# Help!?! EKOS vs Infusion Catheter



## Chlrtrep

Help!!!!

 I am at a new facility and there is some crazy coding going on regarding EKOS catheter procedures. This  procedure is new to me so naturally I have been trying to get up to speed on the what it is and how it works.

My understanding is an EKOS catheter is coded just like any other infusion catheter procedure involving a thromobolytic infusion.

For example

Reviewing a dictation of procedure of intial day of therapy would include insertion of EKOS cathter and tpa(thromobytic) infusion parameters. 37211 (A) or 37212 (V)

Subsequent day brought into lab for follow-up,  I would expect to see status of therapy and wether or not infusion continued or discontinued.  37213 continue, 37214 cessation.

How is this different then if a procedure was done the same way with the use of a standard infusion therapy catheter.

Are they not coded the same? 


Currently I have a physican that tried to use an EKOS catheter but could not pass the ultrasonic wire into the problematic vessel so she left the outer sheath of the EKOS catheter in place and ran an infusion drip like you would in a regular infusion catheter. I ask for clarification of her dicatation or lack thereof and she is arguing about charging this as a EKOS procedure. I stated that is is coded the same whether you use the EKOS catheter or not. She disagress, she states that there is a different charge/code for the EKOS procedure.


So.....
Currently what I am seeing is initial day insertion being coded 37211 or 37212

Then the subsequent day there is cath placement and angiogram coding/charge being inputed for 75710/36005 instead of 37213.  My understaning is this incorrect. should be 37213


Additionally if the patient is brought down and the physician decided to d/c therapy , pull catheter out and do an intervention there is no mention of the d/c of therapy or removal of infusion catheter. Just a dictation of the intervention. So in this scenario can I code 37214 even though it is not mentioned in the procedure dictation. But if I look in patients chart the infusion is noted to be d/c'd the morning of the final cath lab procedure.


The above physician states if she does and intervention this the therapy is d/c.  I told here I cannot assume this is what you are doing you need to document what you have done.  Physician not happy.

So to summarize  what is the difference in coding for a EKOS infusion therapy case as opposed to a NON EKOS cather infusion therapy case.  This is all non coronary thrombolytic infusion.  Please share your thoughts.


What needs to be in the dictation for correct coding. or can I use information gathered from a progress note on floor to use for coding in the procedure room.

any help would be appreicated..  Feel like I am rocking a boat over here..


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## Jim Pawloski

Chlrtrep said:


> Help!!!!
> 
> I am at a new facility and there is some crazy coding going on regarding EKOS catheter procedures. This  procedure is new to me so naturally I have been trying to get up to speed on the what it is and how it works.
> 
> My understanding is an EKOS catheter is coded just like any other infusion catheter procedure involving a thromobolytic infusion.
> 
> For example
> 
> Reviewing a dictation of procedure of intial day of therapy would include insertion of EKOS cathter and tpa(thromobytic) infusion parameters. 37211 (A) or 37212 (V)
> 
> Subsequent day brought into lab for follow-up,  I would expect to see status of therapy and wether or not infusion continued or discontinued.  37213 continue, 37214 cessation.
> 
> How is this different then if a procedure was done the same way with the use of a standard infusion therapy catheter.
> 
> Are they not coded the same?
> 
> 
> Currently I have a physican that tried to use an EKOS catheter but could not pass the ultrasonic wire into the problematic vessel so she left the outer sheath of the EKOS catheter in place and ran an infusion drip like you would in a regular infusion catheter. I ask for clarification of her dicatation or lack thereof and she is arguing about charging this as a EKOS procedure. I stated that is is coded the same whether you use the EKOS catheter or not. She disagress, she states that there is a different charge/code for the EKOS procedure.
> 
> 
> So.....
> Currently what I am seeing is initial day insertion being coded 37211 or 37212
> 
> Then the subsequent day there is cath placement and angiogram coding/charge being inputed for 75710/36005 instead of 37213.  My understaning is this incorrect. should be 37213
> 
> 
> Additionally if the patient is brought down and the physician decided to d/c therapy , pull catheter out and do an intervention there is no mention of the d/c of therapy or removal of infusion catheter. Just a dictation of the intervention. So in this scenario can I code 37214 even though it is not mentioned in the procedure dictation. But if I look in patients chart the infusion is noted to be d/c'd the morning of the final cath lab procedure.
> 
> 
> The above physician states if she does and intervention this the therapy is d/c.  I told here I cannot assume this is what you are doing you need to document what you have done.  Physician not happy.
> 
> So to summarize  what is the difference in coding for a EKOS infusion therapy case as opposed to a NON EKOS cather infusion therapy case.  This is all non coronary thrombolytic infusion.  Please share your thoughts.
> 
> 
> What needs to be in the dictation for correct coding. or can I use information gathered from a progress note on floor to use for coding in the procedure room.
> 
> any help would be appreicated..  Feel like I am rocking a boat over here..



