Cardiology Coding Alert

Question: After the patient was appropriately prepped and anesthetized, the provider accessed a blood vessel percutaneously. They also inserted a sheath and guidewires as part of the procedure. They then navigated a catheter through the blood vessels to get a suction device to the target treatment area of the heart. The provider dilated blood vessels, used embolic protection, and performed venous thrombectomy as part of the procedure. They used the vacuum device to debulk a mass in the heart. The provider also infused aspirated blood back into the patient during the procedure. They used radiologic guidance throughout the procedure. After removing the surgical instruments, the provider closed the access site. How should I report this procedure?

Maine Subscriber

Answer: You should report 0644T (Transcatheter removal or debulking of intracardiac mass (eg, vegetations, thrombus) via suction (eg, vacuum, aspiration) device, percutaneous approach, with intraoperative reinfusion of aspirated blood, including imaging guidance, when performed).

Never report 0644T in conjunction with percutaneous transluminal mechanical thrombectomy codes 37187 or 37188, per CPT^®.

Code 0644T includes the work of percutaneous access, all associated sheath device introduction, manipulation and positioning of guidewires and selective and non-selective catheterizations, blood vessel dilation, embolic protection if used, percutaneous venous thrombectomy, and closure of the blood vessel by pressure or application of an access vessel arterial closure device.

Don’t miss: Code 0644T is an example of a CPT^® Category III code, a temporary code used to collect information about the use and efficacy of investigational technologies and procedures, as well as new services. A Category III code must be used in place of an unlisted procedure code when available. CPT^® coding guidelines state that the inclusion of a Category III code for a particular procedure does not imply agreement concerning efficacy, safety, or appropriateness of the procedure to clinical practice or payer reimbursement.