Radiology Coding Alert
Check How You Report 37187 and 36870 Despite Bundle
Question: In a patient who has AV graft in the arm, our physician performed thrombectomy of the subclavian vein (due to a clotted old stent) and an additional arterial fogarty thrombectomy just past the arterial anastamosis. Additionally, he performed an angioplasty of the venous side of the AV graft. Is it appropriate to code 37187 (for the subclavian thrombectomy), 36870 (for the thrombectomy of the graft), 36147, 36148, 35476, 75978?
Alaska Subscriber
Answer: For thrombectomy in the subclavian vein you submit code 37187 (Percutaneous transluminal mechanical thrombectomy, vein[s], including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance). You report code 36870 (Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft [includes mechanical thrombus extraction and intra-graft thrombolysis]) with modifier 59 (Distinct procedural service) for thrombectomy in the fistula.
You are also correct to report codes: 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]; initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report [includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava]), +36148 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]; additional access for therapeutic intervention [List separately in addition to code for primary procedure]), 35476 (Transluminal balloon angioplasty, percutaneous; venous),75978 (Transluminal balloon angioplasty, venous [e.g., subclavian stenosis], radiological supervision and interpretation).
No Correct Coding Initiative (CCI) bundles exist between any of these codes except between CPT® 37187 and 36870. However, you can bill both as one code is for the subclavian and the other for the thrombectomy performed in the fistula.
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