Cardiology Coding Alert

Never report +37186 in conjunction with 37184 and +37185.

If your cardiologist performs mechanical thrombectomies, you must know whether it is arterial or venous in order to report the correct code on your claim. When your cardiologist performs an arterial mechanical thrombectomy, you must also check the documentation and note whether it is a primary or secondary procedure.

Read on to learn more.

Tip 1: Look to 37184, + 37185 for Primary Arterial Mechanical Thrombectomy

Your cardiologist may perform either a primary or secondary arterial mechanical thrombectomy.

With a primary arterial mechanical thrombectomy, your cardiologist will diagnose the thrombus prior to performing the procedure, per the CPT^® guidelines. They will preoperatively plan the thrombectomy. After the procedure is over, your cardiologist will also conduct a post-procedure evaluation.

Primary arterial mechanical thrombectomy: Report 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 vessel your cardiologist treats, according to the guidelines.

Don’t miss: If you are reporting the mechanical thrombectomy of an additional vascular family your cardiologist treated through a separate access site, append modifier 59 (Distinct procedural service) to 37184. 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 second or all subsequent vessel(s) within the same vascular family.

“The phrase ‘second and all subsequent vessel(s)’ in the code descriptor means that code +37185 is reported only once, no matter how many subsequent vessels are treated in a given vascular family,” according to CPT^® Assistant, Volume 29, Issue 9.

“The key to deciding whether the thrombectomy was primary or secondary revolves around intent of the procedure,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “Was the intent of the procedure to remove the thrombus? Often thrombus may be removed, and the provider finds an area of stenosis that requires an angioplasty or stent. In this case the thrombectomy is still primary and you would code for the other percutaneous intervention as well.”

According to CPT^® Assistant, “Even though another intervention, such as angioplasty may take place, the thrombectomy is the focus of the procedure,” Peterson says. “A thrombectomy following transcatheter thrombolysis is also considered to be primary, according to SIR Interventional Radiology Coding Update 2016.”

Tip 2: Report Secondary Arterial Mechanical Thrombectomy This Way

Sometimes, your cardiologist may need to perform a secondary arterial mechanical thrombectomy to remove or retrieve short segments of thrombus or embolus when performed prior to or after another percutaneous intervention.

Secondary arterial mechanical thrombectomy: Report +37186 (Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)) for a secondary arterial mechanical thrombectomy. Primary procedures for this code would be percutaneous interventions such as lower extremity revascularization procedures, transcatheter placement of an intravascular stent, or percutaneous transluminal angioplasty, according to Peterson.

Your cardiologist will perform a secondary arterial mechanical thrombectomy in conjunction with another primary intervention such as transluminal balloon angioplasty or stent placement and is sometimes referred to as a “rescue” thrombectomy, Peterson says. Usually with this procedure, a small segment of clot needs to be removed prior to the planned angioplasty or stent procedure or the intervention dislodges clot that needs to be retrieved following the intervention.

Per CPT^® Assistant, removal of the clot is an inherent part of an atherectomy procedure and should not be reported separately, Peterson adds. However, removal of clot from a different vascular territory downstream from the primary lesion may be reported separately.

Never report +37186 in conjunction with 37184 and +37185. You cannot bypass the National Correct Coding Initiative (NCCI) edit between a primary and secondary thrombectomy.

Tip 3: Focus on Codes for Venous Mechanical Thrombectomy

When your cardiologist performs a venous mechanical thrombectomy, report 37187 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance) for the initial application. If you need to report bilateral venous mechanical thrombectomy your cardiologist performed through a separate site, append modifier 50 (Bilateral procedure) to code 37187.

Report 37188 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy) for repeat treatment on a subsequent day during a course of thrombolytic therapy.

“Venous thrombectomy codes can be used for peripheral or intracranial veins, and there is no separate code for secondary thrombectomy in this code set. The procedure is for one or more veins in the same extremity and may be the only procedure the provider performs, or it may be performed with infusion therapy,” Peterson says.

Tip 4: Mark Down Separately Reportable, Not Separately Reportable Services

Some procedures are considered an inherent part of the mechanical thrombectomy codes, so these services are not separately reportable.

For example, codes 37184-37188 already include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure, so those procedures are not separately reportable, per the CPT^® guidelines.

Similarly, “Intraprocedural injection(s) of a thrombolytic agent is an included service and not separately reportable in conjunction with mechanical thrombectomy,” according to the guidelines.

On the other hand, you can separately report specific codes with the mechanical thrombectomy codes. For example, you can report codes for catheter placement(s), diagnostic studies, and other percutaneous interventions such as a transluminal balloon angioplasty or a stent placement.

You can also report subsequent or prior continuous infusion of a thrombolytic with 37211 (Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day) through 37214 (Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method).