Radiology Coding Alert

Question: Please advise me on the correct way to code for mechanical stripping of a Mediport catheter in addition to a Mediport study for patency, as described in the following report.

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Procedure: Informed written consent was obtained form the patient, and a Mediport study was performed through both ports, revealing a fibrin sheath around the lateral port. The medial port had free flow of contrast.

Next, the right groin was prepped and draped in the usual sterile fashion. One-percent lidocaine was infused for local anesthesia. Access was obtained into the right common femoral vein using a micropuncture set, as the patient was on Coumadin. A 6 Fr sheath was advanced through the inferior vena cava up to the level of the tip of the catheter. Through the sheath, a 018 wire through a straight catheter was used to strip the tip of this Mediport. Stripping was performed multiple times.

Post-stripping evaluation of the lateral port revealed no further fibrin sheath.

Impression:

1. Injection of the lateral port reveals a fibrin sheath at the tip.

2. The catheter was stripped from below using an 018 wire through a straight catheter.

3. Post-stripping of the lateral port revealed no further evidence for a fibrin sheath.

4. The patient tolerated the above procedure well without complication.

Answer: Although it is not clearly outlined in reference guides, CPT code 37203 is the correct code for this procedure (transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fracture venous or arterial catheter]).

The language describing 37203 indicates this code is most commonly assigned for transcatheter retrieval. However, according to Cheryl A. Schad, BA, CPCM, CPC, owner of Schad Medical Management in New Jersey, it also can be applied more broadlyas in this case where a 018 wire was surgically inserted for mechanical stripping for fibrin material from the tip of the Mediport.

In addition, Schad notes, CPT code 75961 would be added as the appropriate radiology supervision and interpretation code (transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous arterial catheter], radiological supervision and interpretation).