Radiology Coding Alert

Question: Our radiologist provided imaging guidance for angioplasty and  vacuum thrombectomy of the inferior vena cava. What are the most appropriate procedure codes we can report?

Tennessee Subscriber

Answer: Report the angioplasty using 35476 (Transluminal balloon angioplasty, percutaneous; venous) and 75978 (Transluminal balloon angioplasty, venous [e.g., subclavian stenosis], radiological supervision and interpretation). If you’re reporting only the radiologist’s services, add modifier 26 (Professional component) to 75978. 

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). Since your radiologist is only providing imaging guidance, you may not report this code. This code may best be submitted for the services of a vascular surgeon. This code is inclusive of fluoroscopic guidance. 

The code 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.”

For catheter insertion in the inferior vena cava, report 36010 (Introduction of catheter, superior or inferior vena cava), if your physician did one.