General Surgery Coding Alert

Question: Our vascular surgeon accessed the occluded femoral vein through a tiny incision at the patient’s groin, then performed venography by injecting contrast material through the incision into the vein to localize the exact site 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. Which CPT^® code should I report for this procedure?

North Carolina Subscriber

Answer: This is an example of a combined technique of mechanical thrombectomy and pharmacological thrombolytic injection to treat an 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 application. If your surgeon performs a bilateral venous mechanical thrombectomy through a separate access site(s), append modifier 50 (Bilateral procedure) to 37187.

Remember: If your vascular surgeon performs repeats treatment of an occlusion in a vein by using a combined technique of mechanical thrombectomy and pharmacological thrombolytic injection on a subsequent day during the course of 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).

Caution: 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^®.