@ethc.com said:


> Needing some input. 92973 is only to be used for mechanical thrombectomy. If an aspiration thrombectomy is done according to Z health they recommend the unlisted code. Last I knew Z health was waiting for clarification from AMA and ACC  on this. Has anyone heard if the clarification came? Some of our physicians are asking and I cannot fine the answer.
> 
> Thank you,



Hi Theresa,
I am taking this from Dr.Z's book; 
Code 92973 is utilized for removal of thrombus (thrombectomy) from a coronary artery.  This may be performed with an Export AP aspiration catheter, Pronto V3, Angiojet or other simular catheter/device.  I have billed this code, and have not heard if it wasn't accepted.  Has anyone else had any problems?

Thanks,
Jim Pawloski, CIRCC


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## theresa.dix@tennova.com

Jim Pawloski said:


> Hi Theresa,
> I am taking this from Dr.Z's book;
> Code 92973 is utilized for removal of thrombus (thrombectomy) from a coronary artery.  This may be performed with an Export AP aspiration catheter, Pronto V3, Angiojet or other simular catheter/device.  I have billed this code, and have not heard if it wasn't accepted.  Has anyone else had any problems?
> 
> Thanks,
> Jim Pawloski, CIRCC



Jim,
 Read this article by dr z on thrombectomy coding. You will see what why I am asking.If for some reason you cant open I will send article.

http://www.zhealthpublishing.com/About-Us-Engine.asp?NavigationTopLevel2MenuID=42


Let me know what you think!


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## jewlz0879

theresa.dix@ethc.com said:


> Needing some input. 92973 is only to be used for mechanical thrombectomy. If an aspiration thrombectomy is done according to Z health they recommend the unlisted code. Last I knew Z health was waiting for clarification from AMA and ACC  on this. Has anyone heard if the clarification came? Some of our physicians are asking and I cannot fine the answer.
> 
> Thank you,



This is from Medlearn just in May: 

May 30, 2011
Question:
*Previous Question/Answer: When using a thrombectomy catheter during percutaneous cardiac intervention (PCI), can 92973 be assigned when a manual extraction catheter such as the Pronto or Quick-Cat is used? 

Answer: Yes, code 92973 can be used regardless of the method of thrombectomy. 


Answer:
*Further explanation of above answer: In a previous question regarding the use of an extraction catheter (e.g. for aspiration of clot), MedLearn indicated that code 92973 would be the appropriate code for an aspiration thrombectomy. Recently the American Medical Association (AMA) and the American College of Cardiology (ACC) released new information that revises this answer. In their CPT Reference Guide for Cardiovascular Coding, they state the following: 

"Code 92973 is used to report mechanical thrombectomy using an Angiojet or similar catheter that mechanically fragments and removes clots. Other procedures using catheters (e.g. pronto, Fetch) that aspirate thrombus but do not mechanically fragment thrombus are not reportable with codes 92973."


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## jewlz0879

jewlz0879 said:


> This is from Medlearn just in May:
> 
> May 30, 2011
> Question:
> *Previous Question/Answer: When using a thrombectomy catheter during percutaneous cardiac intervention (PCI), can 92973 be assigned when a manual extraction catheter such as the Pronto or Quick-Cat is used?
> 
> Answer: Yes, code 92973 can be used regardless of the method of thrombectomy.
> 
> 
> Answer:
> *Further explanation of above answer: In a previous question regarding the use of an extraction catheter (e.g. for aspiration of clot), MedLearn indicated that code 92973 would be the appropriate code for an aspiration thrombectomy. Recently the American Medical Association (AMA) and the American College of Cardiology (ACC) released new information that revises this answer. In their CPT Reference Guide for Cardiovascular Coding, they state the following:
> 
> "Code 92973 is used to report mechanical thrombectomy using an Angiojet or similar catheter that mechanically fragments and removes clots. Other procedures using catheters (e.g. pronto, Fetch) that aspirate thrombus but do not mechanically fragment thrombus are not reportable with codes 92973."



So they really didn't answer the question. Well, AMA and ACC didn't offer the 'correct' code


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## Jim Pawloski

jewlz0879 said:


> So they really didn't answer the question. Well, AMA and ACC didn't offer the 'correct' code



I read the Medlearn answer, and it confused me even more.  That's why I still bill for the thrombectomy until someone gives me an answer.

