Cardiology Coding Alert

Question: My cardiologist performed a diagnostic angiography on the patient’s main pulmonary artery, in the hospital. My cardiologist also administered a TPA injection. He performed an angiojet thrombectomy with multiple passes in the main pulmonary artery, an IVC venogram to identify the renal veins, and an IVC filter placement. I’m new to cardiology, and I have no idea which codes to report on my claim. Can you please help me?

Florida Subscriber

Answer: You should report the following codes on your claim:

• 36013 (Introduction of catheter, right heart or main pulmonary artery)
• 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) — for the thrombectomy. However, since code 37184 includes intraprocedural thrombolytic injections, you cannot report the TPA injections separately.
• 75746-26 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation; Professional component) — for the radiological portion of the main pulmonary artery. Important: Code 75746 is bundled into 37184, so you should report 75746 only if it’s for a truly diagnostic angiogram (such as no previous ones were available, the cardiologist’s decision to perform the thrombectomy was based on this angiography, etc.). To report a true diagnostic angiogram, you would append modifier 59 (Distinct procedural service) to code 75746.
• 37191 (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance [ultrasound and fluoroscopy], when performed) for the IVC filter placement.