Both the EKOS and infusion thrombolysis are the same.  The EKOS catheter is an infusion catheter for TPA.  The wire that is inserted in the catheter helps  disrupt the thrombus in the vessel so the lysis process is sped up (hopefully). So there is no difference between EKOS and infusion thrombolysis for coding.
HTH,
Jim Pawloski, R.T.(CV), CIRCC


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## Fakhruddin Saifi

I have general question regarding EKOS catheter, we have a code for insertion of EKOS catheter 37211 & 37212 for day one and what about removal of EKOS catheter on the next day if thrombectomy not done...….? Please help.


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## SharonCollachi

Have you looked at the next couple of CPT codes in that section of the book?


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## such78

Fakhruddin Saifi said:


> I have general question regarding EKOS catheter, we have a code for insertion of EKOS catheter 37211 & 37212 for day one and what about removal of EKOS catheter on the next day if thrombectomy not done...….? Please help.



37211 and 37212 included the catheter removal. Since the next day thrombectomy was not preformed, code it as initial.


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## Jim Pawloski

No Sue that's incorrect. 37211 is for the first day of thrombolysis in an artery. 37212 is for the first day of thrombolysis for a vein. 37213 is for any catheter checks to see how the lysis is working. 37214 is for the final lysis check w/ cessation of treatment. Angioplasty and stent placement may bill coded if performed.
Thanks,
Jim Pawloski, CIRCC, R.T. (CV)


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## such78

Jim Pawloski said:


> No Sue that's incorrect. 37211 is for the first day of thrombolysis in an artery. 37212 is for the first day of thrombolysis for a vein. 37213 is for any catheter checks to see how the lysis is working. 37214 is for the final lysis check w/ cessation of treatment. Angioplasty and stent placement may bill coded if performed.
> Thanks,
> Jim Pawloski, CIRCC, R.T. (CV)



I agree with you. 

 "I have general question regarding EKOS catheter, we have a code for insertion of EKOS catheter 37211 & 37212 for day one and what about removal of EKOS catheter on the next day if thrombectomy not done...….? Please help."  

I meant since the thrombectomy not done in the next day and the catheter removal, So either 37211, 37212, or both (since Saifi didn't specify it is for artery, vein, or both) assign for the initial and completion on the same day 
and catheter removal is included in CPT 37211/37212. 

In my notes:
37211/37212 1st day treatment
37213 2nd day treatment(continue/subsequent)
37214 final day /termination treatment
Venous thrombectomy is reported with 37211-37214 if performed, it is for one or more vessels in the same extremity. 
Catheterization is included in thrombolysis. 

Correct me, Jim. I am still in a learning process.


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## Fakhruddin Saifi

Good morning All,

I understand the catheter removal is inclusive within initial procedure 37211 or 37212. However, my question was if next day only catheter removal is happening, then do we have any code for catheter removal. After a little research, I reached out on my conclusion, that we may use CPT-36589 for catheter removal only. Please advise.


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## Jim Pawloski

Let me rephrase my post;
37211/37212 is for the start of infusion thrombolysis either arterial or venous.
37213 is for when the patient comes back to the angio suite and the catheter is injected with contrast to evaluate how the thrombolysis is going. Any intervention on this day can be coded.
37214 is used when the thrombolysis is finished, when all catheters and sheaths are removed for the body. Any interventions (angioplasty or stent placement) may be coded. No, you cannot code 36589 as if you read the end of the CPT description for 37214 is cessation of thrombolysis including removal of catheter and vessel closure by any method. Sue, thrombolysis and thrombectomy are two different things. Thrombolysis can be done without thrombectomy. Thrombectomy is a surgical procedure to remove a clot. Thrombolysis is dissolving a clot with medication.
Thank you,
Jim Pawloski, MSA, CIRCC, R.T. (R)(CV)


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