Jim Pawloski, CIRCC


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## theresa.dix@tennova.com

Jim Pawloski said:


> I read the Medlearn answer, and it confused me even more.  That's why I still bill for the thrombectomy until someone gives me an answer.
> 
> Jim Pawloski, CIRCC



lol yea I understand. I am going to use the unlisted code since Dr Z says he recommends that until he gets more clarification.


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## Jim Pawloski

theresa.dix@ethc.com said:


> lol yea I understand. I am going to use the unlisted code since Dr Z says he recommends that until he gets more clarification.



A lillte more information that may help.  After reading this, I am not going to bill for suction thrombectomy until either the AMA or ACC come out with a better explaination.

Description of 92973 in The Coders Desk Reference.


The physician percutaneously removes a blood clot from a native or grafted coronary artery.  A double lumen catheter is passed to the area of the clot.  A high-pressure saline stream (via a pump) is introduced through a lumen that has multiple jet orifices located at the distal tip.  The low pressure zone created by the jets causes the clot to  break-up into small pieces and be pushed through the catheter with a force that drive debris from the thrombus through the other lumen(exhaust) and out of the body.  The procdure is useful to clear fatty and degenerated arteries and to modify plaques in preparation for more definitive treatment with adjunctive balloon angioplasty or stenting.   

CPT Assistant March 2002 pg 10.
Question:
How should I report an angiojet coronary vessel treatment?

AMA Comment:
A new code was added to CPT 2002 for percutaneous thrombectomy procedures performed for the coronary vessels.  Code +92973, Percutaneous transluminal coronary thrombectomy (list separately in addition to code for primary procedure), should be used to report the performance of coronary artery thrombectomy specifically by catheter-based angiojet.
Use of an angiojet procedure to clear a blockage in the coronary vessel(s) was preciously reported with the unlisted code 93799.  This service/procedure designed is to diagnose or treat or the conditions of intracoronary thrombus in patients with recent MI or acute coronary syndrome, saphenous vein graft thrombus in patients with recent MI or acute coronary syndrome, and acute myocardial infarction with extensive local thrombus formation

Let us know your thoughts on this.
Hey Danny  what do you think?

Jim Pawloski, CIRCC


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## dpeoples

Jim Pawloski said:


> A lillte more information that may help.  After reading this, I am not going to bill for suction thrombectomy until either the AMA or ACC come out with a better explaination.
> 
> Description of 92973 in The Coders Desk Reference.
> 
> 
> The physician percutaneously removes a blood clot from a native or grafted coronary artery.  A double lumen catheter is passed to the area of the clot.  A high-pressure saline stream (via a pump) is introduced through a lumen that has multiple jet orifices located at the distal tip.  The low pressure zone created by the jets causes the clot to  break-up into small pieces and be pushed through the catheter with a force that drive debris from the thrombus through the other lumen(exhaust) and out of the body.  The procdure is useful to clear fatty and degenerated arteries and to modify plaques in preparation for more definitive treatment with adjunctive balloon angioplasty or stenting.
> 
> CPT Assistant March 2002 pg 10.
> Question:
> How should I report an angiojet coronary vessel treatment?
> 
> AMA Comment:
> A new code was added to CPT 2002 for percutaneous thrombectomy procedures performed for the coronary vessels.  Code +92973, Percutaneous transluminal coronary thrombectomy (list separately in addition to code for primary procedure), should be used to report the performance of coronary artery thrombectomy specifically by catheter-based angiojet.
> Use of an angiojet procedure to clear a blockage in the coronary vessel(s) was preciously reported with the unlisted code 93799.  This service/procedure designed is to diagnose or treat or the conditions of intracoronary thrombus in patients with recent MI or acute coronary syndrome, saphenous vein graft thrombus in patients with recent MI or acute coronary syndrome, and acute myocardial infarction with extensive local thrombus formation
> 
> Let us know your thoughts on this.
> Hey Danny  what do you think?
> 
> Jim Pawloski, CIRCC



I think I have a headache . We have a perfectly good code for this (cpt description does not specify mechanical) and the professional societies (ACC/AMA) have clouded the water. Why did they issue this new guideline? Perhaps they want to develope a new code?
Fortunately for me, all the coronary thrombectomies I see are with an angioget (so far).

stay tuned....


