Revenue Cycle Insider

Question: Which code or codes should I use to report a primary arterial mechanical thrombectomy?

Rhode Island Subscriber

Answer: A cardiologist may perform a primary arterial mechanical thrombectomy after diagnosing a thrombus. Sometimes, a percutaneous intervention may precede or follow the thrombectomy, according to CPT^® guidelines.

Report code 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel) per vascular family for the initial arterial vessel your cardiologist treats, according to the CPT^® guidelines.

While performing the thrombectomy to remove the clot, the cardiologist may find an underlying area of stenosis that requires attention and possibly intervention. In such a situation, the procedure would still be considered a primary arterial mechanical thrombectomy because the main purpose of the procedure was removing the clot.

Modifier: If the cardiologist accessed an additional vascular family via a separate site, you should append modifier 59 (Distinct procedural service) to 37184.

Additionally, you should report +37185 (… second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)) for the second or all subsequent vessels within the same vascular family.

Even if your cardiologist treats several subsequent vessels in a vascular family, you should report +37185 only once, according to CPT^® Assistant Volume 29, Issue 9. The guidance says, “Note should be made that other interventions (eg, percutaneous transluminal angioplasty) may be performed in conjunction with the thrombectomy to treat a previously unidentified (revealed only after clearing the thrombus) underlying pathology (eg, stenosis), and may be separately reported.”

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC