# Bilateral Lower Extremity DVT w/ report



## camsgram (Mar 20, 2014)

1. Perc Mechanical Thrombectomy, bilat LE DVT
2. Perc Mechanical thrombectomy, Inferior Vena Cava
3. Catheter directed Thromolysis, bilat LE DVT
4. Bilat LE Venography
5. Bilat Catheter plavcement, IVC
6. Bilat U/S guided popliteal venous access

Report:
Bilateral popliteal venous access. Bilateral selective lower extremity venography was performed demonstrating in the right leg chronic appearing DVT in the right femoropopliteal venous system. Acute partially occlusive DVT was noted inthe right common femoral vein. The right iliac venous system demonstrated acute occlusive DVT extending into the inferior vena cava.  In the left leg, there appeared to be occlusive acute DVT extending from the popliteal vein all the way through the femoral venous system to the common femoral vein and involving the iliac venous system.

We upsized to a 6 Fr sheaths bilaterally. We advanced wires and glide catheters into the IVC bilaterally and performed an inferior vena cavogram that demonstrated total thombosis of the vena cava up to the level of the IVC filter. Numerous collaterals were noted around this area, reconstituting the left renal vein and ultimately the IVC just above the filter, which was patent.

We advanced wires bilaterally through the thrombosed IVC filter and into the suprarenal IVC. We then performed a mechanical thrombectomy using the Angiojet catheter bilaterally. We used a power pulse spray technique to instill TPA along the ____ in both legs and the IVC. After approx. 20 mintues of allowing TPA to dwell bilaterally, we performed a mechanical thrombectomy with the Angiojet catheter bilaterally. This was also performed in the vena cava and within the vena cava filter. Completion venography demonstrated persistent occlusive DVT bilaterally extending all of the way to the vena cava. We opted to start catheter-directed thrombolysis at this point.

In the right leg, we delivered a 40 cm EKOS infusion catheter. In the left leg, we delivered a 50cm infusion catheter. These catheters were placed through the IVC filter. A TPA drip was started for each catheter and a heparin drip was started for each indwelling popliteal venous sheath. These were secured. He was taken to recovery in stable condition.

I came up with cpt codes:
76937-50
36010-50
75825
75822-50
37212-50
37187 x3

Any help is greatly appreciated.


----------



## Sathish (Apr 8, 2016)

*37191*

Hello,

Looks like this document we can bill CPT 37191 along with mentioned below CPT codes.

Please read Transcatheter procedure guidelines as well as CPT codes, Radiological codes are included with procedures. 




camsgram said:


> 1. Perc Mechanical Thrombectomy, bilat LE DVT
> 2. Perc Mechanical thrombectomy, Inferior Vena Cava
> 3. Catheter directed Thromolysis, bilat LE DVT
> 4. Bilat LE Venography
> ...


----------



## Chlrtrep (Apr 11, 2016)

Sathish said:


> Hello,
> 
> Looks like this document we can bill CPT 37191 along with mentioned below CPT codes.
> 
> Please read Transcatheter procedure guidelines as well as CPT codes, Radiological codes are included with procedures.



Hmm,

Based on OP report listed it does not state the IVC filter was implanted at this encounter it appears it was already present. 

 In regards to venography during trans Catheter thrombolytic  therapy procedures.  These codes do include the RSI regarding the placing of catheter on initial day, and the all angiography follow up on subsequent and final days.  However you can code for the diagnostic venography separately on initial day in done for diagnostic purposes.

CPT code 75822  is already a bilateral code Venography, extremity, bilateral, radiological supervision and interpretation)   therefore -50 should not be applied

I do question the coding of 37212-50  were both EKOS catheters placed into the IVC for tPA infusion on were the placed in the legs.  I interpret the report as the EKOS were inserted from each leg and placed into the IVC.  Therefore should only code 37212 once since only one vessel is being treated.  I could be interpreting this portion report wrong so this is just my opinion.


----------

