Cardiology Coding Alert

Answer: The code for the thrombectomy is 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection[s]; initial vessel). 

 

The thrombectomy code includes intraprocedural thrombolytic injections, so you should not report the TPA injections separately.

 

The code for the radiological portion of main pulmonary artery angiography is 75746-26 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation; Professional component). Code 75746 is bundled into 37184, so you should report 75746 only if it’s for a truly diagnostic angiogram (no previous ones available, the decision to perform the thrombectomy was based on this angiography, etc.). To report a true diagnostic angiogram, append modifier 59 (Distinct procedure) to 75746.

 

Finally, for IVC filter placement, use 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).