Cardiology Coding Alert

Hint: Never report +37185 alone on a claim.

When your physician removes a blood clot (thrombus) from a vessel to help restore circulation, you must navigate numerous codes to accurately report the mechanical thrombectomy procedure. You also must identify whether the physician performed arterial or venous mechanical thrombectomy.

Read on to learn more.

Turn to 37184 for Primary Arterial Mechanical Thrombectomy

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

With primary arterial mechanical thrombectomy, your cardiologist will diagnose the thrombus before 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.

For 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, per the guidelines.

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 vessel(s) within the same vascular family, according to CPT^®.

However, if you are reporting the mechanical thrombectomy of an additional vascular family the cardiologist treated through a separate access site, append modifier 59 (Distinct procedural service) to 37184.

Don’t miss: Never report 37184 or +37185 in conjunction with 61645, 76000, or 96374.

“After a primary thrombectomy, a physician may discover an underlying stenosis and choose to perform an angioplasty or stent

procedure. Even if another intervention takes place, the thrombectomy remains primary,” says Robin Peterson, CPC, CPMA, Sr. manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “According to CPT^® Assistant (February 2013), ‘Even though another intervention, such as percutaneous transluminal angioplasty (PTA) may also take place, the thrombectomy is the focus of the procedure’. In these cases, an NCCI modifier should be appended when reporting both the thrombectomy and the other intervention,” she adds.

Mark Down Add-On Code for Secondary Arterial Mechanical Thrombectomy

In some cases, your cardiologist may need to perform a secondary arterial mechanical thrombectomy to remove or retrieve short segments of thrombus or embolus found before or after other percutaneous interventional procedures like a percutaneous transluminal balloon angioplasty or stent placement.

Report secondary mechanical thrombectomy with +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)). As you can see, +37186 is an add-on code, meaning you cannot report it on its own. Primary procedures for this code would be percutaneous interventions such as lower extremity revascularization procedures (37220-+37234), transcatheter placement of an intravascular stent (37236), or percutaneous transluminal angioplasty (37246), according to Peterson.

Don’t miss: Never report +37186 in conjunction with 76000, 96374, or 61645 for treatment of the same vascular territory.

Learn These 2 Codes for Venous Mechanical Thrombectomy

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

If your cardiologist performs repeat venous mechanical thrombectomy on a subsequent day during thrombolytic therapy, 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).

Understand Separately Reportable, Not Separately Reportable Services

“You should not separately report procedures that are considered an inherent part of the mechanical thrombectomy,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia.

For example, 37184-37188 already include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure, so you should not separately report those services.