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## theresa.dix@tennova.com

dpeoples said:


> I think I have a headache . We have a perfectly good code for this (cpt description does not specify mechanical) and the professional societies (ACC/AMA) have clouded the water. Why did they issue this new guideline? Perhaps they want to develope a new code?
> Fortunately for me, all the coronary thrombectomies I see are with an angioget (so far).
> 
> stay tuned....




LOL  Well I have something from Medtronic that tells angiojet 92973 unlisted fetch and pronto. The water is getting deeper. If you want to see this I can forward it to your emails. If not I understand. lol


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## Jim Pawloski

dpeoples said:


> I think I have a headache . We have a perfectly good code for this (cpt description does not specify mechanical) and the professional societies (ACC/AMA) have clouded the water. Why did they issue this new guideline? Perhaps they want to develope a new code?
> Fortunately for me, all the coronary thrombectomies I see are with an angioget (so far).
> 
> stay tuned....



For me, it the opposite.  Suction using a pronto catheter.

Jim


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## donnajrichmond

Jim Pawloski said:


> I read the Medlearn answer, and it confused me even more.  That's why I still bill for the thrombectomy until someone gives me an answer.
> 
> Jim Pawloski, CIRCC



We (MedLearn) asked CPT KnowledgeBase about 92973 because we don't agree with the ACC policy.  We pointed out that the code didn't say "mechanical", we pointed to the 2002 CPT Changes description, etc.  
They answered back with ACC's response.  Export catheter aspiration is not separately coded with an intervention.  Angiojet is the only device that fits 92973 currently.  To qualify for 92973 the device must mechanically fragment the clot.


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## theresa.dix@tennova.com

donnajrichmond said:


> We (MedLearn) asked CPT KnowledgeBase about 92973 because we don't agree with the ACC policy.  We pointed out that the code didn't say "mechanical", we pointed to the 2002 CPT Changes description, etc.
> They answered back with ACC's response.  Export catheter aspiration is not separately coded with an intervention.  Angiojet is the only device that fits 92973 currently.  To qualify for 92973 the device must mechanically fragment the clot.




Ok. that is how I understood it too. I guess that is how I will code it then unless I hear something different. Thanks!


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## Jim Pawloski

donnajrichmond said:


> We (MedLearn) asked CPT KnowledgeBase about 92973 because we don't agree with the ACC policy.  We pointed out that the code didn't say "mechanical", we pointed to the 2002 CPT Changes description, etc.
> They answered back with ACC's response.  Export catheter aspiration is not separately coded with an intervention.  Angiojet is the only device that fits 92973 currently.  To qualify for 92973 the device must mechanically fragment the clot.



Thank you for the response to our question.
Jim Pawloski,
CIRCC


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## Jess1125

Thanks everyone for the threads. I only encounter aspiration thrombectomies and after reviewing the articles am also going to go on the advice of the article and use the unlisted code for these.  (Even though I had a perfectly good code for this!)

If there is any update to this in the future that anyone knows of please let me know! 

Jessica CPC, CCC


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## Jim Pawloski

Jess1125 said:


> Thanks everyone for the threads. I only encounter aspiration thrombectomies and after reviewing the articles am also going to go on the advice of the article and use the unlisted code for these.  (Even though I had a perfectly good code for this!)
> 
> If there is any update to this in the future that anyone knows of please let me know!
> 
> Jessica CPC, CCC



New from Dr. Z's website/ e-mail

AMA Supports ACC Position on Use of Coronary Thrombectomy Code 92973


The American Medical Association (AMA) has stated that they agree with the American College of Cardiology (ACC) that code 92973, Percutaneous transluminal coronary thrombectomy (List separately in addition to code for primary procedure), may only be used to report removal of thrombus utilizing a mechanical system.  It may not be reported when thrombus is removed with an aspiration catheter.

