General Surgery Coding Alert

Question: What is the best way to report an angioplasty and vacuum thrombectomy of the inferior vena cava?

Utah Subscriber

Answer: For the inferior vena cava mechanical vacuum thrombectomy, the most appropriate code is 37187 (Percutaneous transluminal mechanical thrombectomy, vein[s], including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance).

Code 37187 explicitly includes thrombolytic injections performed during the procedure and fluoroscopic guidance, but CPT® guidelines state, “Code(s) for catheter placement(s), diagnostic studies, and other percutaneous interventions (e.g., transluminal balloon angioplasty, stent placement) provided are separately reportable.”

That’s why you can separately report the angioplasty using 35476 (Transluminal balloon angioplasty, percutaneous; venous). You should also report a separate code for radiological supervision and interpretation, which is 75978 (Transluminal balloon angioplasty, venous [e.g., subclavian stenosis], radiological supervision and interpretation).

If your surgeon performs a catheter insertion in the inferior vena cava, you should also report 36010 (Introduction of catheter, superior or inferior vena cava).