Cardiology Coding Alert

Question: My cardiologist accessed the occluded femoral vein through a tiny incision at the patient’s groin. They performed venography by injecting contrast material through the incision into the vein to localize the exact site of the clot. Under fluoroscopic guidance, they inserted a guidewire to the site of the occlusion and threaded a catheter over the guidewire. My cardiologist used the catheter, which had a small blade at its tip, to break the clot. They further dissolved the clot with multiple injections of a thrombolytic agent. Which CPT^® code should I report for this procedure?

North Carolina Subscriber

Answer: This is an example of a combined technique of mechanical thrombectomy and pharmacological thrombolytic injection to treat an occlusion. On your claim, you should report code 37187 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance) for the initial application. If your cardiologist performs a bilateral venous mechanical thrombectomy through a separate access site(s), append modifier 50 (Bilateral procedure) to 37187.

Remember: If your cardiologist performs repeats treatment of an occlusion in a vein by using a combined technique of mechanical

thrombectomy and pharmacological thrombolytic injection on a subsequent day during the course of 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).

Caution: Never report codes 37187 or 37188 in conjunction with codes fluoroscopy code 76000 or +96375 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)), per CPT^®.