# 37186, Secondary Thrombectomy



## Robbin109 (Oct 10, 2013)

Patient had a atherectomy of the SFA then the MD noticed there was slow flow into the peroneal that could have been secondary to spasm, thrombus or emboli. He preformed selective thrombectomy of the peroneal with the same Trailblazer Catheter.

Is this billable with a 37186. Is this considered  aspiration thrombectomy?


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## Jim Pawloski (Oct 11, 2013)

Robbin109 said:


> Patient had a atherectomy of the SFA then the MD noticed there was slow flow into the peroneal that could have been secondary to spasm, thrombus or emboli. He preformed selective thrombectomy of the peroneal with the same Trailblazer Catheter.
> 
> Is this billable with a 37186. Is this considered  aspiration thrombectomy?



It considering "clot chaseing", or "oops, I didn't mean to do that", or other things that the doctor says that we can't repeat. (Happy Friday!!)  But 37186 can be done any method, it's just not the primary thrombectomy, but as an add-on to another procedure, in this case the thrombectomy.
HTH,
Jim Pawloski, CIRCC


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## Robbin109 (Oct 14, 2013)

I believe 37186 can only be billed if Mechanical as well since it is under the category of "Arterial Mechanical Thrombectomy".

Thoughts, anyone?


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## Jim Pawloski (Oct 14, 2013)

Robbin109 said:


> I believe 37186 can only be billed if Mechanical as well since it is under the category of "Arterial Mechanical Thrombectomy".
> 
> Thoughts, anyone?



To quote Dr. Zielske " Secondary percutaneous arterial thrombectomy (37186) refers to arterial thrombectomy when not initially planned.  This would be utilized when a stent placement is performed and completion angiography shown an occluded distal vessel, requiring limited catheter thrombectomy, snare, or suction removal of clot.  This code may also be utilized when there is a short occlusion with clot noted prior to intervention requiring a "quick" thrombectomy to allow the intended stent placement.  Accutate physician documentation is mandatory to appropriately code these procxedures"  Z-health Publishing, Diagnostic and Interventional Cardiovascular Coding Reference, Pg. 310.

HTH,
Jim Pawloski, R.T.(CV), CIRCC


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