Radiology Coding Alert

Question: Our physician did an angiojet thrombectomy with multiple passes in the main pulmonary artery. Additionally, he placed an IVC filter. Imaging during this procedure included the following: 

• Diagnostic angiography on the main pulmonary artery 
• TPA injection
• IVC venogram to identify renal veins.

How can we best report these procedures and which imaging services can we separately report? 

Codify Subscriber

Answer: You should report the 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection[s]; initial vessel) for the thrombectomy. This thrombectomy code includes intraprocedural thrombolytic injections, so you should not report the TPA injections separately.

The code for the radiological portion of main pulmonary artery angiography is 75746 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation). You append modifier 26 (Professional component) to 75746. Code 75746 is bundled into 37184, so you should report 75746 only if it’s for a truly diagnostic angiogram, meaning no previous angiogram is available and your physician decided to perform the thrombectomy based on this angiogram. To report a true diagnostic angiogram, append modifier 59 (Distinct procedural service) to 75746.

For the IVC filter placement, use 37191 (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance [ultrasound and fluoroscopy], when performed). No additional radiology code is appropriate.