# How would you code this!



## jdibble (Nov 10, 2014)

The physician did the following:

The patient was referred for thrombolysis of the bilateral pulmonary emboli.

Procedure:  
1. Right and left common femoral veous access
2. Selective right pulmonary angiogram
3. Selective thrombolysis of the right main and left main pulmonary artery using an EKOS catheter.

Patient was prepped and draped in a sterial fashion after informed consent was obtained.  A micropuncutre kit was used to access the right common femoarl vein. A 6-French sheath was advnaced into the right common femoarl vein over a guidewire. Next, a micropuncture kit was used to access the left common femoral vein and 6-French sheath inserted into the left common femoral vein. Next, a glidewire was advanced through a multipurpose catheter and advanced into the left main pulmonary artery. Next, a multipurpose catherter was advanced over the guidewire through the left common femoral sheath and advanced up into the right main pulmonary artery.  The multipurpose catheter was removed. An 18cm EKOS cahteter was advanced through the right common femoral venous sheath and positioned in the lower branch of the main right pulmonary artery. Next, a 12cm EKOS cahteter was advanced through the left common femoral venous sheath and positioned in the lower branch of the main left pulmonary artery. Ultrasound core was advanced through both EKOS catheters and secured in place.  TPA was infused through both dahteters with ultrasound assistance. The sheaths were taped in place and the patient transferred to the intensive care unit in stable condition.  Right pulmonary angiogram revealed large thrombus burden in the distal right  main pulmonary artery involving the upper and lower branches.

I have 37211-50, 36014-50. Not sure if these are the correct codes and if there are other codes that I should be adding or using.

Also, the next day the patient was returned to the OR for removal of the catheters - I was using 37214-50.

Any help would be great!!!


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## Jim Pawloski (Nov 10, 2014)

jdibble said:


> The physician did the following:
> 
> The patient was referred for thrombolysis of the bilateral pulmonary emboli.
> 
> ...



Was a pulmonary angio. performed?  If so, then add 75743 for bilateral (although I don't see one in the dicataion).  For the end of procedure, you use 37214.
HTH,
Jim Pawloski, CIRCC


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## jdibble (Nov 11, 2014)

Thanks Jim! This type of coding is really confusing to me as to what can/should be and cannot be coded together.  The doctor did do a Right pulmonary angiogram only, not bilateral, per the note. So then I would use 75741 I guess?  I just thought that those codes were bundled into the 37211?


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## Jim Pawloski (Nov 14, 2014)

jdibble said:


> Thanks Jim! This type of coding is really confusing to me as to what can/should be and cannot be coded together.  The doctor did do a Right pulmonary angiogram only, not bilateral, per the note. So then I would use 75741 I guess?  I just thought that those codes were bundled into the 37211?



As long as the arteriogram is diagnostic, you can charge for it using modifier -59.
Thanks,
Jim


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## jdibble (Nov 25, 2014)

Thanks Jim! That is very helpful to know!


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