General Surgery Coding Alert

Question: Treating thrombosis, the surgeon accessed the initial artery, placed vascular clamps, then performed an arterial puncture in the first blocked vessel followed by arterial heparin/saline irrigation. Using fluoroscopic guidance, the surgeon inserted a guidewire into the second vessel to the arterial thrombosis and advanced the catheter to the occlusion, injecting a thrombolytic agent to fragment the clot. The surgeon then suctioned the clot fragments to restore blood supply to the affected artery before removing the catheter and controlling bleeding at the access site. How should we code this?

Colorado Subscriber

Answer: The best code for the procedure you describe is 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).

You may also report add-on code +37185 (… second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure) because the report documents advancing to a secondary vessel. Note that this code is not “per vessel,” and you should use just one unit of this code for the second and any subsequent vessels in the same vascular family.

Included: Never report 37184 with codes 76000 (Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time) or 96374 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug), per CPT^® instruction, because code 37184 includes those services, if performed.