The AMA goes even further and states that removal of coronary thrombus by any means other than mechanical is not separately reportable.  It is part of any other intervention performed.  So, when thrombus is removed prior to percutaneous transluminal coronary angioplasty (PTCA) or coronary stent placement by a means other than use of a mechanical device, it is included in those procedures.


Performance of an aspiration thrombectomy without another intervention is rare, but happens on occasion.  Add-on code 92973 may not be utilized with aspiration devices.  Unlisted code 93799 would be used to report a “stand-alone” aspiration thrombectomy of a coronary artery.


According to the AMA, at this time the only catheter that meets the requirement for use of code 92973 is the Angiojet® (which includes the Angiojet Expedior®).  All other catheters currently having FDA approval are not mechanical devices.  The limitation on the use of code 92973 goes back to the American Medical Association Specialty Society Relative Value System Update Committee (RUC) description of procedure code 92973.  The definition of the procedure was: utilization of a system that includes a drive unit, pump, and foot pedal.  The physician steps on a foot pedal to activate the catheter which is then withdrawn across the lesion in order to remove the intracoronary thrombus.

Code 92973 will have limited usage with the AMA's clarification on the intent of the code as many successful coronary artery thrombectomies are performed with aspiration catheters.


HTH,
Jim Pawloski, CIRCC


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## rpcarrillo

I was also disheartened to see this in the most recent Dr. Z newsletter, as my facility uses Pronto catheters almost exclusively for thrombectomies. According to the ACC, and now the AMA, aspiration thrombectomy is considered bundled into the intervention and therefore not billable at all, unlisted or otherwise.

But now that AMA has agreed with ACC, I'm sure the CPT terminology will be modified in a future version, possibly even the 2012 version (although they're running out of time to make it into the 2012 version by October).


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## theresa.dix@tennova.com

131343 said:


> I was also disheartened to see this in the most recent Dr. Z newsletter, as my facility uses Pronto catheters almost exclusively for thrombectomies. According to the ACC, and now the AMA, aspiration thrombectomy is considered bundled into the intervention and therefore not billable at all, unlisted or otherwise.
> 
> But now that AMA has agreed with ACC, I'm sure the CPT terminology will be modified in a future version, possibly even the 2012 version (although they're running out of time to make it into the 2012 version by October).



Well there ya go. Thanks Jim!


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## dpeoples

While I certainly believe Jim, I was wondering where I could find this information from publically available source. I have been unable to locate this news on the Zhealth website, or that of the AMA or ACC 

I need to show it to others but email from another coder will not suffice (no offense Jim  )
Does anyone have any ideas where I could find this?


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## theresa.dix@tennova.com

dpeoples said:


> While I certainly believe Jim, I was wondering where I could find this information from publically available source. I have been unable to locate this news on the Zhealth website, or that of the AMA or ACC
> 
> I need to show it to others but email from another coder will not suffice (no offense Jim  )
> Any ideas?




Jim,
 I didnt get the new newsletter from dr Z. Could you please send it to me?


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## rpcarrillo

Danny, I also looked for the news on the AMA and ACC websites but it appears it hasn't made it to their websites.

The ACC does mention this coding advice in their CPT Reference Guide for Cardiovascular Coding, but of course you have to buy it ($125 for members) to read it and get the info  

http://www.cardiosource.org/Certifi...-and-Products/Cardiovascular-Coding-2011.aspx

Barring that, here is a link from MedLearn that discusses it, scroll down to May 30, 2011:

http://www.medlearn.com/questions/cardiology_arch.html

Also a mention from Dr. Z on the website from June 3, 2011, but keep in mind this is old. After the most recent news that AMA does concur with ACC, Dr. Z now does not recommend billing unlisted for aspiration thrombectomy.

http://zhealthconsulting.com/ZHealth-News.asp

As I mentioned before though, I have a feeling this will be addressed in a future CPT update and will be ironed out, either through a terminology change in the description for 92973, or (crossing fingers!) a new code for aspiration thrombectomy. The new code might be wishful thinking though, if they really do believe it is bundled into the intervention then no new code will be forthcoming.

I guess we can hope at least...


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## jewlz0879

Well I suppose the revised code give us our answer...

92973 Percutaneous transluminal coronary thrombectomy _mechanical_

They made sure to add "mechanical" in there.


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