Radiology Coding Alert

Watch for documentation of significant thrombosis to avoid audit trouble

Knowing where in the body a procedure took place can be almost as important as the procedure itself when you choose a CPT Codes . Our experts share how to handle tPA infusions, percutaneous transluminal balloon angioplasty (PTA), and thrombectomy not performed within a graft.

Oust Your Outside-the-Graft Troubles

Some Medicare carriers will pay when a thrombus is present outside the graft, because you have to provide separately identifiable therapy, says Deepa Malhotra, CPC, president of Healthcare Educational Resource Services (HERS Inc.) in Chicago.
 
If your documentation supports this procedure, report 37201 (Transcatheter therapy, infusion for thrombolysis other than coronary) and 75896 (Transcatheter therapy, infusion, any method [e.g., thrombolysis other than coronary], radiological supervision and interpretation) says Donna Richmond, CPC, RCC, a radiology coding expert with CodeRyte Inc. Remember: Append -26 (Professional component) to 75896 if you're coding for physicians.
 
Before you use this code pair, be sure there is significant and clinically important thrombosis outside of the fistula or graft, which is fairly rare. Example: Complete thrombosis of the subclavian vein and the superior vena cava or complete thrombosis of the feeding brachial or radial artery could warrant these codes if the documentation is clear and imaging and clinical evidence support the use of the codes.
 
Caution: Be sure that the infusion takes at least an hour and you see thorough documentation of medical necessity before you code this service, Malhotra says. You also want to choose the correct ICD-9 Code - such as 453.8 (Other venous embolism and thrombosis; of other specified veins). Remember: To code PTA of vein segments central to the axillary vein, be particularly sure your documentation supports coding 453.8 to show medical necessity, she adds.
 
Bonus: You should also report any follow-up studies with 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion), Malhotra says. Again: Append modifier -26 for physician coding. And don't use this code to document postangioplasty imaging.

Nix Your Native Vessel Confusion

If your report indicates mechanical thrombectomy in the native vessel (other than coronary and AV Graft) using Fogarty or angiojet rheolytic thrombectomy system, you must use 37799 (Unlisted procedure, vascular surgery),  Malhotra says. "Never use 36870 for any other place except AV grafts," she says.
 
Helpful: If the physician accesses the site from anywhere other than the AV graft or if you see he accessed the lower-extremity vein or artery to catheterize the vessel in the arm, you can also code the catheter placement separately, Malhotra says.
 
For tPA in the native artery, use codes 37201 and 75896 and any follow-up with 75898. You can code PTA of the native artery, but only if the physician truly performed that service by itself, Malhotra says. For both of these scenarios, you must have documentation in the operative/radiographic report and supporting images.