General Surgery Coding Alert

Question: Our surgeon accessed the occluded femoral vein through a tiny incision at the patient’s groin. They made a small incision at the patient's groin and then performed venography. During venography, they injected contrast material through the incision into the vein. This helped them pinpoint the precise location of the clot. Under fluoroscopic guidance, they inserted a guidewire to the site of the occlusion and threaded a catheter over the guidewire. The surgeon used the catheter, which had a small blade at its tip, to break the clot, and dissolved the clot with multiple injections of a thrombolytic agent. How should I code this procedure?

Minnesota Subscriber

Answer: This is a classic case of using a dual approach to tackle an occlusion. The provider combined mechanical thrombectomy, which involves physically removing the clot, with pharmacological thrombolytic injection, where clot-dissolving medication is directly injected into the affected area. By using both techniques together, the surgeon maximizes the chances of successfully treating the 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 procedure. If your surgeon performs a bilateral venous mechanical thrombectomy through a separate access site(s), append modifier 50 (Bilateral procedure) to 37187.

Take note: If your surgeon needs to repeat the treatment of a vein occlusion by using a combination of mechanical thrombectomy and pharmacological thrombolytic injection on a different day while undergoing 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).

Remember: Never report fluoroscopy codes 76000 (Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time) 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)) in addition to code 37187 or 37188, per CPT^®.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC