Radiology Coding Alert

Home in on a CPT^® Assistant article for a crucial set of instructions.

Mechanical thrombectomy coding requires knowledge surrounding anatomy, guidelines, and an ability to maneuver through the CPT^® index in order to find the precise code you’re looking for. To ease the burden of this process, there are a few important tips you should integrate into your coding practices in order to maximize accuracy and efficiency.

However, keep in mind that not all the rules surrounding mechanical thrombectomy coding can be found within the CPT^® code book. You’ll often have to utilize outside authoritative sources in order to ensure you’ve got the right code on your claims.

Check out these five tips to improve your mechanical thrombectomy coding and drive the point home with a useful example.

Tip 1: Define Mechanical Thrombectomy for Clarity

“Mechanical thrombectomy involves the removal of a thrombus (blood clot) from a vessel (eg, thrombotic occlusion of an extremity artery) to help restore circulation,” according to CPT^® Assistant Vol. 29, No. 9.

You have separate code sets for both arterial (37184-+37186) and venous transcatheter therapies (37187 and 37188).

Don’t miss: Codes 37184-37188 include the intraprocedural fluoroscopic radiological supervision and interpretation services for the thrombectomy guidance, according to the CPT^® guidelines. However, you can separately report catheter placement, diagnostic studies, and other percutaneous interventions such as a transluminal balloon angioplasty and stent placement.

Tip 2: Follow Rules for Primary Arterial Mechanical Thrombectomy

When your interventional radiologist performs a primary arterial mechanical thrombectomy, he will diagnose the thrombus prior to performing the mechanical thrombectomy procedure. The interventional radiologist will also preoperatively plan the thrombectomy. After he performs the thrombectomy, he will conduct a post-procedure evaluation.

You should report 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) for “endovascular mechanical thrombectomy in the initial arterial vessel,” per CPT^® Assistant. Note: You should never report 37184 in conjunction with intracranial arterial transluminal mechanical thrombectomy code 61645, fluoroscopy code 76000, or injection code 96374, according to the CPT^® guidelines.

Caution: If you are reporting mechanical thrombectomy of an additional vascular family the interventional radiologist treated through a separate access site, you should append modifier 59 (Distinct Procedural service) to 37184 for the mechanical transluminal thrombectomy.

And, you should report +37185 (… second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)) for the second or all subsequent vessels within the same vascular family. “The phrase ‘second and all subsequent vessel(s)’ in the code descriptor means that code +37185 is reported only once, no matter how many subsequent vessels are treated in a given vascular family,” according to CPT^® Assistant. “… other interventions (eg percutaneous transluminal angioplasty) may be performed in conjunction with the thrombectomy to treat a previously unidentified (revealed only after clearing the thrombus) underlying pathology (eg, stenosis), and may be separately reported.”

Note: You should never report +37185 in conjunction with 76000 or injection code +96375, according to CPT^®. Additionally, you should never report +37185 in conjunction with 61645 for the treatment of the same vascular territory.

Tip 3: Delve Into Secondary Arterial Mechanical Thrombectomy

If your interventional radiologist performs a “secondary” transcatheter procedure, you should report +37186 (Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)).

“A ‘secondary’ transcatheter thrombectomy procedure is performed for the removal or retrieval of segment(s) of a thrombus or embolus, typically after another percutaneous intervention that was complicated by a thrombotic event,” according to CPT^® Assistant. “Alternatively, when arterial pathology is known prior to an endovascular intervention and pre-procedure planning is focused on correction of the pathology (eg angioplasty or stenting), secondary thrombectomy may be performed to remove short segments of thrombus also known to be present to prevent complications (distal clot embolization) or to enhance the correction of the pathology.”

Don’t miss: Your interventional radiologist will always perform a secondary arterial mechanical thrombectomy in conjunction with another primary intervention such as a transluminal balloon angioplasty or a stent placement, and you will report those procedures separately.

“You may see angioplasty performed to macerate clot,” says Robin Peterson, CPC, CPMA, manager of professional coding, Pinnacle Integrated Coding Solutions, LLC. “Thrombectomy codes include getting rid of clot by any method, including balloon maceration.”

Caution: You should never report +37186 in conjunction with the following codes:

• 37184 and +37185,
• 76000,
• +96375, or
• 61645 for the treatment of the same vascular territory.

Tip 4: And, Rely on These Codes for Venous Mechanical Thrombectomy

If the surgeon uses venous transcatheter therapies, you should report code 37187 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance) for the initial application.

Don’t forget: If the surgeon performs a bilateral venous mechanical thrombectomy through a separate access site(s), you should append modifier 50 (Bilateral Procedure) to code 37187.

On the other hand, if the surgeon performs repeat treatment on a subsequent day during the course of thrombolytic therapy, you should 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).

Tip 5: Put it All Together With an Example

Coding example: In the hospital, the interventional radiologist performed a diagnostic angiography on the main pulmonary artery. He also administered a tissue plasminogen activator (TPA) injection. The interventional radiologist performed an angiojet thrombectomy with multiple passes in the main pulmonary artery and an IVC venogram to identify the renal veins, as well as an Inferior Vena Cava (IVC) filter placement.

Coding solution: For the thrombectomy, you should report 37184. Since this code includes intraprocedural thrombolytic injections, you cannot report the TPA injections separately.

The correct code for the radiological portion of the 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 Procedural Service) to 75746.