# Direct Puncture Thrombin Injection



## hwilcox07 (Apr 23, 2014)

Would I use CPT code 37242 for this: Or maybe37211??

Procedure: Direct Puncture Thrombin Injection

History: Abd aortic aneurysm type II endoleak status post previous type I endoleak treated with an aortic cuff revision, status post distal left iliac cuff revision, status post previous lumbar collateral embolization.

Patient was placed in supine position amd the anterior abdominal wall localized with ultrasound, cleaned and prepped. Using maximum sterile barrier and a local anesthetic an 18 gauge needle was directed down into the aneurysm with ultrasound guidance. Subsequently, the sylette was removed and there was pulsatile flow. After clearing the needle with saline, 4000 units of thrombin were slowly infused obliterating the first of two endoleaks.
The patient was watched for 15 minutes but the second smaller site of endo leak opacification by ultrasound did not dissipate.
Subsequently, the 18 gauge needle was reinserted and directed at the site of second endoleak after two punctures failed. With the needle in adequate position, the stylus was removed and there was pulsatile flow. The needle was cleared with saline and then approximately 3000 units of thrombin were slowly infused while retracting the needle. Pressure was applied. The patient was watched for additional 15 minutes prior to termination of the procedure. The patient was admitted for observation. No residual bleeding was noted by ultrasound. Orders were written.

Impression: Successful direct puncture thrombin injection. Recommend follow-up in 4 weeks time with ultrasound. Patient admitted for 23 hour observation.


----------



## jkayser (Apr 25, 2014)

Hello, CPT 37242 would be correct for this procedure involving 2 endoleaks.  It would be billed only once.

CPT 37211 is for thrombolysis which is to break up clots.  Your procedure was the injection of thrombin for the opposite purpose - to cause thrombosis - in order to seal the endoleaks.  

I hope that helps.

Jean Kayser CPC CIRCC


----------



## hwilcox07 (Apr 25, 2014)

Thank you!! That's how I coded it but the physician was questioning and wanted clarification between the 2 codes.


----------

